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Grayish Areas That Cannot Be Cleaned

Q: I'm having a weird problem that's making me very self-conscious. Recently, the folds of my armpits and creases along my neck have a grayish cast and look dirty, no matter how hard I scrub. I haven't used any new soaps or deodorants. What's causing this and is it permanent?

Dr. Donnica:
You are describing a classic presentation for acanthosis nigicans, a relatively common hyperpigmentation disorder usually related to insulin resistance or obesity in which melanin accumulates in the skin. The appearance may range from a thickened, velvety brown streaking to a leathery lesion, most often on the neck or in skin folds under the arm or breasts, around the belt line or in the groin, but it may develop elsewhere. Invariably, those affected describe it as you did: a "dirty area" that cannot be cleaned. Since this discoloration may herald a developing serious medical problem, medical attention is required. If an underlying health problem is diagnosed, proper treatment will generally reverse the discoloration, although it may take six months or more for the dark areas to disappear. During that time, a prescription cream like Retin A, 20% urea, alpha hydroxyacids, or salicylic acid prescriptions This condition should not be confused with melasma, a common discoloration of the face which often occurs in pregnancy or when women are taking birth control pills. Treatments for melasma include bleaching agents, laser therapy, and a new medication (Tri-Luma cream) that combines hydroquinone, tretinoin, and fluocinolone acetonide.

Created: 10/14/2006  -  Donnica Moore, M.D.

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