Acanthosis Nigricans Mimicking Melasma

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Case Report and Pearls for Accurate Diagnosis – An Interview with the Author

During the 2018 Skin of Color Seminar Series (now the Skin of Color Update), approximately twenty posters could be seen hanging in the poster viewing area.  Each of these posters highlights novel and exciting research in skin of color. In one such poster, Dr. Monica Huynh and colleagues presented a case of acanthosis nigricans mimicking melasma.

Case Report

The patient was a 45-year-old female with a pertinent past medical history of diabetes mellitus type 2. They presented with discoloration of the cheeks for several years.  She had been treated previously with hydroquinone 4% with minimal improvement. Physical examination revealed brown-gray hyperpigmented, velvety, lichenified plaques on the lateral zygoma and hollow of the cheeks bilaterally as well as on the posterior neck.  Given the patient’s clinical presentation and past medical history of diabetes mellitus, a diagnosis of acanthosis nigricans was made. The dermatology team initiated treatment with salicylic acid cleanser twice daily, hydroquinone 4% cream twice daily, and tretinoin 0.025% cream nightly. After 8 weeks, the patient was switched to triple combination cream with improvement in facial hyperpigmentation. Due to facial dryness, the cleansing regimen was changed to salicylic acid cleanser in the morning and mandelic acid cleanser plus toner in the evening.

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