Article by Dr Raghuram Y.S. MD (Ayu) & Dr Manasa S, BAMS

Acanthosis Nigricans presents with hyperpigmentation of skin. This occurs mainly at the skin folds and creases. There is notable thickening, itching, odour and appearance of tags over the affected skin.

Common areas wherein Acanthosis Nigricans is manifested is – sides or back of neck, arms, groin, anal or genital regions, in skinfolds – back of the knees, under the breasts, crooks of the elbow. It may be a sign of an underlying condition that requires treatment.

In this condition rapid reproduction of skin cells take place due to excess insulin. These new cells contain more melanin in people with darker skin tones. This would lead to the formation of darker patches of skin in comparison to the surrounding skin. Acanthosis Nigricans is a significant predictor of future diabetes.

Related Reading – ‘Acanthosis Nigricans – causes, symptoms, treatment, Ayurveda Understanding’

Ayurveda Understanding of Acanthosis Nigricans

1. Dosha Perspective of Acanthosis Nigricans

Now let us see this from Ayurveda angle and dosha perspective.

Hyperpigmentation – Karshnya is one of the symptoms of Vata Vriddhi – abnormal increase of vata. Karshnya means ‘blackish discolouration’. Karshnya also explains hyperpigmentation.

Skin thickening – at the skin fold and creases associated with itching and appearance of tags might be a condition which is caused by predominance of vata and kapha.

Summing up

• If there is hyperpigmentation at the mentioned places of the body without thickening of skin, it can be a pure vata condition.
• If there is thickening of skin at the mentioned places of the body associated with hyperpigmentation, it is a kapha-vata condition.

Also,

Bhrajaka Pitta – It is a subtype of pitta which imparts natural colour and complexion to the skin. Hyper-expression or over production of Bhrajaka Pitta in the places meant for manifestation of Acanthosis Nigricans can contribute to hyperpigmentation. Increased Bhrajaka Pitta can be associated with aggravated vata or can also be triggered by the same.

Udana Vata – It is a subtype of vata which is responsible for bestowing colour and complexion to the individuals. ‘Varna krit’ has been mentioned clearly in the description of functions of udana vata in this direction. Udana Vata dysfunctions can also produce hyperpigmentation and related symptoms of Acanthosis Nigricans.

2. Disease Perspective

Since Acanthosis Nigricans is a skin disorder, it should be considered under the umbrella of ‘Kushta’. Kushta encompasses wide array of skin disorders, major, minor, curable and incurable ones.

Seeing the dosha predominance in Kushta, Vata or Vata-Kapha type of Kushta, especially those presenting with hyperpigmentation, thickness of skin or both can be considered for explaining Acanthosis Nigricans.

Kushta Purvarupa

The below mentioned features mentioned amongst the premonitory symptoms of Kushta point towards the symptoms of Acanthosis Nigricans –

• Ati Khara Sparsha – excessive roughness of the skin
• Vivarnata / Vaivarnyam – discoloration of the skin
• Kandu – itching

Twachi Swapaha / Sparshaagnatwam – numbness or loss of sensation or feel of touch is mentioned among the purvarupas of Kushta. This is one of the symptoms of the advanced stages of or complication of diabetes (neuropathy). Acanthosis Nigricans is said to be a cutaneous marker of diabetes mellitus and insulin resistance. Master Charaka has placed chapter of Kushta Chikitsa (treatment of skin disorders) immediately after the chapter of Prameha Chikitsa (treatment of diabetes) in ‘Charaka Samhita Chikitsa Sthana’ section. This establishes the relationship between diabetes and skin disorders according to Ayurveda.

Kapala Kushta

This is one among the 7 types of Maha Kushta – greater skin diseases. It presents with blackish blue or blackish brown coloured skin lesions or patches. They resemble Kapala – a fresh piece of new earthen pot. They are dry and rough, spreads abruptly and has pain. Though not exactly, the features match with those of Acanthosis Nigricans. The seat of Kapala Kushta has not been specified. So, it can also occur at the skin folds and creases. Kapala like appearance and being dry and rough depicts thickening of skin and the abnormal discolouration of skin mentioned in the context points towards hyperpigmentation. Hyperpigmentation is a feature of vata increase and Kapala Kushta is a vata predominant skin disorder.

Eka Kushta

It is one among the 11 types of Kshudra Kushta i.e. minor skin diseases. It is a large patch – lesion. It is described as Matsya shakala upamam – resembling the skin of a fish – scaly, rough and thick, elevated – all of which are features of Acanthosis Nigricans. This condition is caused by vata and kapha. Vata contributes to hyperpigmentation and kapha to thickness. Though dark skin has not been mentioned in the Ayurveda description, we can infer that it happens due to involvement of vata.

Charma Kushta / Charmakhya Kushta

This is also one among the 11 kinds of Kshudra Kushta. The skin patch / lesion appears like skin of an elephant – described as hasti charmavat. The skin is thick and devoid of layers. This condition is also caused by combined aggravation of vata and kapha. Resemblance with hasti charma indicates thick and dark skin, as in Acanthosis Nigricans.

Dosha Pradhana Kushta

Vata Pradhana Kushta – The terms kharam – roughness, shyavam – blackish discolouration and ruksham – dryness indicates Acanthosis Nigricans like patches in vata predominant kushta.

All these conditions are caused due to abnormal proliferation of epidermal skin. 

3. Other conditions: Sthoulya, medoroga, prameha & kushta loop

Some forms of Acanthosis Nigricans are said to be associated with obesity.

Acanthosis Nigricans is a predictor of future diabetes mellitus.

Obesity and diabetes are interrelated.

According to Ayurveda, prameha vis-à-vis diabetes is caused due to contamination of medovaha srotas – fat transportation channels. Excessive accumulation of medas will lead to sthoulya – obesity and medoroga – diseases caused due to errors in fat metabolism. Meda i.e. fat is one of the tissues involved in the pathogenesis of prameha.

So, both Ayurveda and modern medicine agree on the interrelationship between obesity and diabetes.

Master Charaka tells that Prameha and Kushta – skin diseases are interrelated. Acanthosis Nigricans is included under Kushta as we have already discussed.

So, prameha, kushta, medo roga and sthoulya are interrelated pathological conditions / diseases.

Ayurveda Management of Acanthosis Nigricans

Nidana Parivarjana – The causative factors of the disease should be kept away, especially those which are known to have caused or triggering the disease or its symptoms. They may be foods, activities, habits or behaviours. In this context, foods and activities which aggravate vata or kapha or both, and those which cause kushta, sthoulya, medoroga, prameha and contamination of fat transporting channels shall be kept away.

Other treatment principles

Acanthosis Nigricans shall be treated on the lines of treatment of below mentioned conditions –

• Kushta – Vata or Kapha predominant Kushta
• Prameha
• Medoroga
• Sthoulya
• Medovaha Sroto Dushti

This goes with the rule that the treatment should be focussed on the underlying disease which is causing the condition being addressed, Acanthosis Nigricans in this context. While treating sthoulya or medoroga on the backdrop of the mentioned disease, priority should be given towards planned weight reduction so as to resolve hyperkeratotic lesions, as in karshnya. Udwarthana might be a gamechanger while included along with external snehana and swedana.

Udwarthana can be a standalone treatment in these conditions or may be included amidst Panchakarma detox programs, while abhyana and swedana are administered as preparation for virechana. 

Panchakarma Therapies

While Virechana is the main Panchakarma inclusion in the treatment of Acanthosis Nigricans, Vamana can be situationally included. Sarpi-pana – consumption of medicated ghee in metered / scheduled doses can be considered in vata predominant symptoms in kushta.

Useful formulations

• Tiktaka Kashayam / Ghrtam
• Mahatiktaka Kashayam / Ghrtam
• Varanadi Kashayam / Ghrtam
• Guggulutiktaka Kashayam / Ghrtam
• Aragwadhadi Kashayam
• Patolakaturohinyadi Kashayam
• Varadi Kashayam
• Nishakatakadi Kashayam
• Mahamanjishtadi Kashayam
• Dhanwantaram Ghrtam
• Navaka Guggulu
• Triphala Guggulu