Skin tags (acrochordons) and warts (verrucae) are two of the most common benign growths on human skin. These small lesions often look similar, causing confusion when identifying a new bump. While both are harmless, they have fundamentally different origins, appearances, and health implications. Understanding these distinctions is the first step toward determining appropriate care.
Underlying Causes and Contagion Risk
The primary difference between a skin tag and a wart lies in its etiology. Skin tags are non-viral growths, meaning they are not caused by an infectious agent. They form from an overgrown layer of skin (epidermis) containing a core of collagen fibers and blood vessels (fibrovascular core). Their formation is strongly associated with mechanical friction, such as skin rubbing against skin or clothing, which explains their common location in skin folds.
The development of acrochordons is also linked to metabolic and hormonal factors, including insulin resistance, type 2 diabetes, obesity, and hormonal shifts during pregnancy. Because they are not caused by a virus or pathogen, skin tags are not contagious and cannot be spread from person to person or from one part of the body to another. They are essentially an individual response to irritation, genetics, and underlying health conditions.
Warts, conversely, are caused exclusively by infection with the Human Papillomavirus (HPV). The virus enters the skin, often through small cuts, and triggers a rapid, excessive growth of skin cells (keratinocytes). Warts are highly contagious and can spread through direct contact or indirectly by touching contaminated surfaces, such as public shower floors or shared towels.
Warts can spread through autoinoculation, where a person scratches an existing wart and transfers the virus to another area of their body. More than 150 types of HPV exist, responsible for various wart types, including common, plantar, and flat warts. The active virus makes warts an infectious lesion, unlike the inert skin tag.
Distinct Visual Characteristics and Common Locations
Observing the texture and structure provides the most practical way to distinguish a skin tag from a wart. Skin tags are characteristically soft, pliable, and smooth, often resembling a tiny, deflated balloon of tissue. They are typically attached to the skin by a thin stalk, known as a peduncle, allowing the growth to dangle freely.
These small, flesh-colored to slightly hyperpigmented growths are almost always found in areas of high friction, such as the neck, armpits, eyelids, groin, and under the breasts. Skin tags are generally movable and painless unless they become irritated, twisted on their stalk, or snagged. Their size usually ranges from one to five millimeters.
Warts possess a firm, rough, and grainy texture due to the excessive buildup of keratin caused by the viral infection. Common warts often present with a dome-like or cauliflower-like surface, lacking the soft, dangling nature of a skin tag. A defining feature of many warts is the presence of tiny black or dark red dots embedded within the growth, which are actually clotted blood vessels (thrombosed capillaries).
Warts tend to appear on the hands, fingers, knees, and the soles of the feet, areas prone to minor skin trauma that allows HPV to enter. Unlike skin tags, warts are sessile, meaning they are broad-based and firmly rooted in the skin. Plantar warts on the feet can cause pain when walking due to pressure on the firm growth.
Treatment Options and Medical Consultation
The difference in origin dictates distinct approaches to removal and management. Skin tags are generally harmless, and removal is primarily for cosmetic purposes or because they are irritated by friction. Professional removal methods involve destroying the tissue via cauterization (burning), cryotherapy (freezing), or simple surgical excision (snip removal).
Wart treatment focuses on destroying the infected tissue to eliminate the virus and prevent further spread. Over-the-counter options commonly use salicylic acid to slowly peel away the wart layers. Dermatologists may employ stronger cryotherapy, prescription-strength topical medications, or laser treatment for persistent or widespread warts.
It is important to seek professional diagnosis before attempting any removal method, as some growths may resemble warts or skin tags but could be more serious conditions. A medical professional can confirm the growth type, such as by looking for thrombosed capillaries in a wart, to ensure the correct and safest course of action is taken. Self-diagnosis and at-home removal carry risks of bleeding, infection, and scarring.