An overweight adolescent presents with velvety brown thickening of skin in the axillae, groin, and neck folds. What is the initial step in management?

An overweight adolescent presents with velvety brown thickening of skin in the axillae, groin, and neck folds. What is the initial step in management?

• A. Consultation with a pediatric dermatologist
• B. Prescribing topical retinoic acid cream
• C. Performing metabolic laboratory tests
• D. Referral to a pediatric endocrinologist

Answer: (C)

Acanthosis nigricans in an overweight adolescent is a sign of insulin resistance and metabolic risk. Because the skin finding is a clue to an underlying metabolic problem, the initial step is to screen for metabolic abnormalities with laboratory tests. Start with fasting glucose or HbA1c to assess for diabetes or prediabetes, and a fasting lipid panel to evaluate cardiovascular risk; check liver enzymes if there’s concern for fatty liver disease. These results help guide urgent lifestyle interventions focused on weight loss, diet, and physical activity to address the root issue. Consulting a dermatologist would treat the skin but not the metabolic problem, topical retinoids don’t address insulin resistance, and referring to endocrinology isn’t necessary unless the metabolic workup is abnormal or there are other endocrine concerns.

Acanthosis nigricans in an overweight adolescent is a sign of insulin resistance and metabolic risk. Because the skin finding is a clue to an underlying metabolic problem, the initial step is to screen for metabolic abnormalities with laboratory tests. Start with fasting glucose or HbA1c to assess for diabetes or prediabetes, and a fasting lipid panel to evaluate cardiovascular risk; check liver enzymes if there’s concern for fatty liver disease. These results help guide urgent lifestyle interventions focused on weight loss, diet, and physical activity to address the root issue.

Consulting a dermatologist would treat the skin but not the metabolic problem, topical retinoids don’t address insulin resistance, and referring to endocrinology isn’t necessary unless the metabolic workup is abnormal or there are other endocrine concerns.