A Comparative Study of Effect of Oral Myoinositol Plus Topical Lactic Acid versus Oral Alpha Lipoic Acid plus Topical Lactic Acid in Patients with Acanthosis Nigricans

Abstract

Background: Acanthosis nigricans (AN) is a cutaneous marker of insulin-resistant states. Alpha-lipoic acid (ALA) and myo-inositol (MI) both improve metabolic profiles, yet comparative evidence in AN is limited.

Objective: To compare the clinical efficacy of oral MI + topical lactic acid (LA) versus oral ALA + topical LA in patients with AN.

Methods: In this hospital-based, prospective, comparative study (July 2022–December 2023), 72 consecutive AN patients were alternately allocated to MI + LA (Group A) or ALA + LA (Group B) for six months. Primary outcome was change in neck-lesion severity grade (0–4 scale). Secondary endpoints included insulin resistance (HOMA-IR) and safety. Data were analysed with χ², t-tests, and one-way ANOVA (α = 0.05).

Results: Mean age was 31.5 ± 8.2 years; 70.8 % were male. Baseline characteristics, HOMA-IR (mean 1.68), and grade distribution were comparable between groups. After 6 months, 58.3 % of all patients achieved ≥1-grade reduction; 13.9 % achieved ≥2 grades. Mean grade reduction was 1.36 ± 0.79 (ALA + LA) versus 0.89 ± 0.71 (MI + LA); between-group difference 0.47, F = 0.40, p = 0.53. No serious adverse events occurred.

Conclusion: Both regimens significantly improved AN severity, with numerically greater—but statistically non-significant—improvement in the ALA + LA arm. Either combination may be chosen according to patient preference and tolerability. Larger randomized trials are warranted.