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Skin Tag (Acrochordon)

Soft, pedunculated, benign fibroepithelial polyps of skin attached by narrow stalk; common in middle-aged adults, particularly in skin folds (neck, axilla, groin, eyelids); associated with insulin resistance, obesity, type 2 diabetes, polycystic ovary syndrome, and human papillomavirus.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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What is Skin Tag (Acrochordon)?

Acrochordon (skin tag, fibroepithelial polyp, soft fibroma, papilloma) is a common benign cutaneous lesion presenting as a small, soft, pedunculated polyp attached to the skin surface by a narrow stalk. Prevalence is 25-46 percent of the general adult population, increasing with age — affecting 50 percent of individuals over age 50, and up to 70 percent in obese individuals. Skin tags are equally common in men and women, more common in pregnancy (50 percent of pregnant women develop new skin tags due to hormonal changes).

Etiology and pathogenesis: Multifactorial — friction in skin folds (mechanical trauma to skin), insulin resistance and hyperinsulinemia (insulin-like growth factor IGF-1 promotes keratinocyte proliferation, explains association with type 2 diabetes, obesity, polycystic ovary syndrome PCOS, acanthosis nigricans, metabolic syndrome), genetic predisposition (familial clusters), low-risk human papillomavirus (HPV types 6, 11, 16, 18 detected in some lesions), pregnancy hormones (estrogen, progesterone), and possibly leptin signaling.

Clinical presentation: Small (1-5 mm typically, occasionally up to 1-2 cm — 'fibroepithelial polyp' or 'skin tag' for smaller, 'soft fibroma' for larger), soft, flesh-colored to hyperpigmented (brown), pedunculated polyp attached by narrow stalk; usually multiple, asymptomatic; common locations include neck (collar friction), axilla (clothing friction), groin (skin fold), inframammary fold (breast support), eyelids (rubbing), umbilicus (rare), perianal area (rare); irritation from clothing, jewelry catching, or shaving leads to thrombosis (sudden darkening to black) or hemorrhage; rare in childhood — Birt-Hogg-Dubé syndrome (BHD) presents with multiple skin tags + fibrofolliculomas + renal cancer + lung cysts (autosomal dominant FLCN gene mutation).

Symptoms

Soft, flesh-colored or brown pedunculated growth on skin
Most common in skin folds: neck, axilla, groin, eyelids, inframammary, umbilical
Size 1-5 mm typically, occasionally larger (1-2 cm soft fibroma)
Multiple lesions usually present together
Asymptomatic in most cases
Catches on clothing, jewelry, or during shaving causing irritation
Acute color change to dark/black if thrombosed (twisted on stalk)
Bleeding or pain if traumatized or torn

Risk Factors

Age (more common over 50, increases with age)
Obesity (BMI > 30 increases prevalence to 70 percent)
Type 2 diabetes mellitus and insulin resistance
Metabolic syndrome (central obesity, dyslipidemia, hypertension, insulin resistance)
Polycystic ovary syndrome (PCOS)
Pregnancy (50 percent develop new skin tags)
Acanthosis nigricans
Low-risk HPV infection (types 6, 11)
Family history of skin tags
Birt-Hogg-Dubé syndrome (rare genetic cause, FLCN mutation)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New, rapidly growing skin lesion
  • Color change of existing skin tag (asymmetric, irregular, multicolored)
  • Bleeding, ulceration, or non-healing skin lesion
  • Multiple new skin tags appearing simultaneously (warrants metabolic screening for diabetes, PCOS)
  • Cosmetically distressing skin tags
  • Painful or repeatedly traumatized skin tag
  • Suspicion of melanoma or non-melanoma skin cancer (asymmetric, irregular borders, color variation, diameter > 6 mm, evolving)
  • Birt-Hogg-Dubé syndrome family history (multiple lesions + lung cysts + renal cancer)

Treatment Methods

01
Diagnosis is clinical based on characteristic appearance; dermoscopy shows a pedunculated lesion with normal vascular pattern; biopsy only required if suspicion of seborrheic keratosis (warty surface), neurofibroma (often pendulous, soft), wart (HPV, hyperkeratotic), molluscum contagiosum (umbilicated), or rare basal cell carcinoma (pearly papule with telangiectasia)
02
Metabolic workup if multiple new lesions: fasting glucose and insulin (HOMA-IR > 2.5 = insulin resistance), lipid panel, BMI calculation, blood pressure; diabetes screening with HbA1c if indicated; PCOS evaluation in women with hirsutism, oligomenorrhea, hyperandrogenism (testosterone, DHEA-S, LH/FSH ratio, pelvic ultrasound)
03
Reassurance: skin tags are completely benign and pose no health risk; treatment is for cosmetic, irritation, or persistent trauma reasons; conservative management often appropriate if asymptomatic
04
Removal techniques: 1) Scissor excision — quick, simple, commonly used in clinic; iris scissors for small lesions, no anesthesia needed for very small (< 2 mm), local anesthesia (lidocaine 1 percent injection) for larger; achieve hemostasis with aluminum chloride 20 percent solution, electrocautery, or pressure; 2) Cryotherapy with liquid nitrogen — spray or cotton tip applicator, two freeze-thaw cycles 10-15 seconds each, useful for multiple small lesions, allows treatment without bleeding, healing 7-14 days, hyperpigmentation possible especially in darker skin types; 3) Electrocautery / electrodessication — coagulates and removes lesion, hemostasis in same step, requires local anesthesia, scarring possible; 4) Ligation — tie thin suture or rubber band around stalk causing necrosis, lesion falls off in 7-10 days, useful for very pedunculated lesions
05
Postoperative care: clean wound with mild soap and water, apply petroleum jelly (Vaseline) to keep moist, no need for elaborate dressings, healing in 5-14 days; avoid picking scab; sun protection on healing site to prevent hyperpigmentation; uncommon complications include infection (rare with proper wound care), scarring (minimal with skilled technique), recurrence at same site (5-10 percent), formation of new lesions in same anatomical area (common, related to underlying friction and metabolic factors)
06
Lifestyle modification for prevention of new lesions: weight loss if obese (10 percent reduction can decrease insulin resistance), regular exercise (improves insulin sensitivity), Mediterranean diet (low glycemic index, reduces insulin resistance), management of diabetes (target HbA1c < 7), management of PCOS (metformin for insulin resistance, oral contraceptive pills for hormonal regulation), reduce skin friction (loose-fitting clothing, weight loss reduces skin folds)
07
When to refer: multiple skin tags requiring extensive removal (dermatologist), suspected non-melanoma skin cancer or melanoma (urgent dermatologist), Birt-Hogg-Dubé syndrome family history (genetic testing FLCN, lung CT for cysts, renal ultrasound for cancer screening), recurrent infection after removal (general practitioner or dermatologist)

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.