Obesity is one of the main causes of preventable death. Complications of childhood obesity include cardiovascular risk, impaired glucose tolerance, type 2 diabetes mellitus, and acanthosis nigricans (AN; associated with obesity as a manifestation of cutaneous insulin resistance). An interaction between AN and obesity as well as a detailed mechanism for the pre- and co-obesity appearance of AN in children are still to be revealed.This research tries to assess involvement of the insulin/insulin-like growth factor (IGF) receptor pathway in childhood pre- and co-obesity AN via a study of the association of polymorphisms of the INSR, IRS1, and IGF1R genes with pre- and co-obesity AN.In total, 99 children with pre- and co-obesity AN and 100 healthy controls were genotyped and analyzed by the polymerase chain reaction-restriction fragment length polymorphism method.Intergroup frequency differed starkly for INSR His1085His and IGF1R IVS7-20, but not in the IRS1 Ala804Ala or IGF1R Thr766Thr genotypes. The T allele of INSR His1085His and C allele of IGF1R IVS7-20 both conferred a starkly( p=0.04 and 2.84E-6 = 2.84 x 10 −6 , respectively)higher risk for AN.The above findings suggest that certain genetic variants in insulin/insulin-like growth factor (IGF) receptor pathway might be correlated with the appearance of AN prior to or concurrent with obesity, and also reveal the insulin/IGF receptor pathway as crucial in pre- and co-obesity AN.