A 2023 case-control study found that the risk of metabolic syndrome was 11.13 times higher in people with skin tags than in controls. A 2024 study in Pediatric Dermatology found 17.1 percent of children with obesity had skin tags compared to just 1.2 percent of normal-weight children. Skin tags are not just a cosmetic nuisance. They are often a visible warning sign of metabolic dysfunction.
What are skin tags?
Skin tags, medically called acrochordons, are small benign growths that form in friction-prone areas of the skin. They typically range from 1 to 5 mm in size, though they can grow larger (up to 1-2 cm). Skin tags hang from the skin on a thin stalk called a peduncle, are flesh-colored or slightly darker, and have a soft, smooth or slightly wrinkled texture.
Skin tags are extremely common. Roughly 46 percent of adults develop at least one skin tag in their lifetime, with prevalence increasing sharply after age 40. They are not contagious, not cancerous, and almost never become cancerous, but they can be a useful clinical sign of what is happening internally.
The 6 actual causes of skin tags (ranked by impact)
1. Insulin resistance and hyperinsulinemia
This is the most overlooked and most important cause. When your cells become resistant to insulin, your pancreas pumps out more of it to compensate. That elevated insulin activates insulin-like growth factor-1 (IGF-1) receptors in skin cells, which stimulates abnormal growth and proliferation in friction-prone areas.
The evidence is consistent. A 2009 study in the European Journal of Endocrinology found that people with skin tags had significantly higher fasting insulin and HOMA-IR scores than controls. A 2017 paper in the International Journal of Molecular Sciences described skin tags as one of the most reliable cutaneous markers of insulin resistance, alongside acanthosis nigricans (the dark velvety patches at the neck and underarms).
If you have 3 or more skin tags and are not pregnant, ask your doctor for a fasting insulin test, HOMA-IR calculation, and HbA1c. Many people discover prediabetes through this exact pathway.
2. Friction
Skin tags appear where skin rubs against skin or clothing. This is why the most common locations are:
- Neck (45 percent of skin tags) - especially under collars and necklaces
- Armpits (32 percent) - constant skin-on-skin contact during arm movement
- Groin and inner thighs - friction during walking, especially with weight gain
- Under breasts - chronic moisture and skin folds
- Eyelids - rubbing during sleep, makeup application
- Anywhere clothing rubs (waistband, bra straps, watch bands)
Friction alone usually does not cause skin tags. It needs to combine with insulin or hormonal triggers. This is why a thin, metabolically healthy person with the same friction patterns as an insulin-resistant person rarely develops skin tags.
3. Hormonal changes (pregnancy, PCOS, menopause)
Hormonal shifts trigger skin tag formation by changing skin cell growth signals.
Pregnancy: Up to 25 percent of pregnant women develop new skin tags, particularly in the second and third trimesters. They are driven by elevated estrogen, progesterone, and human chorionic gonadotropin. Many fall off or shrink after birth, though some persist.
PCOS: Women with polycystic ovary syndrome have skin tags at significantly higher rates than the general population. The cause is the combination of insulin resistance (present in approximately 70 percent of PCOS cases) and androgen excess. Both stimulate skin cell growth.
Menopause: The hormonal shift of menopause, combined with often-changing weight distribution and reduced skin elasticity, creates new conditions for skin tag formation.
4. Obesity and weight gain
Obesity is one of the strongest predictors of skin tags. The 2024 Pediatric Dermatology cohort study found a 14-fold higher rate of skin tags in children with obesity versus normal-weight peers. Two mechanisms drive this: more skin folds create more friction, and obesity itself drives insulin resistance and inflammation.
The good news: weight loss often reduces the formation of new skin tags within 3-6 months. Existing skin tags may not disappear, but the trend usually reverses.
5. Genetics
If your parents or siblings have multiple skin tags, you are more likely to develop them. The genetic component is not fully mapped, but family history is a strong predictor independent of body weight or insulin status.
Genetics is not destiny here. Even people with strong family histories of skin tags can prevent new ones with metabolic and lifestyle interventions.
6. Aging
Skin loses elasticity with age, and the cumulative effect of decades of friction adds up. Skin tags peak in incidence between ages 50 and 60. After 60, the rate of new skin tag formation slows, but existing ones often persist.
Are skin tags a sign of something serious?
Skin tags themselves are benign. They never become skin cancer. But they can be a clinical sign pointing to underlying conditions worth investigating:
| Pattern | What it might indicate | Recommended action |
|---|---|---|
| 3+ skin tags, not pregnant | Insulin resistance, prediabetes | Fasting insulin, HbA1c, HOMA-IR |
| Skin tags + irregular periods + acne | PCOS | Hormone panel, pelvic ultrasound |
| Skin tags + dark velvety patches | Acanthosis nigricans + insulin resistance | Glucose tolerance test |
| Sudden appearance of many tags | Metabolic shift, possible diabetes onset | Full metabolic workup |
| Skin tag bleeding, growing fast | Possible other skin lesion | See dermatologist for biopsy |
How to prevent new skin tags
Existing skin tags rarely disappear on their own, but you can stop new ones from forming.
Improve insulin sensitivity
This is the highest-leverage prevention strategy because it addresses the root cause for most skin tags. The evidence-backed approach:
- Eat protein at every meal. Aim for 25-30 grams. Protein blunts blood sugar spikes and improves satiety. Eggs, Greek yogurt, fish, chicken, tofu, lentils.
- Cut refined carbs and added sugar. White bread, pastries, sugary drinks, and breakfast cereals are the biggest insulin spikers in most diets.
- Add fiber. Aim for 25-35 grams per day. Vegetables, berries, oats, beans, chia seeds. Fiber slows glucose absorption.
- Walk after meals. A 10-15 minute walk after eating reduces post-meal glucose spikes by 20-30 percent.
- Strength train 2-3 times per week. Muscle is the largest glucose sink in the body. More muscle equals better insulin sensitivity.
- Sleep 7-9 hours. Even one night of poor sleep raises insulin resistance the next day by 25 percent or more.
Reduce friction in vulnerable areas
- Wear loose, breathable clothing in friction zones
- Apply zinc oxide or petroleum jelly to areas where skin rubs skin (under breasts, inner thighs)
- Avoid tight necklaces, watch bands, and waistbands
- Keep skin folds clean and dry, especially after exercise
Safe ways to remove existing skin tags
If existing skin tags bother you, all safe removal methods are medical procedures. They take 5-10 minutes in a dermatologist office, with minimal pain and good cosmetic results.
| Method | How it works | Best for |
|---|---|---|
| Cryotherapy | Freezing with liquid nitrogen | Small to medium tags |
| Electrosurgery (cautery) | Burning with electric current | All sizes, minimal scarring |
| Surgical excision | Cutting with scissors or scalpel | Larger tags |
| Ligation | Tying off the blood supply | Stalked tags |
Avoid these home removal methods
Home removal of skin tags causes infection, scarring, and bleeding without addressing the underlying cause. Methods to avoid:
- Tying with floss or thread. High infection risk, painful, often incomplete
- Cutting with scissors or nail clippers. Bleeding, scarring, infection
- Apple cider vinegar. Causes chemical burns to surrounding skin
- Tea tree oil. No good evidence, can cause contact dermatitis
- OTC freeze kits. Designed for warts, can damage surrounding skin
Professional removal typically costs $100-300 per session and is sometimes covered by insurance if the tags cause irritation or bleeding.
When to see a doctor
See your doctor if you notice any of the following:
- Multiple new skin tags appearing within a few months (and you are not pregnant)
- A skin tag that has changed color, become darker, or grown rapidly
- A skin tag that bleeds, hurts, or becomes irritated
- Skin tags appearing alongside dark velvety patches at the neck, underarms, or groin
- Skin tags combined with other PCOS symptoms (irregular periods, acne, hair changes)
- Family history of type 2 diabetes plus new skin tags
For metabolic workup, ask your doctor specifically for: fasting insulin, fasting glucose, HbA1c, HOMA-IR (calculated from insulin and glucose), lipid panel, and (if PCOS is suspected) total testosterone, DHEA-S, LH, FSH, and SHBG.
Frequently Asked Questions
What causes skin tags?
Skin tags are caused by a combination of friction (skin rubbing on skin or clothing), insulin resistance (high insulin signals skin cell growth via IGF-1), and hormones (particularly during pregnancy and PCOS). A 2023 case-control study found that the risk of metabolic syndrome was 11.13 times higher in people with skin tags than in controls.
Are skin tags a sign of insulin resistance?
Yes. Multiple studies have established skin tags as a clinical marker for hyperinsulinemia in non-diabetic patients. High insulin activates IGF-1 receptors in skin cells, stimulating growth in friction-prone areas. If you have multiple skin tags, ask your doctor for a fasting insulin test and HOMA-IR calculation.
Are skin tags a sign of diabetes?
Skin tags are strongly associated with type 2 diabetes and prediabetes. They often appear before diabetes is diagnosed because insulin resistance precedes blood sugar elevation by years. A 2024 cohort study found 17.1% of children with obesity had skin tags vs 1.2% of normal-weight children. Get tested with fasting glucose and HbA1c.
Why am I getting skin tags suddenly?
Sudden appearance of multiple skin tags often signals a metabolic shift, most commonly worsening insulin resistance, weight gain, or pregnancy. If you notice 5+ new skin tags within a few months and you are not pregnant, see your doctor for metabolic testing.
Do skin tags mean PCOS?
Skin tags are common in women with PCOS because PCOS involves both insulin resistance (in 70% of cases) and androgen excess. Combined with irregular periods, acne, hirsutism, or weight gain around the midsection, skin tags raise the index of suspicion for PCOS. Diagnosis requires the Rotterdam criteria.
Where do skin tags usually appear?
The most common locations are the neck (45%), armpits (32%), groin and inner thighs, under the breasts, and eyelids. These are all friction zones where skin rubs against skin or clothing.
Can skin tags go away on their own?
Skin tags rarely disappear on their own. Some twist on their stalk and fall off if blood supply is cut off, but most persist indefinitely. Addressing insulin resistance through diet and exercise prevents new skin tags from forming. Weight loss often reduces formation rates within 3-6 months.
How do you remove skin tags safely?
The only safe removal methods are medical: cryotherapy (freezing), electrosurgery (burning), surgical excision (cutting), or ligation (tying off the blood supply). Avoid home removal kits, dental floss tying, or apple cider vinegar. These cause infection, scarring, and bleeding without addressing the underlying cause.
Can diet prevent skin tags?
Yes. A low-glycemic, anti-inflammatory diet can prevent new skin tags by addressing insulin resistance. Focus on protein at every meal, fiber over 25g per day, low-GI carbs, healthy fats, and limiting refined sugar. Strength train 2-3 times per week to improve insulin sensitivity.
Related Articles
- PCOS 101: A Complete Guide to Polycystic Ovary Syndrome
- Best Foods for PCOS-Related Acne
- Can Stress Cause Ovarian Cysts?
- Inositol for Weight Loss
- Take the PCOS Type Quiz
How This Article Was Made
Sources include a 2024 retrospective cohort study in Pediatric Dermatology on acrochordons, obesity, and metabolic syndrome (DOI: 10.1111/pde.15639), a 2023 case-control study from Eastern India on skin tags and metabolic syndrome (PMID: 31312133), a 2017 review in the International Journal of Molecular Sciences on cutaneous manifestations of insulin resistance (PMC5336429), and the StatPearls clinical reference on acrochordons (NBK547724). This article is reviewed periodically and updated with new research.
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