Obesity⁃associated acanthosis nigricans is a core cutaneous marker of insulin resistance and hyperinsulinemia, closely associated with obesity⁃related complications such as metabolic syndrome and metabolic dysfunction⁃associated steatotic liver disease. Accurate differentiation of malignant, drug⁃induced and hereditary acanthosis nigricans is a prerequisite for effective treatment. The core contradiction in clinical management lies in how to develop individualized regimens based on the patient's degree of obesity and metabolic disorder status. Combining single⁃center experience and existing evidence, this paper clarifies the core strategies for clinical management: bariatric metabolic surgery provides a key approach for severely obese patients to achieve skin lesion remission and complication improvement through significant weight loss and metabolic remodeling, while postoperative issues such as skin laxity require vigilance. Among non⁃surgical interventions, lifestyle modification serves as the foundation, medications such as metformin and glucagon⁃like peptide 1 receptor agonists target and improve insulin resistance, while retinoids and laser therapy optimize the appearance of skin lesions. This review provides core evidence for the selection of surgical and non⁃surgical regimens and stratified patient management in clinical practice, strengthens the practical value of multidisciplinary collaboration, and ultimately helps improve patients' metabolic health and quality of life.

无