Fort Worth, Texas,
04:46 PM

My child's skin looks dirty or stained. What are these darkened patches?

An endocrinologist explains acanthosis nigricans

You see it sometimes with children wearing tank tops or swim suits – darkened patches of skin in certain body areas like the neck or armpit. Parents and children may think that it is simply dirt that needs to be washed off. Children might even get teased about these areas.

But these patches of darkened skin called acanthosis nigricans may also be a sign of something more serious, said Joel Steelman, M.D., an endocrinologist at Cook Children’s.

The exact cause for acanthosis nigricans appearance is not yet known, but current scientific research suggests over-growth in the outer layer of the skin lead to the darkened, rough, velvety patches of skin seen in the condition.

Common body areas where patches of acanthosis nigricans may be seen include the neck, knuckles, armpits, elbows and knees. It can be more widespread and impact areas like the face, chest or belly. In severe situations, it can even be seen in the lips or cheeks.

The condition appears equally between boys and girls and seems to be more common in Hispanics, African Americans and Native Americans, compared to other ethnic groups. One recent study found about five-fold higher likelihood of acanthosis in blacks or Hispanics, compared to whites.

Dr. Steelman said in an overall healthy child, the most likely cause of acanthosis nigricans is a higher level of the hormone insulin in association with obesity. Insulin helps the body grow and store energy from food. That growth effect from too much insulin is thought to be the reason in most obese children causing the skin to develop acanthosis nigricans.

“Since, the main cause for acanthosis nigiricans is linked strongly to obesity and a higher risk for diabetes, I recommend that parents first take steps at home to manage their child’s weight,” Dr. Steelman said. “These steps which include making improvements in the diet and encouraging more physical activity pay off in so many ways.”

The changes Dr. Steelman recommends should be something that the whole family does together. He says this will benefit parents, grandparents and others in the family. If there is a strong family history of diabetes or their child is considerably overweight, parents may want to bring their child to their pediatrician for a checkup. Labs may be ordered to search for higher risk findings for diabetes or metabolic syndrome. Also, more detailed kinds of investigation may be needed in children who don’t have the usual medical history seen with acanthosis nigricans risk.

The skin condition itself doesn’t usually cause too many problems for the child, other than causing the child to be itchy in a few cases. Topical treatments applied to the skin like moisturizers, bleaching creams, and exfoliating creams are used in situations where the person is bothered by the appearance of the acanthosis.

“But the main treatment begins with a talk about obesity and weight,” Dr. Steelman said. “I think the discussion has to be framed in a way to discuss the reward and minimize the negative. It may sound pretty trite, I know, but it really means a conversation about, ‘Let’s get healthy.’ Getting healthy means a lot more than just looking good. It means feeling better, achieving more, etc.”

Read more about acanthosis nigricans here.

- Credit to KidsHealth® for photo.


Get to know Joel Steelman, M.D.

Dr. Steelman is an endocrinologist at Cook Children's. He trained in endocrinology at the University of Colorado Children’s Hospital in Denver, where the magnificent setting turned Dr. Steelman into a lifelong outdoor sport enthusiast, with a strong desire to lead a healthy life. On his rare days off, he could be found skiing, mountain biking and trail running. He loves to go back to the Rockies as often as possible, and just a few years ago, he ran the Pike’s Peak ascent half marathon. He continues to run for exercise regularly. 

During his tenure in Colorado, where he met his future wife, Dr. Steelman trained at the internationally renowned Barbara Davis Diabetes Center, one of the world’s largest and most esteemed diabetes medical facilities for adults and children, specializing in type 1 diabetes research. Along the way, he discovered another strong research interest in the area of bone disorders, and Dr. Steelman began to treat children with osteogenesis imperfecta, or brittle bone disease-- a rare, crippling malady. After completing his training, Dr. Steelman left the West to enter academic medicine at Vanderbilt Children’s hospital in Nashville, Tennessee. Over the next seven years he focused on research projects and medical education.

As a self-described ‘techie,’ Dr. Steelman has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to Checkup Newsroom.

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My youngest son has this and he is not fat instead he is a slender 15 year old male. He is also always been very hairy since birth and, we sometimes have to use a very light layer of facial hair removal on his neck and shoulders. If they are not removed this areas will not stay clean and he will begin to get a darkened patch in those areas that I later have to Nair, lighten, Moisturize and, sunscreen. He has acanthosis nigricans that are very noticeable if the process above is not done. He was also instructed by doctor to keep this areas as clean as possible and sunscreen added when he goes out in the sun. These areas are very sensitive to the sun and they will also itch with it. Now Diabetes does run in the family but once again my son is not obese or even slightly over weight so, I wonder if it may still be a precursor to him possibly being a diabetic when he is older. We are Hispanic with White, Native and I wouldn't be surprised if there is Black in us as well. By the way all my 5 children are from same daddy but, they all different hues ranging from White to very brown (the very brown one is the 15 year old mentioned here). He did have an uncle with a similar condition as a child, he too was the darkest one in the family and the youngest as as a slender child unfortunately he died in an drowning accident when he was 9 years old so, we don't have anything to go by there. He also has a cousin who is 6 months older than he and, he has a similar condition but, not as severe and, He too is the darkest and youngest one of his siblings. My son is also the youngest and the Darkest of his siblings. Now I mention that all three of these boys are or were the youngest and darkest of their siblings because I feel that may be too much of a coincidence and not because I'm obsessed with color so, don't go getting all race card on me.
photo:Jeff Calaway
Jeff Calaway
Senior Content Specialist
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