Response of acanthosis nigricans to adapalene gel

A healthy, somewhat obese 17 year old woman presented with a 10 year history of severe disfiguring acanthsis nigricans affecting the neck, axillae, groin, and antecubital fossae. This had not reponded adequately to tretinoin 0.25% cream, which was stopped because of irritation.

The free testosterone was elevated at 0.76 mmol/L (N= 0.03 - 0.25). The total testosterone, AM and PM cortisol, FSH, LH, and TSH were within normal limits.

She was started on adapalene (Differin) gel daily or bid to the involved areas. This was well tolerated and at 6 weeks (see attached 39K JPEG) there was a great improvement in the acanthsis nigricans. She was very pleased, and has continued Differin gel every other day prn to maintain the improvement.

Conclusion: adapalene (Differin) gel may be more effective and better tolerated than tretinoin 0.025% cream for the management of severe disfiguring acanthosis nigricans.

Kevin C. Smith MD FRCPC