What causes skin tags?

Causes of Skin Tags

Skin tags (acrochordons) are primarily caused by friction and rubbing of skin against skin or clothing, often associated with obesity, insulin resistance, and metabolic syndrome.

What Are Skin Tags?

Skin tags are benign skin lesions that are typically:

• Skin-colored or hyperpigmented, pedunculated growths 1
• Commonly found in areas of skin friction such as the neck, axilla (armpits), and groin regions 1
• Usually painless and benign in nature 1

Primary Causes of Skin Tags

Friction and Mechanical Factors

• Skin tags develop in areas where skin rubs against skin or clothing 2
• Common locations include skin folds and areas where friction occurs regularly 1
• The constant irritation from friction appears to stimulate skin growth in susceptible individuals 2

Metabolic Associations

Skin tags have strong associations with several metabolic conditions:

1. Obesity

   • Higher body mass index (BMI) is significantly associated with multiple skin tags 3
   • Patients who are overweight are more likely to present with multiple skin tags compared to those at normal weight 3
   • The mechanical friction in skin folds of obese individuals contributes to skin tag formation 2

2. Insulin Resistance

   • Multiple skin tags are strongly associated with insulin resistance independent of other risk factors 4
   • The presence of more than 5 skin tags is associated with elevated HOMA-IR values (a measure of insulin resistance) with an odds ratio of 1.4 4
   • Qualitatively elevated HOMA-IR levels (>3.8) showed an even stronger association with skin tags (odds ratio = 7.5) 4

3. Metabolic Syndrome

   • The risk of developing metabolic syndrome is 11.13 times higher in patients with skin tags 5
   • Among metabolic syndrome components, high waist circumference and low HDL levels show the strongest association with skin tags 5

4. Dyslipidemia

   • Hypercholesterolemia shows a significant association with skin tags 3
   • Hypertriglyceridemia is directly associated with skin tag formation 4

5. Diabetes Mellitus

   • The prevalence of diabetes is significantly higher in patients with skin tags 5
   • Skin tags may serve as a cutaneous marker for underlying diabetes 4

6. Thyroid Abnormalities

   • Some evidence suggests a possible association between skin tags and hypothyroidism 3
   • This relationship requires further investigation with larger sample sizes 3

Other Associated Factors

• Skin Type: Individuals with Fitzpatrick Skin Type III are more likely to develop multiple skin tags compared to those with Skin Type I 3
• Acanthosis Nigricans: Multiple skin tags have been independently associated with acanthosis nigricans, another skin condition linked to insulin resistance 3
• Genetic Factors: Family history may play a role in susceptibility to skin tag formation 4

Clinical Implications

• The presence of multiple skin tags should prompt evaluation for metabolic syndrome and its components 5
• Early detection of patients with insulin resistance through recognition of skin tags may play an important preventive role in managing metabolic disorders 4
• Skin tags may serve as visible markers for underlying metabolic abnormalities that require medical attention 5

Treatment Considerations

• Removal options include excision with micro-scissors after ethyl chloride spray anesthesia, which patients report as comfortable and painless 1
• Addressing underlying metabolic conditions may help prevent the formation of new skin tags 4, 5