Skin Tag

Skin tags are probably the single most common bump on adult skin.

Skin tags are common, acquired, benign skin-colored growths that resemble small, soft balloons suspended on slender stalks. They are harmless and can range in number from one to hundreds. Men and women are equally prone to developing skin tags. Obesity seems to be associated with skin tag development. Although some skin tags may fall off spontaneously, most persist once formed. The medical name for the skin tag is acrochordon. Some people call them "skin tabs."

Do skin tags get bigger?

While skin tags can grow, they usually do not significantly increase in size over time. Skin tags are made up of excess skin and sometimes collagen fibers, a type of protein fiber. These elements can gradually grow and increase in size. The rate and extent of growth can vary greatly, with factors such as friction, irritation and individual biology affecting the process.

Early on, skin tags may be as small as a flattened pinhead-sized bump. While most tags are typically small (2 mm to 5 mm in diameter) at approximately one-third to one-half the size of a pencil eraser, some may become as large as a big grape (1 cm in diameter) or a fig (5 cm in diameter). It's important to note that not all skin tags enlarge; some may remain stable in size throughout a person's lifetime. If a skin tag suddenly changes in appearance, such as becoming significantly larger, changing color or bleeding, it's essential to consult a healthcare professional.

Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as "skin tabs" or warts.

Why do skin tags form? The precise cause of skin tags is unknown. They become more common with age and occur more frequently in people with a family history of skin tags. People with metabolic disorders, such as obesity and diabetes, are also more likely to develop skin tags.

The exact cause of skin tags is not fully understood, but several factors are believed to contribute to their development, such as:

• Friction and rubbing: Skin tags are more likely to develop where skin rubs against skin, jewelry or clothing. This constant friction can cause the skin to thicken and form a tag-like growth. Areas such as the neck creases, armpits, groin and under the breasts are particularly prone to friction-induced skin tags.
• Skin irritation and inflammation: Conditions such as dermatitis or other skin disorders that cause chronic irritation or inflammation may increase the risk of developing skin tags in affected areas.
• Insulin resistance and obesity: Studies show a significant correlation between increased BMI and the development of skin tags. Obesity is often accompanied by insulin resistance and high insulin levels in the blood, which can promote the growth of skin cells and contribute to the development of skin tags. Also, obesity is associated with changes in hormones, such as estrogen and androgen, which can further influence skin tag formation.
• Hormonal changes: Hormonal fluctuations, particularly during puberty, menstruation, pregnancy and menopause, can affect the skin's elasticity and collagen production. This can lead to skin rubbing and folding more efficiently, creating an environment conducive to skin tag formation. Estrogen and progesterone levels can also influence the activity of skin cells, potentially contributing to the development of skin tags. High levels of androgens, male sex hormones, can contribute to the development of skin tags, especially in women with conditions such as polycystic ovary syndrome (PCOS).
• Genetics: Individuals with a family history of skin tags are more likely to develop them. Genetic factors can influence various aspects of skin health, including the risk of developing benign growths like skin tags.
• Growth hormone disorders: Growth hormone disorders, such as acromegaly, can lead to an increase in insulin-like growth factor 1 (IGF-1) levels, which can cause skin tags to develop, as cells in the affected area multiply at a higher rate. 
• Age: As people age, their skin slows down the production of collagen and elastin, two proteins essential for healthy, youthful skin. The loss of these proteins can increase the risk of skin tags. Skin tags can develop at any age but are more likely to occur in middle-aged and elderly individuals.
• Sun exposure: While less common than other factors, sun exposure may play a role in the development of some skin tags. Ultraviolet (UV) radiation from the sun can damage skin cells and lead to the formation of growths including skin tags.

Skin tags can occur almost anywhere on the body covered by skin. However, the two most common areas are the neck and armpits. Skin tags typically occur in the following locations:

• The base of the neck
• Underarms
• Eyelids
• Groin folds
• Buttock folds
• Under the breasts

Tags are typically thought to occur where the skin rubs against itself or clothing. Plump babies may also develop skin tags in areas where the skin rubs against itself, such as the sides of the neck. Younger children may develop tags at the upper eyelid areas, often in areas where they may rub their eyes. Older children and preteens may develop tags in the underarm area from friction and repetitive skin rubbing from sports.

Are there vaginal skin tags?

Typically, skin tags are not usually seen on the vagina or other moist, mucosal surfaces. However, other types of benign polyps can occur in these areas. Irritation polyps or soft fibromas may occur on vaginal areas, mouth and anal skin. Skin tags most commonly occur on dry skin such as the neck, armpits and groin folds.

Skin tags may sometimes occur on the external genitalia such as the labia majora and labia minora. Sexually transmitted viral conditions such as genital warts may need to be ruled out by tissue biopsy of growths in this area.

Can you get skin tags on the penis and scrotum?

Skin tags may occur at unusual sites such as the penis, scrotum and opening of the penis tip. These growths may be skin tags or may be a result of a sexually transmitted viral condition such as genital warts, caused by the human papillomavirus (HPV), can require a tissue biopsy for diagnosis.

More than half, if not all, of the general population has been reported to have skin tags at some time in their lives. Although tags are generally acquired (not present at birth) and may occur in anyone, they are much more common in middle age and tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags, particularly in the underarm and neck areas. Skin tags are more common in overweight people.

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags. So, skin tags are more frequent in pregnant women. Tags are essentially harmless and do not have to be treated unless they cause discomfort. If bothersome, they may be easily removed during or after pregnancy, typically by a dermatologist.

Although skin tags are generally not associated with any other diseases, there seems to be a group of obese individuals who, along with many skin tags, develop a condition called acanthosis nigricans on the skin of their neck and armpits and are predisposed to have high blood fats and sugar.

Certain structures resemble skin tags but are not. The accessory tragus and an accessory digit occasionally can be confused with skin tags. Pathological examination with a biopsy of the tissue can help distinguish skin tags from these conditions.

Skin tags are a type of harmless skin growth or benign tumor. Tags are generally not cancerous (malignant) and don't become cancerous if left untreated.

There are extremely rare instances where a skin tag may become precancerous or cancerous. Skin tag-like bumps that bleed, grow or display multiple colors such as pink, brown, red or black can require a biopsy to exclude other causes, including skin cancer.

No. There is no evidence to suggest that common skin tags are contagious.

Except for the cosmetic appearance, skin tags generally cause no physical pain or discomfort. These tiny skin growths generally cause symptoms when they are repeatedly irritated (for example, by the collar or in the groin). Cosmetic reasons are the most common reason for skin tag removal.

The following symptoms and signs may necessitate skin tag removal:

• It has become irritated and red from bleeding (hemorrhage) or black from twisting
• Death of the skin tissue (necrosis)

Sometimes, they may become snagged by clothing, jewelry, pets or seat belts, causing pain or discomfort. Occasionally, a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, some tags may occur in less obvious locations.

Other skin growths that may look similar to a skin tag include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts and "barnacles" or the so-called "Rice Krispies" (seborrheic keratoses).

Warts tend to have a "warty" irregular surface, whereas skin tags are usually smooth. Warts tend to be flat unlike tags, which are more like bumps hanging from thin stalks. While warts are almost entirely caused by human papillomavirus (HPV), tags are rarely associated with HPV.

Groin and genital skin lesions resembling skin tags may be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, basal cell carcinoma, squamous cell carcinoma or malignant melanoma may mimic a skin tag, but this is very uncommon.

Laboratory preparation of the tissue is required before looking at the skin tag under a microscope. The skin is stained with a stain called hematoxylin and eosin ("H&E"). Under the microscope, there is a colored spherical tissue attached to a small stalk. The purple outer layer (epidermis) overlies a pink core (dermis).

The outer layer of the skin (the epidermis) shows overgrowth of normal skin (hyperplasia), and it encloses an underlying layer of skin (the dermis), in which the normally present collagen fibers appear abnormally loose and swollen. Usually, there are no hairs, moles or other skin structures present in skin tags.

While the majority of skin tags are simply destroyed, sometimes tissue is sent for a microscopic exam by a health care specialist known as a pathologist. They determine the exact diagnosis and find out whether an abnormality such as skin cancer is present. Irregular skin growths that are larger, bleed or have an unusual presentation may require pathology examination to make sure there are no irregular cells or skin cancers.

Some common skin conditions that can mimic skin tags include seborrheic keratoses, moles, warts, cysts, milia, neurofibromas and nevus lipomatosus. Rarely, skin cancers such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma may mimic skin tags.

Skin tags are usually harmless. But some people may choose to get them removed if cause irritation or for cosmetic reasons. Skin tag removals should be performed by a board-certified dermatologist (skin specialist).

Here are some medical procedures performed by health professionals to remove skin tags:

Cauterization

• Cauterization involves burning the skin tag off using a heated implement, such as a special tool or a small electrical current. The heat destroys the tissue, causing the skin tag to fall off.
• This procedure is relatively quick and may cause minor discomfort. However, there's a risk of scarring or infection if not done properly.
• Cauterization is typically performed by dermatologists or other trained health care professionals.

Cryosurgery

• Cryosurgery, also known as cryotherapy, involves freezing the skin tag using liquid nitrogen or another freezing agent.
• The extreme cold destroys the cells in the skin tag, leading to its eventual removal.
• Cryosurgery is a common and effective method for removing skin tags. It's relatively quick and usually well-tolerated.
• However, there may be some discomfort during the procedure, and temporary redness or blistering of the skin is common afterward.

Ligation

• Ligation, also known as tying off, involves cutting off the blood supply to the skin tag by tying it tightly at the base with a piece of surgical thread or dental floss. This causes the skin tag to eventually wither and fall off.
• Ligation is a simple and relatively painless procedure that can often be done in a doctor's office. However, it may take several days or even weeks for the skin tag to detach completely.

Excision

• Excision involves physically cutting the skin tag off using a sharp tool, such as scissors or a scalpel. Before the procedure, the area is typically numbed with a local anesthetic to minimize discomfort.
• After the skin tag is removed, the wound is usually closed with stitches or left to heal naturally.
• Excision is a quick and effective method for removing skin tags, but it may leave a small scar. This procedure is usually performed by dermatologists or other trained health care professionals.

You should never attempt to remove skin tags yourself at home by cutting them off, as this can lead to infection and bleeding. Always seek professional advice for safe and effective removal.

For skin tag removal, you can consult the following:

• Dermatologists: They are skin health specialists who have the training and expertise to remove skin tags safely and effectively. Skin tags come in various shapes and sizes, and they can be mistaken for warts or skin cancer. Board-certified dermatologists can tell the difference between something minor and something major.
• Other health care professionals: Other healthcare professionals, such as primary care physicians, general practitioners and specially trained nurses may also be able to remove skin tags, but it's essential to ensure that they have the necessary training and experience.
• Estheticians or skin care therapists: Estheticians are skin care professionals who may offer skin tag removal services, but it's crucial to ensure that they are properly trained and have the necessary equipment and expertise.

Over-the-counter (OTC) products for skin tag treatment

• These include topical creams, lotions and solutions that are designed to gradually remove the skin tag over a period.
• Most of these treatments contain ingredients such as salicylic acid or tea tree oil, which work by breaking down the tissue of the skin tag.
• OTC treatments are generally painless and can be applied at home. However, they may take several weeks to show results. These treatments typically require consistent application over several weeks or months.
• However, the effectiveness of these products is not scientifically proven, and they may cause skin irritation or allergic reactions.

Home remedies: These are a popular choice for skin tag removal, but it's essential to note that their effectiveness is not scientifically proven. Some common home remedies include:

• Applying apple cider vinegar or tea tree oil to the skin tag
• Rubbing a banana peel on the skin tag
• Applying vitamin E oil or garlic to the skin tag

These remedies are often recommended because they are noninvasive and can be done at home. However, it's crucial to remember that home remedies may not be effective for everyone, and they can sometimes cause skin irritation or allergic reactions.

Currently, there are no medically approved creams for the removal of skin tags. Skin tags are typically removed by physical methods such as cutting off or tying off with dental floss. It is not advisable to use unapproved products such as Dermasil, wart removers, tea tree oil, nail polish, toothpaste or hair-removal creams like Neet or Nair. Use of unapproved creams may cause irritation and possible secondary complications.

No evidence exists that removing a skin tag will cause more tags to grow. There is no expectation of causing skin tags to "seed" or spread by removing them. In reality, some people are simply more prone to developing skin tags and may have new growths periodically. Some individuals request periodic removal of tags at annual or even quarterly intervals.

Many if not all insurance carriers classify skin tags as cosmetic and therefore a self-pay treatment. In uncommon instances, documented medical necessity of suspicious growths or highly symptomatic growths may support payment for medical skin tag treatment.

Skin tag-like bumps that bleed, grow or appear in multiple colors such as red, pink, brown or black might require a biopsy to rule out other causes, including skin cancer. What’s the procedure for removing moles and skin tags? Most typical small skin tags may be removed without sending tissue for microscopic examination or biopsy.

However, some larger or atypical growths may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is a skin tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination.

Some common skin tag look-alikes include benign lesions such as seborrheic keratoses, common moles, warts, neurofibromas and a fatty mole called nevus lipomatosis. While extremely rare, there are a few reports of skin cancers found in skin tags. Skin cancers such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma may rarely mimic skin tags, as described above.

The long-term results after the destruction of the individual skin tag are excellent. However, it should be understood that this does not prevent the development of new skin tags.

A thrombosed or clotted skin tag may suddenly change colors, becoming purple, black and irritated when its blood supply is inadequate. Thrombosed skin tags typically may fall off on their own in 3 to 10 days and don't require additional treatment.

Skin tags that have changed color or bleed may require your doctor's evaluation and reassurance. Rarely, thrombosed skin tags may be a sign of another condition and need to be biopsied.

No. Skin tags are frequently and inadvertently shaved off while removing hair from the armpit either with a razor or by waxing. There is typically no harm done when small skin tags are removed by shaving.

Sometimes, even a small skin tag base may bleed for a while and require constantly applied pressure for 10-15 minutes to stop bleeding. Skin infection is a rare possible complication of accidentally shaving off skin tags.

No. It is not possible to prevent skin tags.

What's the link between skin tags and insulin resistance?

Skin tag are a common occurrence in individuals with insulin resistance, and their presence is associated with an increased risk of diabetes and other health problems. Early detection of insulin resistance is crucial, as it can play a significant role in primary prevention. Skin tags and acanthosis nigricans can serve as early warning signs of insulin resistance, prompting individuals to make lifestyle changes and seek medical attention

Clinical studies have shown a higher prevalence of skin tags in individuals with insulin resistance, obesity and type 2 diabetes compared to those without these conditions. It's important to note that while there is evidence supporting the association between insulin resistance and skin tags, more research is needed to fully understand the underlying mechanisms. Additionally, not everyone with insulin resistance will develop skin tags and other factors such as genetics and environmental influences may also play a role in their formation.

Can you remove skin tags with liquid nitrogen?

It is possible to remove skin tags with liquid nitrogen. This method is commonly referred to as cryotherapy, and it involves applying a small amount of super-cold liquid nitrogen to the skin tag. 

What are skin tags a warning for?

Skin tags can serve as a warning sign for several underlying health issues, such as:

• Obesity, insulin resistance and diabetes
• High cholesterol
• Hormonal imbalances
• HPV infection
• Aging and collagen production

It is essential to consult a health care professional if skin tags change in size, shape, color or become painful, as they can provide guidance on whether further investigation or treatment is necessary.

What naturally kills skin tags?

Skin tags can become a nuisance or get irritated when they catch on clothing or jewelry. Here are some natural methods to remove skin tags:

• Applying liquid vitamin E directly to the skin
• Applying a few drops of tea tree oil
• Soaking a cotton ball in apple cider vinegar and applying it to the skin tag
• Placing a piece of banana peel over the skin tag and covering it with a bandage overnight
• Applying crushed garlic to the skin tag and covering it overnight
• Applying iodine solution directly to the skin tag

If a skin tag is causing discomfort or bleeding, it's best to seek medical advice for safe and effective removal options.

What removes skin tags instantly?

No method can remove skin tags instantly. The most effective ways to remove skin tags are through professional medical procedures performed by a health care provider, such as excision, cauterization and cryosurgery.