Acanthosis nigricans in adolescents with polycystic ovary syndrome


  • Bijay Khan Department of Obstetrics and Gynecology, KPC Medical College, Kolkata, West Bengal, India
  • Ranjan Basu Department of Obstetrics and Gynecology, KPC Medical College, Kolkata, West Bengal, India



Acanthosis nigricans, Adolescent, Body mass index, Modified Ferriman-Gallwey, Polycystic ovary syndrome, Risk factors


Background: In this study we compared the clinical and biochemical variables of adolescent females with PCOS (polycystic ovarian syndrome) and its association with or without acanthosis nigricans (AN).

Methods: Adolescent girls (14-19 years) with oligomenorrhoea and hyperandrogenism were studied. Clinical parameters like blood pressure (BP), body mass index (BMI), abdominal circumference (AC), presence or absence of acne and AN and hirsutism score were noted. Biochemical tests included serum total testosterone (TT), sex hormone binding globulin (SHBG) levels and free androgen index (FAI). Postprandial plasma insulin (PPI) and glucose (PPG) levels were measured to assess insulin resistance and glucose tolerance respectively.

Results: Significant differences were observed in BMI, AC, DBP, TT and FAI between the two groups. The difference in the prevalence rate of abnormal glucose tolerance and insulin resistance between the two groups was insignificant. Logistic regression modelling with AN as the response variable of interest and BMI, AC, SBP, DBP, testosterone level, PP insulin and PPG levels as its predictors yields BMI, testosterone, PP sugar, PPI, SHBG as main determinants. The model signifies positive impacts of BMI and testosterone level, while negative influence of PP sugar, PPI level and SHBG levels on AN. This analysis was an evidence for a strong relation between BMI and AN.

Conclusions: AN in adolescent girl with PCOS is another clinical marker of obesity but not an indicator of underlying insulin resistance or glucose intolerance. Further studies are needed to detect how many of them ultimately develop insulin resistance or diabetes in future.


Phiske MM. An approach to acanthosis nigricans. Indian Dermatol Online J. 2014;5(3):239-49.

Sudevan R, Kumar SV, Sunny C. Prevalence of acanthosis nigricans and its association with physical activity in adolescents-school-based analytical cross-sectional study from Kochi, Kerala. J Fam Med Prim Care. 2021;10(11):4218.

Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges. Adolesc Health Med Ther. 2017;8:1.

Majumdar I, Espino B, Bianco K, Epstein J, Mamilly L, Harmon CM. Multi-disciplinary weight management compared to routine care in youth with obesity: what else should be monitored? Endocrine. 2019;65(2):263-9.

Sadeghian G, Ziaie H, Amini M, Nilfroushzadeh M. Evaluation of insulin resistance in obese women with and without acanthosis nigricans. J Dermatol. 2009;36(4):209-12.

Wongwananuruk T, Rattanachaiyanont M, Indhavivadhana S. Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome. Int J Endocrinol. 2012;2012:529184.

Rendon MI, Cruz PD, Sontheimer RD, Bergstresser PR. Acanthosis nigricans: a cutaneous marker of tissue resistance to insulin. J Am Acad Dermatol. 1989;21:461-9.

Bougrini Y, Belghol R, Elkhachine Y, Naji-Amrani H, Ouarssani A. Acanthosis nigricans over the face revealing primitive bronchial adenocarcinoma: About a case. Pan Afr Med J. 2021;39.

Al-Saeed WY, Al-Dawood KM, Bukhari IA, Bahnassy A. Dermatoses in obese female schoolchildren in the Al-khobar area, eastern saudi arabia. J Family Community Med. 2006;13(2):65-9.

Kahn CR, Flier JS, Bar RS. The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man. N Engl J Med. 1976;294(14):739-45.

Hermanns-Lê T, Scheen A, Piérard GE. Acanthosis nigricans associated with insulin resistance: Pathophysiology and management. Am J Clin Dermatol. 2004;5(3):199-203.

Esperanza LE, Fenske NA. Hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) syndrome: spontaneous remission in a 15-year-old girl. J Am Acad Dermatol. 1996;34(5):892-7.

Jones LH, Ficca M. Is acanthosis nigricans a reliable indicator for risk of type 2 diabetes? J Sch N. 2007;23(5):247-51.

Khan B, Basu R. A study on correlation between acanthosis nigricans and polycystic ovarian syndrome (PCOS) in Indian adult women population. IOSR J Dent Med Sci. 2016;15(7):13-6.

Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223-36.

Shivaprakash G, Basu A, Kamath A. Acanthosis Nigricansin PCOS patients and its relation with type 2 diabetes mellitus and body mass at a tertiary care hospital in Southern India. J Clin Diagn Res. 2013;7(2):317.

Lopez-Alvarenga JC, Chittoor G, Paul SFD. Acanthosis nigricans as a composite marker of cardiometabolic risk and its complex association with obesity and insulin resistance in Mexican American children. PLoS One. 2020;15(10):0240467.

Lewy V, Danadian K, Arslanian S. Sex hormone binding globulin (SHBG) and insulin-like growth factor binding protein-1 (IGF-BP1) in children with acanthosis nigricans: a marker for insulin resistance and/or hyperinsulinemia? Pediatr Res. 1998;43(4):80.

Silfen ME, Denburg MR, Manibo AM. Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab. 2003;88(10):4682-8.

Kansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: a review. Front Pediatr. 2021;8:866.

O’Brien B, Dahiya R, Kimble R. Hyperandrogenism, insulin resistance and acanthosis nigricans (HAIR-AN syndrome): an extreme subphenotype of polycystic ovary syndrome. BMJ Case Rep. 2020;13(4):231749.






Original Research Articles