This was a prospective case controlled study to determine the association of Acanthosis Nigricans (AN) and Metabolic Syndrome (MS) in obese children 10–16 years of age. We recruited 50 obese children with AN (cases) and 50 obese children without AN (controls) attending the Pediatric OPD from May 2013 to August 2014 after obtaining informed consent from their parents. Children were defined as obese if their BMI was ≥ 95^th percentile for age and sex (CDC). International Diabetes Federation (IDF) 2007 criteria were used to define MS. Detailed history, physical examination, anthropometry and blood sampling were done in each case. Samples for High Density Lipoprotein Cholesterol (HDL–C), Fasting Plasma Glucose (FPG) and Triglycerides (TG) were evaluated at the in–hospital NABL certified SRL laboratory. MS was found in 64% of obese children with AN as compared to 30% of obese children without AN which was highly significant. Therefore, AN is a significant marker of MS.