Acanthosis nigricans significantly impacts individuals with skin of color. No United States Food and Drug Administration (FDA)-approved therapy exists for acanthosis nigricans. This review evaluates visual scoring tools for assessing acanthosis nigricans severity, focusing on their utility in monitoring therapy response in clinical trials. Our analysis included five visual scoring tools and revealed that the Acanthosis Nigricans Scoring Chart is the most effective tool for monitoring acanthosis nigricans severity in response to therapy, while the Acanthosis Nigricans Area and Severity Index also remains a strong option for split-neck trials. Future tools should match severity scores with detailed descriptions and images. The inclusion of lesion size in future assessment tools requires careful consideration due to variable reliability among evaluators. This study highlights the need for a universally accepted acanthosis nigricans severity assessment tool. Advancing such methods is crucial to developing effective treatments and addressing healthcare disparities, particularly for individuals with skin of color. J Drugs Dermatol. 2025;24(2):156-161. doi:10.36849/JDD.8168R1.
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