Skin tags form on the neck primarily because of friction. The neck is one of the body’s most active friction zones, where skin rubs against itself, against collars, and against necklaces dozens of times a minute. This repeated irritation triggers the body to produce extra cells in the skin’s top layers, creating small, soft growths that hang from the surface by a thin stalk. But friction alone doesn’t explain why some people get them and others don’t. Insulin levels, hormones, genetics, and even certain viruses all play a role.
How Friction Triggers Skin Tags
Skin tags form when the body overproduces collagen and grows new blood vessels in response to repeated skin-on-skin contact. Under a microscope, a skin tag shows loosely arranged collagen fibers and dilated capillaries and lymphatic vessels. Think of it as the body’s overzealous repair response to low-grade, constant irritation.
The neck is especially prone because it has natural creases where skin folds over itself, and it moves constantly as you turn your head, look down at your phone, or shift during sleep. Clothing with tight collars, scarves, and chain necklaces add extra rubbing throughout the day. This is why skin tags cluster in predictable spots: the sides of the neck, just below the jawline, and along the nape where shirt collars sit.
The Insulin Connection
Friction explains where skin tags appear, but metabolic health often determines whether they appear at all. High insulin levels are one of the strongest risk factors. When insulin is chronically elevated, it binds to receptors for a related hormone called insulin-like growth factor 1 (IGF-1). That binding kicks off a chain reaction that causes two types of skin cells, keratinocytes and fibroblasts, to multiply faster than normal. The result is excess tissue that bunches into small growths at friction points.
This link is strong enough that researchers now view skin tags as a potential early marker of metabolic problems. A case-control study published in the Journal of Investigative Dermatology found that people with skin tags were three to four times more likely to have metabolic syndrome than people without them. Nearly 39% of skin tag patients in the study met criteria for metabolic syndrome, compared to about 16% of controls. The number of skin tags a person had also correlated with specific measurements: higher waist circumference, higher fasting blood sugar, and higher triglycerides all tracked with a greater number of growths.
This doesn’t mean every person with a skin tag has a metabolic issue. But if you’re noticing a sudden increase in skin tags, particularly on the neck and underarms, it may be worth asking your doctor to check your fasting blood sugar and insulin levels.
Hormonal Changes and Pregnancy
Hormonal shifts can accelerate skin tag formation, which is why many women first notice them during pregnancy. Estrogen and progesterone levels surge throughout pregnancy, and skin cells have estrogen receptors that respond directly to those changes. The combination of increased hormone signaling, weight gain, and greater skin-on-skin contact in areas like the neck creates ideal conditions for new skin tags to appear.
Birth control pills can produce a similar, though milder, effect. Some women notice new skin tags after starting hormonal contraception, driven by the same estrogen-receptor mechanism. Skin tags that develop during pregnancy sometimes shrink or fall off after delivery as hormone levels normalize, though many persist.
Genetics and Family History
Some people are simply more prone to skin tags regardless of their weight or metabolic health. If your close family members have skin tags, your risk is higher. This inherited susceptibility likely involves variations in how your skin cells respond to friction and growth signals, though the specific genes haven’t been fully mapped.
In rare cases, numerous skin tags appearing at a young age can signal a genetic condition called Birt-Hogg-Dubé syndrome, which involves multiple types of benign skin tumors. This is uncommon, but it’s one reason dermatologists pay closer attention to skin tags in children than in adults.
A Possible Viral Factor
There’s growing evidence that certain strains of human papillomavirus (HPV) may contribute to skin tag development. A study published in the Egyptian Journal of Medical Microbiology tested skin tag tissue from 30 patients and found HPV DNA (types 6 and 11, which are low-risk strains) in about 71% of samples. By contrast, only 13% of normal skin samples from the same patients tested positive. The high-risk HPV types linked to cancer (types 16 and 18) were absent from every sample.
The researchers were careful to note that finding viral DNA in a skin tag doesn’t prove the virus caused it. About 29% of skin tags in the study had no detectable HPV at all, suggesting the virus is a contributing factor rather than a necessary one. It may be that HPV, combined with friction and other triggers, tips the balance toward excess cell growth in some people.
Age and Who Gets Them
Skin tags become increasingly common with age. A large study tracking skin tag prevalence across age groups found that about 55% of people in their 40s had at least one skin tag. That number climbed to 59% by the 50s and held steady through the 70s and beyond. They’re rare in children and teenagers but start appearing in the 20s and 30s, with prevalence rising sharply after 40.
The likely reason is cumulative: decades of friction, gradual changes in insulin sensitivity, and the natural slowdown in skin cell turnover that comes with aging all converge to make skin tags more likely over time.
How to Tell Them Apart From Other Growths
Skin tags on the neck can sometimes be confused with warts or moles, but they look and feel distinct. A skin tag is soft, flesh-colored or slightly darker, and hangs from the skin on a narrow stalk. It moves freely when you touch it. Warts, by contrast, are usually rough-textured and flat or dome-shaped, sitting firmly on the skin’s surface rather than dangling. Moles are typically round, darker brown, and embedded in the skin rather than protruding on a stalk. Moles also tend to be flat or only slightly raised, while skin tags are clearly three-dimensional.
Skin tags pose no cancer risk in adults. The American Academy of Family Physicians states plainly that they carry no malignant threat. Pathologic evaluation is unnecessary unless skin tags appear in childhood, where they can occasionally be the first sign of a rare inherited condition. In adults, the only reasons to remove them are cosmetic preference or physical irritation from catching on jewelry or clothing.
Why the Neck Specifically
Nearly every risk factor for skin tags converges at the neck. It’s a high-friction zone with natural skin folds. It’s exposed to constant contact from clothing, jewelry, and hair. It’s one of the first places where weight gain creates new skin-on-skin rubbing. And the skin there is relatively thin and mobile, making it especially responsive to the kind of repetitive, low-level irritation that triggers excess cell growth.
If you’re developing skin tags on your neck, the immediate cause is almost certainly mechanical friction. The more useful question is what’s amplifying that friction’s effect: weight changes, insulin levels, hormonal shifts, or simply the genetic hand you were dealt. Addressing the underlying amplifier, when one exists, can slow the rate at which new skin tags appear.