Skin tags are most strongly associated with insulin resistance, obesity, and the cluster of metabolic problems that raise cardiovascular risk. A single small skin tag on your neck or armpit is extremely common and usually harmless, but when they show up in large numbers or keep appearing, research consistently points toward underlying metabolic disturbance as the driver. The connections run deeper than most people realize, extending into hormonal conditions, certain viral infections, and even rare genetic syndromes.
Insulin Resistance and Type 2 Diabetes
The most studied link between skin tags and an underlying health condition is insulin resistance. When your body’s cells stop responding efficiently to insulin, the pancreas compensates by pumping out more of it. That excess insulin doesn’t just affect blood sugar. It also activates growth factor receptors in the skin, spurring the fibroblasts and skin cells that form the fleshy little growths we call skin tags.
One study measuring insulin resistance with the standard HOMA-IR index found that skin tags were directly associated with higher HOMA-IR values, with an odds ratio of 1.4 after adjusting for diabetes, age, gender, and body composition. When the researchers looked at people with markedly elevated HOMA-IR levels above 3.8, the association jumped to an odds ratio of 7.5.1PubMed. Association between skin tags and insulin resistance That’s a strong signal: people with significant insulin resistance were roughly seven and a half times more likely to have skin tags than those with normal insulin sensitivity, regardless of whether they had been diagnosed with diabetes.
The biological explanation centers on insulin-like growth factor 1, or IGF-1. In people with excess circulating insulin, IGF-1 levels rise. IGF-1 stimulates keratinocytes to multiply and causes fibroblasts to proliferate and lay down connective tissue, which are the two main components of a skin tag.2PubMed Central. Role of insulin-like growth factor-1 in skin tags: a clinical, genetic and immunohistochemical study in a sample of Egyptian patients In other words, skin tags may literally be a visible side effect of your body overproducing insulin and its downstream growth signals.
This is why some dermatologists and endocrinologists view multiple skin tags as a potential early warning sign for prediabetes or type 2 diabetes, especially when they appear alongside darkened, velvety skin patches known as acanthosis nigricans. The two conditions share the same underlying metabolic trigger.3PubMed Central. A CLINICAL EVALUATION OF SKIN TAGS IN RELATION TO OBESITY, TYPE 2 DIABETIS MELLITUS, AGE, AND SEX
Obesity and the Role of Body Weight
Obesity and skin tags go hand in hand, and the relationship isn’t just about skin folds rubbing together (though friction does play a role in where they appear). In one study comparing people with skin tags to matched controls, the average BMI in the skin tag group was about 28 compared to about 24 in the control group. Three-quarters of the skin tag group were overweight or obese, while only a quarter had a normal weight.4PubMed Central. The Correlation between Body Mass Index with the Occurrence of Skin Tag
The connection to obesity feeds back into the insulin resistance story. Increased body fat reduces the expression of insulin receptor substrate-1 in cells, which makes them less sensitive to insulin. The pancreas responds by making more insulin, which raises IGF-1 and drives the skin cell proliferation described above.2PubMed Central. Role of insulin-like growth factor-1 in skin tags: a clinical, genetic and immunohistochemical study in a sample of Egyptian patients So while friction from skin folds helps explain why tags cluster in the neck, armpits, and groin, the metabolic consequences of excess weight explain why heavier people develop more of them in the first place.
Research on mast cells in skin tags adds another layer. A study found that obese patients had significantly higher mast cell counts within their skin tags compared to overweight patients, and those mast cell counts correlated with triglyceride levels.5PubMed Central. Skin Tags: A Link Between Lesional Mast Cell Count/Tryptase Expression and Obesity and Dyslipidemia Mast cells are involved in local tissue remodeling and inflammation, suggesting that the inflammatory environment of obesity may contribute to skin tag growth beyond insulin resistance alone.
Metabolic Syndrome and Cardiovascular Risk
Metabolic syndrome is diagnosed when someone has at least three of five risk factors: high waist circumference, high triglycerides, low HDL cholesterol, high blood pressure, and elevated fasting blood sugar. A case-control study from Eastern India found that the risk of having metabolic syndrome was over eleven times higher in people with skin tags compared to controls. The strongest individual associations were with large waist circumference and low HDL cholesterol.6PubMed Central. Association of Skin Tag with Metabolic Syndrome and its Components: A Case–control Study from Eastern India
Another study looking at the metabolic profile of skin tag patients found that they had higher levels of glucose, insulin, triglycerides, LDL cholesterol, uric acid, and free fatty acids compared to controls. That study also detected higher levels of high-sensitivity C-reactive protein, an inflammatory marker tied to cardiovascular risk, leading the authors to suggest that skin tags may be a marker for increased risk of atherosclerosis and cardiovascular disease.7PubMed. The metabolic profile in patients with skin tags Separate research confirmed that the presence of skin tags independently predicted higher C-reactive protein levels even after accounting for other factors like smoking and BMI.8PubMed Central. The Evaluation of the Impact of Age, Skin Tags, Metabolic Syndrome, Body Mass Index, and Smoking on Homocysteine, Endothelin-1, High-sensitive C-reactive Protein, and on the Heart
Additional work has linked skin tags to abnormal levels of leptin, a hormone that regulates appetite and energy balance, as well as to dyslipidemia more broadly.9PubMed Central. Assessment of Various Biochemical Parameters and BMI in Patients with Skin Tags The picture that emerges is that skin tags don’t just correlate with one metabolic abnormality. They tend to show up alongside the full package of conditions that define metabolic syndrome and raise heart disease risk.
Polycystic Ovary Syndrome
In women, skin tags can be a visible marker of polycystic ovary syndrome. PCOS is a hormonal condition characterized by irregular periods, excess androgens, and cysts on the ovaries, and it’s strongly linked to insulin resistance. A study examining cutaneous signs in women with PCOS found skin tags in about 16% of participants, and every single patient who had skin tags was either overweight or obese. Skin tags also correlated with abnormally high luteinizing hormone levels. Women with skin tags were more likely to have four or more PCOS features simultaneously, suggesting the tags appeared alongside more severe forms of the condition.10PubMed Central. Cutaneous manifestation of polycystic ovary syndrome
If you have PCOS and notice skin tags developing, it’s worth viewing them as part of the same metabolic picture rather than a cosmetic coincidence. They reflect the insulin resistance that underlies much of PCOS and may be worth mentioning to your endocrinologist even if a dermatologist would dismiss them as benign.
Pregnancy
Skin tags commonly develop during pregnancy, which can alarm people who’ve read about the metabolic associations. Pregnancy-related skin tags have their own name in medical literature: molluscum fibrosum gravidarum. They tend to appear on the face, neck, chest, armpits, under the breasts, in the groin folds, and on the inner thighs.11International Journal of Women’s Dermatology. Physiologic changes of pregnancy: A review of the literature
The mechanism here is hormonal rather than pathological. Pregnancy naturally raises levels of estrogen, progesterone, and various growth factors, and it increases insulin resistance as a normal physiological adaptation. These hormonal shifts stimulate the same growth pathways that produce skin tags in metabolically unhealthy individuals, but in the context of pregnancy they’re a benign side effect of normal changes. Many pregnancy-related skin tags shrink or fall off after delivery. They’re considered a cosmetic nuisance, not a sign of disease.
Acromegaly
Acromegaly is a rare condition caused by a pituitary tumor that produces too much growth hormone. Since excess growth hormone drives up IGF-1 levels, the same growth factor implicated in metabolic skin tags, skin tags are one of the most common skin findings in people with acromegaly. One study found skin tags in over half of acromegaly patients.12PubMed. Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies The cutaneous changes in acromegaly result from the direct action of excess growth hormone and IGF-1 on skin cells, and skin tags in this context tend to appear alongside other distinctive features like skin thickening, acanthosis nigricans, and excessive sweating.13PubMed. Skin manifestations in acromegaly
Acromegaly is rare enough that a few skin tags on your neck don’t warrant worry about a pituitary tumor. But if skin tags are accompanied by coarsening facial features, enlarging hands or feet, joint pain, or excessive sweating, the combination is worth investigating.
Human Papillomavirus
A question that occasionally surfaces in the research literature is whether HPV plays a role in skin tag formation. Two studies using PCR to test skin tag tissue found HPV DNA, specifically the low-risk types 6 and 11, in a substantial proportion of samples. One found HPV 6/11 DNA in about half of skin tags tested, while surrounding normal skin was negative.14PubMed. Human papillomavirus and skin tags: Is there any association? An earlier study detected HPV DNA type 6/11 in 88% of skin tags examined.15PubMed. The detection of human papillomavirus DNA in skin tags
These are provocative findings, but they haven’t settled the question. HPV types 6 and 11 are the strains that cause genital warts and laryngeal papillomas, which are growths in the throat. Finding their DNA in skin tags suggests these viruses might promote tissue proliferation in ways that contribute to tag formation. But detection rates vary widely between studies, and finding viral DNA in a tissue doesn’t prove the virus caused the growth. HPV could be a passenger rather than a driver. The metabolic and hormonal explanations remain far better established, and no one currently treats skin tags as an HPV-related condition.
The Colon Polyps Debate
In the 1980s, a study of 100 men referred for colonoscopy reported a striking correlation between skin tags and colon polyps. The sensitivity and specificity of skin tags as a marker for adenomatous polyps were both reported as greater than 75%, and the researchers suggested skin tags might help identify patients at higher risk.16PubMed. Skin tags: a cutaneous marker for colonic polyps A second study of 54 patients with suspected colonic disease found a similar result, with patients with skin tags significantly more likely to have adenomatous polyps.17PubMed. Association between acrochordons and colonic polyps
The problem is that both studies examined people who were already being investigated for suspected colon problems, which is a population with a much higher baseline rate of polyps than average. When a later study tested the same hypothesis in a primary care population using flexible sigmoidoscopy, the association disappeared. Among patients with skin tags, about 10% had polyps, compared to about 8% of those without skin tags — not a meaningful difference.18JAMA Internal Medicine. Lack of Association Between Skin Tags and Colon Polyps in a Primary Care Setting
The most likely explanation is that the original finding was driven by shared risk factors: obesity, metabolic syndrome, and older age all raise the risk for both skin tags and colon polyps. In a high-risk referral population, these factors were concentrated enough to create a statistical correlation. In the general population, having skin tags does not mean you need a colonoscopy any sooner than standard screening guidelines recommend.
Aging and Skin Tag Accumulation
Age is one of the strongest predictors of skin tags, independent of metabolic health. One study found a highly significant positive correlation between the number of skin tags and a patient’s age, with a correlation coefficient of 0.71.5PubMed Central. Skin Tags: A Link Between Lesional Mast Cell Count/Tryptase Expression and Obesity and Dyslipidemia Skin tags are rare in children and become increasingly common from middle age onward. By some estimates, roughly half of adults will develop at least one skin tag by age 50.
Part of this is structural. Histological examination of skin tags shows thinned and reduced elastic fibers compared to normal skin.19International Journal of Pathology and Clinical Research. Reduced and Thinned Elastic Fibers in Skin Tag As skin loses elasticity with age, the connective tissue becomes more susceptible to the outpouchings that form skin tags. Cumulative friction exposure over decades of life likely compounds this. But age also brings increased insulin resistance in many people, so it’s difficult to separate the mechanical and metabolic contributions cleanly.
Birt-Hogg-Dubé Syndrome
One uncommon but medically important association worth knowing about is Birt-Hogg-Dubé syndrome, a genetic condition that predisposes people to kidney tumors, lung cysts, and distinctive skin bumps called fibrofolliculomas. Multiple skin tags have been documented in patients with this syndrome, often distributed across the eyelids, neck, armpits, and groin. In one study, 11 patients across three families had multiple skin tags, and eight of those 11 also had the fibrofolliculomas and trichodiscomas characteristic of the syndrome.20JAMA Dermatology. Birt-Hogg-Dubé Syndrome: A Novel Marker of Kidney Neoplasia
Birt-Hogg-Dubé is rare, and a handful of ordinary skin tags absolutely does not suggest it. But when someone develops numerous small skin-colored bumps on the face, ears, and trunk, especially with a family history of kidney cancer or unexplained pneumothorax, the possibility deserves attention. The skin tags in this context are a clue to a genetic condition with serious surveillance implications.
When a Skin Tag Is Not Actually a Skin Tag
The vast majority of skin tags are exactly what they appear to be: benign outgrowths of skin and connective tissue. But rarely, something more concerning can mimic a skin tag’s appearance. Case reports describe basal cell carcinomas presenting as skin tags, and at least one case involved a cutaneous leiomyosarcoma, a type of soft tissue cancer, that clinically looked like a skin tag on a 50-year-old man’s thigh. The lesion was only identified as malignant after it was removed and examined under a microscope.21Journal of Cutaneous Pathology. Cutaneous Leiomyosarcoma Resembling a Skin Tag
This doesn’t mean every skin tag needs a biopsy. But a solitary growth that is wide-based rather than on a narrow stalk, that changes color or grows quickly, that bleeds without trauma, or that feels firm or hard rather than soft and floppy warrants a trip to a dermatologist. The authors of the leiomyosarcoma case recommended that solitary, wide-based, papilloma-like lesions should be submitted for histological examination to rule out malignancy.
Removal Options
Since skin tags are benign, removal is elective and driven by cosmetic preference or physical irritation from clothing and jewelry. The most common clinical method remains scissor snip excision: the doctor numbs the area and cuts the tag off at its base. A randomized trial comparing scissor excision to a 532-nanometer laser found that scissor removal had a higher healing rate at 12 weeks (85% vs. 71%), lower average pain scores, and was preferred by about two-thirds of patients for future treatments.22PubMed. Removal of skin tags: scissor excision versus non-ablative 532nm-LBO-laser in a randomized intraindividual controlled observer-blinded clinical trial Laser treatment was faster and bloodless, but it left behind a dried remnant that took up to three weeks to fall off and caused more pigmentation changes.
After snipping, doctors typically apply a chemical cautery agent to stop bleeding. A comparison of three common agents found that aluminum chloride and ferric subsulfate caused significantly less pain on application than silver nitrate, while all three stopped bleeding equally fast. Silver nitrate also caused pigmentation changes in half of patients, more than the other two options.23PubMed Central. A Comparison of Ferric Subsulfate Solution, Silver Nitrate, and Aluminum Chloride for Pain Assessment, Time to Hemostasis, and Cosmesis in Acrochordon Snip Excision
Over-the-counter cryogenic devices are also available. One clinical trial found that a home cryotherapy device cleared about 64% of treated skin tags completely, with half disappearing after a single application.24PubMed Central. Efficacy Evaluation of the Pixie(®) Skin Tag Cryogenic Device on Skin Tags in a Prospective, Single-Blinded, Randomized, Comparative Clinical Trial That’s decent for an at-home option, but it also means a third or more of tags may persist and require a second treatment or a visit to the doctor. If you have numerous skin tags, removal addresses the symptom but not the underlying metabolic conditions that produced them. Treating insulin resistance, losing weight, or managing lipid levels won’t make existing skin tags fall off, but may slow the appearance of new ones.
Quality of Life and When to Seek Testing
Despite their associations with serious metabolic conditions, skin tags themselves don’t tend to cause significant distress. A quality-of-life study using the Skindex-29 questionnaire found that 76% of skin tag patients scored in the lowest-impact category, and none of the participants showed truly impaired quality of life.25The Sumatera Medical Journal. QUALITY OF LIFE ASSESSMENT IN SKIN TAG PATIENTS Most people view them as a minor nuisance rather than a source of suffering.
Still, the metabolic signals they carry are worth paying attention to. If you notice a sudden increase in skin tags, especially if you’re also carrying extra weight around your midsection, it’s reasonable to ask your doctor to check your fasting glucose, insulin levels, and a basic lipid panel. You’re not treating the skin tags at that point. You’re using them as a prompt to look for conditions like prediabetes and dyslipidemia that benefit enormously from early intervention. The skin tags themselves are harmless; what they sometimes point to is not.