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I would keep a possibility of pseudoacanthosis nigricans. Pseudoacanthosis nigricans is a skin disorder with darker, thick, velvety skin in body folds and creases. The skin becomes dark, velvety, and thick in the back and sides of the neck, armpits, thighs, elbows, and knees. Acanthosis nigricans usually appear slowly and do not cause symptoms other than skin changes. It typically occurs in individuals younger than 40, may be genetically inherited, and is associated with obesity or endocrinopathies, such as hypothyroidism, acromegaly, polycystic ovary disease, insulin-resistant diabetes, or Cushing's disease. The majority of cases of acanthosis nigricans are associated with obesity or idiopathy. This is likely because of insulin resistance and is more likely to occur in darker-skinned persons. This is also known as Pseudo-Acanthosis Nigricans. Acanthosis nigricans is likely to improve when a known cause is removed. For example, obesity-related acanthosis nigricans will improve with weight loss. People with acanthosis nigricans, in general, should be screened for diabetes. Weight loss and controlling blood glucose levels through exercise and diet often improve symptoms. I would suggest Topical Tretinoin 0.05 % cream once daily at night helps to lighten pigmentation; and weight loss, exercise, and diet management should be followed. Alpha-Lipoic acid has been shown to increase insulin sensitivity and thereby reverse the pseudo-acanthosis nigricans resulting from insulin resistance, as in the case of obesity and diabetes. It is commercially available for prescription in acanthosis nigricans. You can also try tablet Nexna (N-Acetyl Cysteine, Inositol, Alpha Lipoic Acid, Chromium Picolinate, Zinc Gluconate) - twice daily for 1 to 2 months. However, you may consult a specialist doctor and have the medications as instructed.