An acrochordon is a small, soft, benign growth that hangs from the skin by a thin stalk, better known to most people as a skin tag. They are among the most common skin lesions in adults, appearing most often on the neck, armpits, groin folds, and eyelids. Although acrochordons are harmless and painless on their own, research over the past two decades has revealed that they can serve as visible markers for underlying metabolic problems, particularly insulin resistance and its associated conditions.
What an Acrochordon Looks Like Under the Skin
To the naked eye, acrochordons are flesh-colored or slightly darker nubs that dangle from a narrow base. They range from a couple of millimeters to a centimeter or so, though occasionally larger. Under a microscope, the picture is consistent: a core of loose connective tissue wrapped in a layer of skin. That covering tends to show thickened outer layers and sometimes a bumpy, papillated surface.1Tanta Medical Journal. Evaluation of the role of mast cell tryptase in the pathogenesis of skin tags The connective tissue core contains collagen and blood vessels, along with mild inflammatory cells clustered around those vessels.
One consistent microscopic finding is that the elastic fibers inside acrochordons are thinner and fewer than in normal skin. A study examining 30 excised skin tags found moderate to marked thinning of elastic fibers in every specimen, with most also showing a reduced number of those fibers compared to surrounding healthy tissue.2International Journal of Pathology and Clinical Research. Reduced and Thinned Elastic Fibers in Skin Tag That degradation of elastic fibers likely contributes to the characteristic softness and droopiness of these growths.
Friction as a Trigger
The sites where acrochordons cluster most often share a common feature: skin rubs against skin or against clothing. The neck, armpits, groin, and under the breasts are all areas of chronic low-grade friction, which has long been suspected as a contributing cause. A case report described a patient who developed multiple skin tags arranged in a straight line along a friction zone, directly implicating mechanical irritation as a trigger.3PubMed. Friction induced skin tags This fits with the clinical observation that people who carry more body weight, and therefore have more skin-fold contact, tend to develop more skin tags. Friction alone does not fully explain the picture, though. Many people experience friction in these areas without ever developing acrochordons, which points to other factors working alongside mechanical irritation.
The Insulin Resistance Connection
The most clinically meaningful association with acrochordons is insulin resistance, a state where the body’s cells respond poorly to insulin and the pancreas compensates by producing more of it. Elevated insulin levels appear to stimulate skin cell growth in ways that produce these lesions. Multiple studies have confirmed the link from different angles.
A study measuring insulin resistance directly found that skin tags were associated with higher HOMA-IR values (a standard measure of how resistant the body is to insulin), independent of whether the person had been diagnosed with diabetes. People with markedly elevated insulin resistance had roughly seven and a half times the odds of having skin tags compared to those with normal insulin sensitivity.4PubMed. Association between skin tags and insulin resistance Separately, people with skin tags were found to have diabetes at nearly three times the rate of controls, and those with more than 30 skin tags had an especially high risk, with over half of that group found to be diabetic.5PubMed. Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study
A broader metabolic profile study found that among people with skin tags, over half were overweight and about a third were obese. Dyslipidemia (abnormal blood fats) appeared in roughly six out of ten patients, and markers of inflammation were elevated compared to controls.6PubMed. The metabolic profile in patients with skin tags The consistency of these findings across different populations has led some dermatologists to treat a cluster of new skin tags as a soft clinical signal worth investigating with basic blood work, especially fasting glucose and a lipid panel.
Skin Tags and Metabolic Syndrome
Metabolic syndrome is the cluster of conditions that frequently travel together: elevated blood sugar, high blood pressure, excess abdominal fat, high triglycerides, and low HDL cholesterol. The relationship between acrochordons and metabolic syndrome goes beyond a loose correlation. One case-control study from India found that people with skin tags were roughly eleven times more likely to meet criteria for metabolic syndrome than people without them.7PubMed Central. Association of Skin Tag with Metabolic Syndrome and its Components: A Case–control Study from Eastern India
When researchers have tried to tease apart which specific metabolic syndrome components matter most for skin tag development, high triglycerides and low HDL cholesterol consistently stand out. A multivariate analysis adjusting for other metabolic factors found that those two lipid abnormalities were the strongest independent predictors.8PubMed. Skin tags, leptin, metabolic syndrome and change of the life style That same study also found significantly higher leptin levels in skin tag patients, connecting the growth of these lesions to the hormonal environment of obesity.
The lipid connection has been noted at a clinical level as well. A report detailing patients with skin tags primarily on the torso, neck, and armpits documented that all exhibited the so-called atherogenic lipid profile: elevated triglycerides alongside low HDL cholesterol, a combination tied to increased cardiovascular risk.9PubMed Central. Skin tags and the atherogenic lipid profile Skin tag patients have also been shown to have higher total cholesterol and LDL cholesterol compared to healthy controls.10PubMed Central. Serum Leptin, Atherogenic Lipids and Glucose Levels in Patients with Skin Tags
None of this means that every person with a few skin tags has a metabolic problem. But someone who develops numerous acrochordons, especially in middle age, may benefit from a metabolic checkup even if they feel fine.
Growth Factors and Why Insulin Is Not the Whole Story
If high insulin were the only driver, you might expect acrochordons to shrink when insulin resistance is brought under control. That often does not happen, which has led researchers to look at growth factors that may act alongside insulin to stimulate the tissue overgrowth. Insulin-like growth factor 1 (IGF-1) has emerged as a key player.
An Egyptian study found that IGF-1 was significantly upregulated in the skin cells and connective tissue of excised acrochordons compared to normal skin. The researchers also identified specific genetic variants in the IGF-1 gene that were more common in skin tag patients and associated with developing multiple lesions.11PubMed Central. Role of insulin-like growth factor-1 in skin tags: a clinical, genetic and immunohistochemical study in a sample of Egyptian patients This suggests a genetic predisposition: some people’s skin responds more aggressively to growth signals, making them more prone to acrochordons even at similar levels of insulin resistance.
The interplay between insulin resistance and IGF-1 was explored in a study of patients with hepatitis C, a condition that affects the liver’s production of IGF-1. Researchers found that when IGF-1 levels were significantly reduced (as commonly happens with chronic liver disease), skin tags were less numerous despite insulin resistance being present, suggesting that insulin resistance alone may not be sufficient to drive their formation without IGF-1’s contribution.12PubMed Central. Skin Tags and Acanthosis Nigricans in Patients with Hepatitis C Infection in Relation to Insulin Resistance and Insulin Like Growth Factor-1 Levels Skin tags also typically persist after insulin resistance is normalized, pointing to the idea that once the tissue overgrowth has occurred, it does not simply reverse when the metabolic trigger improves.
Do Skin Tags Become More Common With Age?
Yes, and the relationship appears to be strong. One study found a highly significant positive correlation between the number of skin tags and the age of patients, describing it as a strong association. Interestingly, the same study found no significant correlation between the number of lesions and body mass index, blood sugar, cholesterol, or triglycerides individually.13PubMed Central. Skin Tags: A Link Between Lesional Mast Cell Count/Tryptase Expression and Obesity and Dyslipidemia This does not contradict the metabolic syndrome findings, as having skin tags at all was still associated with metabolic abnormalities. But within a group of people who already have skin tags, age was the strongest predictor of how many they had. The cumulative exposure to growth signals, friction, and hormonal shifts over a lifetime likely explains why older adults tend to accumulate more acrochordons than younger people.
Skin tags during pregnancy are also well recognized. Hormonal shifts during pregnancy, particularly elevated estrogen, progesterone, and growth hormones, create conditions favorable for skin cell proliferation. Acrochordons that appear during pregnancy sometimes regress after delivery, but not always.14PubMed Central. Cutaneous Changes During Pregnancy: A Comprehensive Review
The HPV Question
For a time, some researchers hypothesized that human papillomavirus (HPV) might play a role in causing skin tags. An early study found HPV DNA (types 6 and 11) in the vast majority of skin tags examined, which generated considerable interest.15PubMed. The detection of human papillomavirus DNA in skin tags However, subsequent research has not consistently replicated this finding. A later study that tested skin tag specimens for a range of HPV subtypes found that all samples were negative, while two samples in the control group (normal skin) actually tested positive for high-risk HPV. No significant relationship between HPV and skin tags was found.16PubMed Central. An Association of Human Papillomaviruses Low Risk and High Risk Subtypes with Skin Tag
The conflicting results may reflect differences in testing methods, contamination risks in early PCR-based studies, or genuine variation between populations. The current weight of evidence leans against HPV playing a significant role, and most dermatologists do not consider skin tags to be viral in origin. They are not contagious, and there is no reason to treat them as if they are.
When a Skin Tag Is Not Really a Skin Tag
The vast majority of acrochordons are exactly what they appear to be: harmless tissue overgrowths. But there are situations where something that looks like a skin tag turns out to be something else. A case series documented patients with what appeared to be typical pedunculated skin tags. Biopsy revealed that the lesions were actually basal cell carcinomas (a type of skin cancer) presenting as part of nevoid basal cell carcinoma syndrome.17PubMed. Acrochordons as a presenting sign of nevoid basal cell carcinoma syndrome This is rare, but it underscores why a skin tag that changes color, bleeds, or looks unusual compared to typical acrochordons deserves a closer look from a dermatologist.
Perianal skin tags occupy a special category. While they sometimes appear for the same friction-related reasons as tags elsewhere, perianal acrochordons in children or young adults can be an early sign of Crohn’s disease. A case report described a 12-year-old girl whose perianal skin tags and growth impairment turned out to be the first signs of otherwise asymptomatic Crohn’s disease.18PubMed Central. Perianal Skin Tags Revealing Asymptomatic Crohn’s Disease in a 12-Year-Old Child With Growth Impairment: A Case Report Gastroenterologists are generally aware of this association, but it is worth knowing that perianal tags in a child are not automatically benign and may warrant further investigation.
Removal Options
Acrochordons do not need to be removed for medical reasons. People seek removal because the tags catch on jewelry or clothing, become irritated, or are cosmetically bothersome. The standard clinical methods include snipping with sterile scissors, freezing with liquid nitrogen (cryotherapy), and burning with an electric current (electrosurgery). All are quick outpatient procedures.
A randomized trial comparing cryotherapy and electrosurgery for skin tags found that both patients and physicians reported significantly higher satisfaction with electrosurgery.19PubMed Central. Evaluation and Comparison of the Efficacy and Safety of Cryotherapy and Electrosurgery in the Treatment of Sebaceous Hyperplasia, Seborrheic Keratosis, Cherry Angioma, and Skin Tag: A Blinded Randomized Clinical Trial A systematic review of cosmetic outcomes across treatment methods found that electrosurgery and laser treatments were consistently associated with better cosmetic results than cryotherapy, which produced higher rates of pigment changes, especially in darker skin tones. Newer approaches such as tissue clamping and pressure patching showed excellent cosmetic outcomes with minimal discomfort and no scarring.20The Innovation Lab Journal. Best Cosmetic Outcomes for Skin Tag Removal: A Systematic Review of Treatment Modalities and Patient-Reported Aesthetic Results
Post-treatment hyperpigmentation and redness were the most commonly reported side effects across all methods. For people with darker skin, choosing a method with lower pigment-change risk matters. Unfortunately, many studies have not consistently reported participants’ skin types, making it harder to give definitive guidance tailored to specific skin tones.
Removing skin tags does not prevent new ones from forming. Because the underlying causes, whether metabolic, hormonal, or friction-related, remain in place, recurrence is common. Addressing the metabolic factors, where present, may slow the development of new lesions, though no study has rigorously tested that assumption.
Skin Tags in Dogs
Humans are not the only species that develops acrochordons. Dogs can develop them too, particularly certain brachycephalic breeds with loose, wrinkled skin. Veterinary dermatologists have described acrochordonous plaques, an unusual presentation of numerous closely spaced skin tags forming a raised patch, in Bulldogs and Pugs. These plaques tended to appear at the back of the neck and showed the same basic structure under a microscope: a fibrous or swollen connective tissue core enclosed by mildly thickened skin.21PubMed. Acrochordonous plaques in two Bulldogs and a Pug dog In dogs, as in humans, acrochordons are considered benign, though the plaque form can look alarming to an owner unfamiliar with it. Breeds with heavy skin folds and chronic friction are most prone, echoing the same mechanical-irritation hypothesis seen in people.
Immunosuppression and Skin Tag Prevalence
People on immunosuppressive medications appear to develop benign skin growths at higher rates. A study of kidney transplant recipients found skin tags in about a third of the patients surveyed.22Wiley Online Library. Prevalence of benign cutaneous disease among Oxford renal transplant recipients Whether this reflects the immunosuppressive drugs themselves, the metabolic changes common in transplant patients (including post-transplant diabetes and weight gain from corticosteroids), or both remains unclear. For transplant recipients, dermatological screening is already routine because of elevated skin cancer risk, and acrochordons in this population are typically noted and monitored alongside more concerning growths.