Skin Tags: Cosmetic Annoyance or Metabolic Flag?

Skin tags—soft, benign, fleshy and pendunculated protrusions—come in many variations. Most patients report skin tags as just unsightly, but for some patients, skin tags are annoying and physically irritating.

Although usually small, they can become large, increasing risk that the patient will inadvertently snag the skin tag and rip it off. Skin tags are usually present on the head and neck, but particularly irritating skin tags can also grow in the groin and anal areas. Previously considered a cosmetic problem, new research indicates that skin tags may have medical significance.

Pathogenesis Unknown

It's unclear how or why skin tags develop but they are increasingly common with age (60% of individuals aged 69 years or older have multiple skin tags). Friction seems to precipitate skin tags, and viral infection may be a cofactor. Some researchers suggest skin tags develop pursuant to hyperinsulinemia, as insulin is a growth-stimulating hormone. Microscopically, skin tags have fibrovascular cores that induce mild chronic inflammation. Medical terms used to describe skin tags include soft words, acrochorda, cutaneous tags, skin fibroma, and fibroepithelialpolyps.

Systemic Associations

Researchers have recently found associations between skin tags and a number of clinical conditions. Patients who have multiple skin tags are at elevated risk for acromegaly, colonic polyps, Crohn's disease, diabetes, hypertension, lipid disorders, and acanthosis nigricans.

Skin tags are also linked to metabolic syndrome (MetS). New information suggests that skin tags may indicate insulin resistance. This is of concern because MetS and insulin resistance both increase cardiovascular mortality risk.

Other research has associated skin tags with elevated leptin, C-reactive protein, and fasting insulin levels.

Many skin tags harbor human papilloma virus (HPV). Researchers found HPV 6 and HPV 11 DNA in 71% of the skin tags that they biopsied (N = 35). However, HPV 6 and 11 are low-risk viruses. HPV may be a contributing factor in the development of skin tags.

Acanthosis nigricans manifests as areas of dark, velvety discoloration in body creases and folds such as the armpits, groin, and neck, sometimes causing skin to become thickened. This condition occurs most often in people who are obese or who have diabetes. It's also considered a red flag for future diabetes in children, and may predict cancer, especially cancer of the stomach or liver.

Much research on skin tags is preliminary and some is conflicting. The clinical implications from recent research: retail health care clinicians should have a high index of suspicion when patients present with multiple skin tags. Metabolic screening is prudent, and patients may need early intervention to prevent or address MetS, counseling on lifestyle modifications, or prescription medications to lower lipids and elevated glucose levels.

What to Do?

Patients may complain skin tags cause itching or pain. Patients may be reluctant to remove skin tags, believing that removing one skin tag causes more to grow. This is urban legend. Retail health care providers should encourage patients to have irritating skin tags removed. Options include the following:

· Strangling the skin tag by tying it close to the skin with dental floss or string

· Freezing it with liquid nitrogen

· Using electric cautery

· Snipping the tag with scissors with anesthetic (large tags) or without anesthetic (small tags).

Physical removal of skin tags can sometimes cause minor bleeding.

References

Askar H, Darwish N, Abdelgaber S, Eldomiaty A. Human papilloma virus and skin tags. Egypt JMed Microbiol.2016;25(4):113-118.

Hui ES, Yip BH, Tsang KW, et al. Association between multiple skin tags and metabolic syndrome: A multicentre cross-sectional study in primary care.Diabetes Metab.2016;42(2):126-129.

Maluki AH, Abdullah AA. Metabolic associations with skin tags.Int J Dern Clin Res.

Shenoy C, Shenoy MM, Krishna S, et al. Skin tags are not merely cosmetic: A study on its association with metabolic syndrome.Int J Health & Allied Sci.2016;5;50-52. 2016;2(1):3-11.