What Causes Skin Tags?
Skin tags (acrochordons) are benign connective tissue neoplasms that develop primarily due to friction in intertriginous areas, with obesity, metabolic factors, and genetic predisposition playing contributing roles. 1
Primary Mechanism: Friction and Mechanical Trauma
- Friction is the primary mechanical cause of skin tag formation, as demonstrated by patients developing multiple skin tags arranged in linear patterns along areas of repeated skin-to-skin or skin-to-clothing contact 1
- The lesions occur predominantly in intertriginous skin (areas where skin folds rub together), including the neck, axillae, groin, and under breasts 1, 2
- Mechanical irritation leads to localized proliferation of both dermal and epidermal components, resulting in the characteristic soft, pedunculated growths 2
Contributing Metabolic and Systemic Factors
Obesity and Body Weight
- Overweight and obese patients are significantly more likely to develop multiple skin tags compared to those at normal weight 3
- Increased body mass creates more skin folds and friction points, amplifying the mechanical trigger 3
Lipid Abnormalities
- Hypercholesterolemia shows an independent association with skin tag development in multivariate analysis 3
- Elevated triglycerides also demonstrate statistically significant correlation with multiple skin tags 3
- The mechanism may involve altered lipid metabolism affecting dermal connective tissue proliferation 3
Insulin Resistance and Acanthosis Nigricans
- Multiple skin tags are independently associated with acanthosis nigricans, a marker of insulin resistance 3
- This suggests a possible role for hyperinsulinemia in promoting dermal proliferation 3
Thyroid Dysfunction
- Hypothyroidism shows a possible association with skin tag development, though this relationship requires further investigation with larger studies 3
- Patients with multiple skin tags were more likely to have thyroid abnormalities in univariate analysis 3
Clinical Characteristics
- Skin tags present as soft, skin-colored or hyperpigmented, filiform, often pedunculated growths 2, 4
- They are benign neoplasms with no malignant potential 1, 2
- The lesions consist of loose fibrous tissue covered by epidermis, representing a proliferation of dermal connective tissue 2