Is Acanthosis Nigricans a reliable indicator for risk of type 2 diabetes?

Acanthosis nigricans (AN) is a thickening and hyperpigmentation of the skin commonly found on the neck, axilla, or groin and is generally caused by hyperinsulinemia, a consequence of insulin resistance associated with obesity. Insulin resistance is a primary risk factor for the development of type 2 diabetes, hypercholesterolemia, and hypertension. Screening for acanthosis nigricans is controversial and not recommended by the Centers for Disease Control and Prevention; however, some states, such as Texas, are implementing AN screenings in schools to identify those children who are at highest risk for developing type 2 diabetes. With the current epidemics of obesity and diabetes, school nurses will see students in the health office with AN and should be knowledgeable about this skin condition and the association with hyperinsulinemia and obesity. The school nurse's role is to educate and assist students and their families in seeking appropriate medical advice based on current knowledge of risk factors. This article will explore the controversy associated with screening for AN and make recommendations for school nursing practice.