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Developed acanthosis nigricans. Complaining of aching pain in toes and fingers. Cause?

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Practicing since : 2006
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My 13 year old son developed acanthosis nigricans in the last 2 years, manifesting on both hands. We have been able to control it with weight loss and moisturizing creams. Today he was complaining of sudden onset aching pain in his toes and fingers. He says this is brought on by cold. On examination I noticed that his fingernails are almost entirely white.

Do you think these symptoms related? What might be the cause?
Posted Tue, 12 Nov 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 30 minutes later
Brief Answer:
these two are unrelated

Detailed Answer:
Thanks for writing to us.
Acanthosis nigricans and recent manifestation of pain seems unrelated
Presence of pallor in hands and feet associated with pain in relation to cold could be due to raynaud's phenomenon where due to cold exposure the small vessels get contracted. The decreased blood supply leads to paleness, and aching sensation.
There is no need to worry. To treat the same, you may rewarm the area by dipping in warm water. Also to prevent further episodes keep the open areas well protected from cold
If in case, symptoms still persist, oral medicines will be required.
Hope this helped.
Should there be any doubt, please write back
Above answer was peer-reviewed by
Follow-up: Developed acanthosis nigricans. Complaining of aching pain in toes and fingers. Cause? 41 minutes later
You failed to address the third and possibly most worrying symptom - the leukonychia.
FYI I am a pediatric Hem/Onc RN.
Answered by Dr. Kalpana Pathak 1 hour later
Brief Answer:
Please read a detailed answer below

Detailed Answer:
Thanks for writing back.
I misunderstood your query, I was under the impression that white nails that he is having is temporary and developed all of sudden due to cold exposure. If thats the case its not leukonychia but nail pallor
But now as you have specifically mentioned leukonychia then I believe that his white nails have been persistent as Leukonychia is persistent white discoloration of nails.
As you have mentioned his fingernails to be almost entirely white, then it could be leukonychia totalis.
It can be idiopathic but can also occur in response to systemic conditions like hypoalbunemia, protein malaborption, liver disorders and kidney disorders like nephrotic syndrome. So if it is leukonychia then you can get his blood profile done for SGOT,SGPT, Serum bilirubin, blood urea and creatinine, Serum albumin and globulin to rule out any underlying cause. If any underlying cause is seen then it should be treated accordingly.
If at all there is no cause, then there is no cause to worry as leukonychia usually improves over a period of time. One may take biotin supplements to improve nail condition. In children nail biting, nail picking is common which can cause leukonychia as any injury to nail matrix can lead to formation of white nails. But in such cases it is a partial leukonychia visible as little white specks or lines.

Hope this answered your query.
Take care

Above answer was peer-reviewed by
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