Causes of Skin Tags
Skin tags (acrochordons) are primarily caused by friction and rubbing of skin against skin or clothing, especially in skin folds, and are associated with metabolic conditions like obesity, diabetes, and hyperlipidemia.
Etiology of Skin Tags
Skin tags develop due to several factors:
Primary Causes
- Friction and mechanical irritation: Skin tags commonly develop in intertriginous areas where skin rubs against skin or clothing 1
- Hormonal factors: Higher levels of both estrogen and androgen receptors are found in skin tags compared to normal skin 2
- Metabolic disorders: Strong association with:
- Obesity
- Insulin resistance
- Hyperlipidemia
- Type 2 diabetes
Anatomical Distribution
Skin tags most commonly occur in:
- Neck
- Axillae (armpits)
- Groin
- Intertriginous areas
- Eyelids
Associated Conditions
- Acanthosis nigricans: Often co-occurs with multiple skin tags 3
- Obesity: Overweight patients have a higher likelihood of developing multiple skin tags 3
- Hypothyroidism: A significant association has been found between hypothyroidism and multiple skin tags 3
- Hypercholesterolemia: Multivariate analysis shows a significant independent association between elevated cholesterol levels and skin tags 3
Pathophysiology
The development of skin tags involves several mechanisms:
Hormonal influence:
- Skin tags contain significantly higher levels of both estrogen receptors (alpha and beta) and androgen receptors compared to normal skin 2
- This suggests hormone-dependent growth, particularly in areas like the neck, axillae, and groin
Friction-induced growth:
- Mechanical irritation triggers hyperplasia of the epidermis
- Linear arrangement of skin tags often follows friction lines 1
Metabolic pathway:
- Hyperinsulinemia activates insulin-like growth factor receptors
- This promotes epidermal keratinocyte and dermal fibroblast proliferation
- Explains the association with obesity and metabolic syndrome
Clinical Implications
Understanding the causes of skin tags has practical implications:
- Screening opportunity: Multiple skin tags may warrant screening for metabolic disorders including diabetes, hyperlipidemia, and thyroid dysfunction 3
- Prevention strategies: Weight management and reducing friction in susceptible areas may help prevent new skin tag formation
- Treatment considerations: Simple removal techniques include cryotherapy, electrodessication, snip-excision, or newer methods like adhesive patches 4, 5
Important Distinctions
It's important to differentiate skin tags from other similar-appearing lesions:
- Crohn's disease skin tags: These perianal lesions have a different etiology and should not be removed due to high rates of complications 6
- Dermatoses mimicking skin tags: Conditions like seborrheic dermatitis, contact dermatitis, or eczema may sometimes be confused with skin tags 6
Understanding the underlying causes of skin tags helps guide appropriate management and identify patients who may benefit from metabolic screening.