Acanthosis nigricans (AN) is a dermatopathy with a distinctive appearance that facilitates its diagnosis. Although an external condition, it is associated with a wide variety of less obvious internal conditions, either benign or malignant. Insulin resistance figures prominently in its benign associations and plays a primary role in its development. The development of AN rarely requires treatment, although the underlying condition usually does. AN and insulin resistance are found frequently in obese and hyperandrogenic women. The vulva is the most likely place to find this marker. We experienced a case of AN with 71-year obese menopausal woman with diabetes who presented with itching sensation on vulvar area. AN was revealed on pathology and acitretin, control of blood glucose, and weight reduction were used. So we report it with a brief review of literatures.