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A Skin tag, or acrochordon, is a benign skin growth which typically forms in areas where the skin rubs or in skin folds, such as the neck, armpit, and groin.  Skin tags also can appear on the face, particularly on the eyelids.  Microscopically, skin tags are composed of a fibrovascular core, fat cells, and a benign covering of epidermis. These lesions are typically small, grow in clusters, and can hang from the skin by a thin stalk, which is typically pedunculateSkin tags are often itchy and can become irritated from rubbing against clothing.

A Skin tag is also referred to as an acrochordon, cutaneous papilloma, cutaneous tag, fibroepithelial polyp, fibroma molluscum, fibroma pendulum, soft fibroma, or Templeton skin tag. They range in size from 2 millimeters to to 1 centimeter in size, with some skin tags growing in size up to 5 centimeters.

According to the National Institute of Health, approximately 46 percent of the population suffers from skin tags and they are one of the most common benign growths seen in dermatology. Skin tags are extremely common, with more than 3 million cases in the United States diagnosed each year. As patients grow older, they are more lively to develop skin tags.

757px NeckAcrochordons
NeckAcrochordons By Jmarchn – Own work, CC BY-SA 3.0, Link

Where do skin tags appear on the body?

  • armpits
  • under the breasts
  • groin
  • face and eyelids
  • neck
  • upper chest
  • vaginal
  • anal 

What causes skin tags?

Although the exact cause of skin tags is unknown,  dermatologists have observed that they are formed from a collection of collagen and blood vessels trapped in areas of thicker skin, and get activated to grow in areas where the skin rubs. Some studies show a genetic predisposition to having skin tags;  if you have a family history of skin tags you have a greater chance of developing them as well. There is a greater prevalence in women than men, indicating a probable hormonal association. Pregnant women are also more prone to the development of skin tags. Skin tags have been associated with obesity, high levels of growth factors, high cholesterol levels, hypertension, insulin resistance, some types of HPV, and changes in levels of estrogen and progesterone. 

Human Papillomavirus (HPV)

Human Papillomavirus, HPV types 6 and 11, which are low-risk human papillomavirus, has been associated with the evolution of skin tags. If you have skin tags in the groin, genital, or anal area, it is recommended to have these lesions and removed and tested for HPV.  Although skin tags are considered benign, their clinical association with HPV warrants their removal in these sensitive areas, as certain high-risk papillomaviruses have been associated with skin cancer.

Diabetes

The appearance of skin tags can also be an indication of other health issues such as diabetes. When you have diabetes, your blood glucose levels can also cause hormonal imbalances. The hormonal fluctuations caused by blood glucose levels can affect cellular turnover in the skin. With type 2 diabetes, the insulin levels are too high. Due to the skin’s inability to produce healthy skin cells, skin tags are formed. The formation of skin tags will continue to form until the body is regulated and glucose levels stabilize. Although, diabetes can cause skin tags not everyone with diabetes develop skin tags.

Obesity

The diagnosis of obesity not only comes with a slew of other health related problems but skin tags happens to be on the list as well. Obesity can cause hormonal fluctuations which can result in the development of skin tags. Also, obese patients may have more skin friction in the areas prone to skin tags and develop more of them. Patients with type 2 diabetes, are similarly more susceptible to the development of skin tags, do to the increased levels of insulin in the blood.

Friction

Skin friction is a common reason for the development of skin tags, especially in areas around the neck, underarms, under breasts, and under skin folds in overweight patients. Wearing tight fitting clothes or participating in activities which cause the skin to rub together, can cause the development of skin tags, especially in the groin and buttock area.

Which Syndromes are Associated with Skin Tags?

Brit-Hogg-Dube syndrome

This is a very rare genetic condition, typically found in children, which is associated with the development of skin tags, predominantly on the face and upper body. It is also associated with skin tumors including multiple fibrofolliculomas, and trichodiscomas. These patients may also develop carcinomas in the kidneys and colon.

Polycystic ovary syndrome

Polycystic ovary syndrome is a hormonal disorder causing enlarge ovaries with small cysts. Patients can suffer from many dermatologic conditions such as acne, acanthosis nigrIcans, abnormal hair growth and skin tags.

Skin Tag Removal Methods 

Skin tags are common benign skin lesions, which do not need removal. However, because skin tags tend to grow in clusters, many patients want them removed for cosmetic reasons, especially on the eyelids.  In addition, since they also tend to form in areas of the skin which rub together, many patients want them removed because they are itchy, or can cause bleeding when scratched.

Electrodessication

Electrodessication Is a popular method to remove skin tags. Electrodesscation uses a tiny needle which delivers electric current, or heat, to remove the skin tags. The current cauterizes the skin tags which eventually scab up and heal.  Bacitracin ointment or Aquaphor is applied to the treated area after the skin tags are removed for several days.

Cryotherapy

For small skin tags, cryotherapy, which is an application of liquid nitrogen, is usually sufficient to safely remove the growths. This procedure is quick and relatively painless. Liquid nitrogen is approximately 320°F and extremely cold. The gas freezes the skin tag upon contact with the skin. Due to the high freezing point of liquid nitrogen it should be used only by a dermatologist as it can cause severe burns if not administered correctly. The skin tag may blister and scab within a few days after the liquid nitrogen is applied. Proper wound care is necessary to prevent scarring. Due to the possibility of scarring, liquid nitrogen is not the preferred method of treatment.

Excision

For removing large skin tags, other methods of removal should be considered as larger skin tags typically have a thicker stalk. For larger skin tags, surgical excision is usually recommended in addition to electrodessication. The skin can be prepped prior to the procedure with topical anesthesia or an injection of local anesthesia to numb the treated area. Once the area is numb,the skin tag can be excised with sterile surgical scissors or a surgical blade. After the growth has been excised the area should be cauterized using a hyfrecator.  Since skin tags have their own blood supply, cauterization will stop any further bleeding by sealing the blood vessels.

Don’t Try to Get Rid of Skin Tags at Home

There are many DIY home remedies, online skin tag remover kits, and videos for the removal of skin tags such as one showing you tying dental floss around the growth for removal.  There are other home skin care treatments recommended such as  applying tea tree oil or apple cider vinegar to the skin tag for removal. When it comes to skin tag removal at home, there are associated risks of infection and it is advised that these lesions be removed in a doctor’s office. Because skin tags have there own blood supply you risk excessive bleeding if you attempt to remove them yourself. It is best to seek medical advice and consult a dermatologist to ensure that these lesions are benign and remove these skin tags in a sterile medical environment.  In addition to bleeding and infection, other associated risks include scarring and blisters.

How Do You Prevent Skin Tags?

While the appearance of skin tags can be caused by a variety of health conditions, reducing skin friction can certainly help to prevent the development of skin tags.

In addition to preventing the skin from rubbing, maintaining a stable  insulin level and a healthy weight can also help prevent skin tags from developing.

Difference Between Genital Skin Tags & HPV?

Skin tags can also appear on the genitals and they should be evaluated by your dermatologist to determine if they are indeed skin tags and not a form of a sexually transmitted disease (STD). Genital skin tags, though painless, can be uncomfortable, itch, or bleed. Skin tags in the genital area and groin are  also more prone to form clusters and often go undetected.  Most individuals choose to have genital skin tags removed for cosmetic reasons, especially in the genital area. In addition, to the location of these skin tags the concern for a possible STD is a motivating factor to have been skin tags removed.

HPV image

How Are Skin Tags Diagnosed?

A dermatologist and other certified health care providers can determine if a skin growth is indeed a skin tag or some other type of growth. 

Although skin tags are benign, there have been rare cases of skin cancer developing within skin tags.  There are other skin growths and skin conditions which are similar in appearance to skin tags, such as seborrheic keratoses and verrucae, and a trained dermatologist is needed to determine the difference.  Any new skin growth or lesion when removed should be sent to a laboratory for further histologic examination and diagnosis.

If you’re concerned about a new growth or have skin tags which need removal, please don’t hesitate to contact us online today or call 212-535-3088. Dr. Michele S. Green, a board certified NYC dermatologist, can diagnose the issue and see what type of treatment will work best for you.

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