Combination Treatment With Chemical Peels for Acanthosis Nigricans

The efficacy and safety of a combination therapy of keratolytic chemical peels with topical keratolytics for improvement in patients with acanthosis nigricans (AN) is assessed.

Combination of keratolytic chemical peels with topical keratolytics may yield long-term clinical improvement in patients with acanthosis nigricans (AN), study data published in the Journal of Cosmetic Dermatology suggests.

Although a number of treatment modalities are available for AN, few are associated with sustained improvement. Investigators hypothesized that regular sessions of salicylic acid (SA)-mandelic acid (MA) peeling, followed by maintenance treatment with topical keratolytics, may achieve longer-term results.

To assess the safety and efficacy of this proposed treatment modality, authors conducted a pilot study of adults with benign hereditary AN involving the underarms. Patients were enrolled from a dermatology clinic in India. Patients received 6 sessions of a combination peel of 20% SA and 10% MA every 15 days. Peels were applied to both underarms. In between peel sessions, patients were instructed to apply a cream containing glycolic acid, urea, and cetylated fat esters each night. Cream application was continued until 9 months after the completion of peel sessions. AN lesions were evaluated every 3 months following the completion of peel treatment. The primary outcomes were improvement in pigmentation and skin thickening per physician assessment.

The study cohort included 17 patients of mean age 25.2 ± 3.81 years. All patients were of Indian descent and had a Fitzpatrick skin type of 4 or 5. At the 9 month mark, 100% of patients showed significant improvement in both pigmentation and skin thickening. Reductions in skin thickening were designated as “very good” in 41% of patients and “moderate” in 29% of patients. Regarding pigmentation, 35% of patients experienced “very good” improvement and 35% experienced “moderate” improvement. The most common adverse events were post-peel erythema and burning sensation, which were reported by 100% and 90% of patients, respectively. In all patients, side effects resolved quickly and without intervention. During an additional 9 months of follow-up, no patients experienced AN relapse.

The investigators believe that their study demonstrates that “combination of keratolytic chemical peels and topical mild keratolytic application ensures better therapeutic outcome in patients of AN, long lasting effect and without any significant complications,” investigators wrote. Given the small study cohort and lack of a comparator group, however, results should be interpreted with caution. The researchers advocated for further research in a randomized clinical trial.


Zeeshan M, Arfeen N, Sonthalia S, Singh A, Roy PK. Treatment of acanthosis nigricans with sequential salicylic acid-mandelic acid combination peel and maintenance with glycolic acid-urea combination cream: a retrospective pilot study. J Cosmet Dermatol. Published online December 31, 2021. doi:10.1111/jocd.14731