Risk Factors for Skin Tags (Acrochordons)
Skin tags are primarily caused by friction and rubbing of skin against skin or clothing, especially in skin folds, and are strongly associated with metabolic conditions including obesity, diabetes, and hyperlipidemia. 1
Major Predisposing Factors
Metabolic Factors
- Obesity: Higher body mass index (BMI) and obesity are significantly associated with skin tags 2, 3, 4
- Insulin Resistance: Multiple skin tags are strongly associated with insulin resistance (odds ratio = 7.5 for HOMA-IR >3.8) independent of other risk factors 2
- Dyslipidemia: Elevated cholesterol, LDL, and triglycerides are associated with skin tags 3, 5
- Diabetes: Skin tags are commonly found in patients with type 2 diabetes 4
- Hypothyroidism: A significant association between hypothyroidism and multiple skin tags has been demonstrated 3
Physical/Mechanical Factors
- Skin friction: Areas where skin rubs against skin or clothing are most susceptible 1
- Common locations: Neck, axillae, and groin regions - areas prone to friction 6
- Skin type: Individuals with Fitzpatrick Skin Type III are more likely to develop multiple skin tags compared to those with Skin Type I 3
Associated Conditions
- Acanthosis nigricans: Multiple skin tags have been independently associated with acanthosis nigricans 3
- Inflammatory markers: Elevated high-sensitive C-reactive protein, uric acid, and free fatty acid levels are found in patients with skin tags 5
Clinical Significance
The presence of multiple skin tags should prompt consideration of screening for:
- Insulin resistance and diabetes
- Dyslipidemia
- Obesity
- Thyroid dysfunction
Prevention Strategies
- Weight management: Since obesity is strongly associated with skin tags, maintaining a healthy weight may help prevent their formation
- Reducing friction: Minimizing skin-to-skin and clothing friction in susceptible areas
- Metabolic control: Managing underlying conditions like diabetes and hyperlipidemia
Important Considerations
- While skin tags are benign, their presence, especially in multiple numbers, may signal underlying metabolic disorders that increase cardiovascular risk 5
- In diabetic patients, skin tags appear to be more strongly associated with obesity than with diabetic micro or macroangiopathy 4
- The strong association between skin tags and insulin resistance (OR = 1.4) suggests they could serve as a visible marker for metabolic screening 2
When evaluating patients with multiple skin tags, clinicians should consider metabolic screening, particularly for insulin resistance, dyslipidemia, and thyroid dysfunction, as early detection of these conditions may play an important preventive role in reducing cardiovascular risk.