How to treat Acanthosis Nigricans | Dr Davin Lim

Can prescription creams fade dark underarm skin?
Creams have a marginal effect on dark underarms. Your medical dermatologist will guide you. Three types of creams can be used, depending on the cause.

Calcineurin inhibitors such a tacrolimus or pimecrolimus (Protopic or Elidel). This group of creams do not have the long-term side effects of steroids. They can be effective in preventing post inflammatory hyperpigmentation.
Vitamin D creams can be effective in some cases of acanthosis nigricans (about 15% of cases).

Pigment inhibitors are used when Ashy dermatosis is in the remission phases. They include hydroquinone, arbutin, azelaic acid, ascorbic acid & cysteamine. Creams are marginally effective & ideally should be combined with lasers & medical therapy.

Corticosteroids to reduce inflammation. Example: Advantan Fatty ointment. This is used in a pulse manner (your dermatologist will guide you). Steroid creams are only useful in the very early phase of Ashy, even then, their use is controversial as it is used more commonly in other skin conditions that may look like Ashy- e.g. lichen planus pigmentosus.

Botox is an injection, not a cream. It can be very effective in prevention of post-inflammatory hyperpigmentation, especially in cases of friction induced pigment due to excessive sweating or hyperhidrosis.

Dermatologists at The Melasma Clinic are procedural, namely we perform procedures such as lasers & peels. Though we can provide second options, diagnose & investigate all forms of axillary hyperpigmentation, we do not provide ongoing medical management as this entails frequent visits, follow ups & prescriptive medications. We refer patients to Cutis Dermatology in Brisbane, or the Skin Hospital in Sydney for joint management with a medical dermatologist.

What results can I expect from lasers?

Lasers work best for cases of post inflammatory hyperpigmentation once the source of inflammation has subsided. Most patients can expect a reduction of pigmentation by up to 50-80% within a few sessions, spaced 4 weeks apart.

The Melasma Clinic has the most advanced lasers for pigment, including the Picoway & Picosure Pro. Genetic cases may require 10 sessions with a success rate of only 20%, whilst conditions such as acanthosis nigricans do not respond well to lasers.