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 a small, soft balloon suspended on a slender stalk. Skin tags are harmless growths that can vary in number from one to hundreds. Males and females 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."

Early on, skin tags may be as small as a flattened pinhead-sized bump. While most tags typically are small (2 mm-5 mm in diameter) at approximately one-third to one-half the size of a pencil eraser, some skin tags may become as large as a big grape (1 cm in diameter) or a fig (5 cm in diameter).

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.

The precise cause of skin tags is unknown. Skin tags become more common with age and occur more frequently in people with a family history of skin tags. People with metabolic disorders like obesity and diabetes are also more likely to develop skin tags.

Skin tags can occur almost anywhere on the body covered by skin. However, the two most common areas for skin tags are the neck and armpits. Other common body areas for the development of skin tags include the eyelids, upper chest (particularly under the female breasts), buttock folds, and groin folds. Tags are typically thought to occur where skin rubs against itself or clothing. Plump babies may also develop skin tags in areas where skin rubs against skin, like 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.

Skin tags typically occur in the following characteristic locations:

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

While typical skin tags are not usually seen in the vagina or other moist, mucosal surfaces, other types of benign polyps 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 like the neck, armpits, and groin folds. Genital warts, which are growths caused by the sexually transmitted virus HPV, need to be considered in the possible diagnosis of growths in genital areas.

Skin tags may infrequently occur at the external genitalia like the labia majora and labia minora. Again, sexually transmitted viral conditions like genital warts may need to be ruled out by tissue biopsy of growths in this area.

Skin tags may occur at unusual sites like the penis, scrotum, and opening of the penis tip. Sexually transmitted viral conditions (HPV) like genital warts in the genital area 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, more often they arise in adulthood. They are much more common in middle age, and they 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, as skin tags are more frequent in pregnant women. Tags are essentially harmless and do not have to be treated unless they are bothersome. Bothersome skin tags 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 will help distinguish skin tags if there is any question as to the diagnosis.

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 like 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. Overall, these are very benign growths that have no cancer (malignant) potential.

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 but not 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 whereas tags are more like bumps hanging from thin stalk. 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 the 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, who will determine the exact diagnosis and determine 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 like basal cell carcinoma, squamous cell carcinoma, and malignant melanoma may mimic skin tags.

There are no currently medically approved creams for the removal of skin tags. Skin tags are typically removed by physical methods like cutting off or tying off with dental floss. It is not advisable to use unapproved products like Dermasil, wart removers, tea tree oil, nail polish, toothpaste, or hair-removal creams like Neet or Nair. Trial uses 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 treatment of 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 like 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.