Skin Tag

Medical Author : Gary W. Cole, MD, FAAD

Medical Editor : William C. Shiel Jr., MD, FACP, FACR

Collage of skin tags on the body, eyelid and back of the neck.

 

Skin tag facts

  • Skin tags are very common but harmless small, soft skin growths.
  • Skin tags tend to occur on the eyelids, neck, armpits, groin folds, and under breasts.
  • One person may have anywhere from one to over 100 skin tags.
  • Almost everyone will develop a skin tag at some point in their life.
  • Middle-aged, obese adults are most prone to skin tags.
  • Obesity is associated with skin tags.
  • Removing a skin tag does not cause more to grow.
  • Some people are just more prone to forming skin tags.
  • Treatments include freezing, tying off with a thread or suture, or cutting off the skin tag.
    A doctor examines skin tags on a woman's neck.

    What is a skin tag?

    Skin tags are common, acquired benign skin growths that look like a small, soft balloons of hanging skin. Skin tags are harmless growths that can vary in number from one to hundreds. Males and females are equally prone to developing skin tags. Obesity is associated with skin tag development. Although some skin tags may fall off spontaneously, most persist once formed. The medical name for skin tag is acrochordon.

    Skin tags are bits of flesh-colored or darkly pigmented tissue that project from the surrounding skin from a small, narrow stalk (pedunculated). Some people call these growths "skin tabs."

    Early on, skin tags may be as small as a flattened pinhead-sized bump. While most tags typically are small (2 mm-5 mm in diameter) at approximately one-third to one-half the size of a pinky fingernail, some skin tags may become as large as a big grape (1 cm in diameter) or a fig (5 cm in diameter).

    Skin tags typically occur in characteristic locations, including the

    • base of the neck,
    • underarms,
    • eyelids,
    • groin folds,
    • buttock folds,
    • under the breasts.
      A3-D illustration shows where skin tags can occur on the body.

      Where do skin tags occur?

      Skin tags can occur almost anywhere on the body covered by skin. However, the two most common areas for skin tags are the neck and armpits. Other common areas for the development of skin tags include the eyelids, upper chest (particularly under the female breasts), buttock folds, and groin folds. Tags are typically thought to occur where skin rubs against itself or clothing. Babies who are plump may also develop skin tags in areas where skin rubs against skin, like the sides of the neck. Younger children may develop tags at the upper eyelid areas, often in areas where they may rub their eyes. Older children and preteens may develop tags in the underarm area from friction and repetitive irritation from sports. 

      Who tends to get skin tags?

      More than half if not all of the general population has been reported to have skin tags at some time in their lives. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age, and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags, particularly in the underarm and neck areas. Skin tags are more common in overweight people.

      Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags are essentially harmless and do not have to be treated unless they are bothersome. Skin tags that are bothersome may be easily removed during or after pregnancy, typically by a dermatologist.

      Although skin tags are generally not associated with any other diseases, there seems to be a group of obese individuals who, along with many skin tags, develop a condition called acanthosis nigricans on the skin of their neck and armpits and are predisposed to have high blood fats and sugar. 

      Will removing a skin tag cause more to grow?

      There is no evidence that removing a skin tag will cause more tags to grow. There is no expectation of causing skin tags to "seed" or spread by removing them. In reality, some people are simply more prone to developing skin tags and may have new growths periodically. Some individuals require periodic removal of tags at annual or even quarterly intervals.

      Is a skin tag a tumor?

      Skin tags are a type of harmless skin growth or tumor, but they are completely benign. Tags are generally not cancerous (malignant) and don't become cancerous if left untreated.

      There are extremely rare instances where a skin tag may become precancerous or cancerous. Skin tag-like bumps that bleed, grow, or display multiple colors like pink, brown, red, or black can require a biopsy to exclude other causes, including skin cancer.

      Are skin tags contagious?

      No. There is not strong evidence to suggest that common skin tags are contagious. Most likely, people do not catch them from anyone and do not transmit them to anyone.

      While warts are caused by a virus called human papillomavirus (HPV) and are known to be very contagious, most skin tags are not thought to be caused by HPV. HPV is associated with the development of warts in all areas of the body covered by skin, including the anal and genital areas.

      What does a skin tag look like under a microscope?

      Laboratory preparation of the tissue is required before looking at the skin tag under the microscope. The skin is stained with a stain called hematoxylin and eosin ("H&E"). Under the microscope, there is a colored spherical tissue attached to a small stalk. The purple outer layer (epidermis) overlies a pink core (dermis).

      The outer layer of the skin (the epidermis) shows overgrowth of normal skin (hyperplasia), and it encloses an underlying layer of skin (the dermis) in which the normally present collagen fibers appear abnormally loose and swollen. Usually there are no hairs, moles, or other skin structures present in skin tags.

      While the majority of skin tags are destroyed, sometimes tissue is sent for microscopic exam by a specialist physician known as a pathologist, who will determine the exact diagnosis and determine whether an abnormality such as skin cancer is present. Irregular skin growths that are larger, bleed, or have an unusual presentation may require pathology examination to make sure there are no irregular cells or skin cancers.

      Some common skin conditions that can mimic skin tags include seborrheic keratoses, moles, warts, cysts, milia, neurofibromas, and nevus lipomatosus. Rarely, skin cancers like basal cell carcinoma, squamous cell carcinoma, and malignant melanoma may mimic skin tags. 

      What problems do skin tags cause?

      Except for the cosmetic appearance, skin tags generally cause no physical pain or discomfort. These tiny skin growths generally cause symptoms when they are repeatedly irritated (for example, by the collar or in the groin). Cosmetic removal for unsightly appearance is perhaps the most common reason they are removed. Occasionally, a tag may require removal because it has become irritated and red from bleeding (hemorrhage) or black from twisting and death of the skin tissue (necrosis). Sometimes, they may become snagged by clothing, jewelry, pets, or seat belts, causing pain or discomfort. Overall, these are very benign growths that have no cancer (malignant) potential.

      Occasionally, a tag may spontaneously fall off without any pain or discomfort. This may occur after the tag has twisted on itself at the stalk base, interrupting the blood flow to the tag.

      How are skin tags treated?

      It is important to keep in mind that skin tags usually do not have to be treated. Deciding not to have treatment is always a reasonable option if the growths are not bothersome. If the tags are bothersome, multiple home and medical treatment options are available:

      • Tie off the tag at its narrow base with a piece of dental floss or string.
      • Freeze the tag with liquid nitrogen.
      • Burn the tag using electric cautery or electro-desiccation.
      • Remove the tag with scissors, with or without anesthetic.

      There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician's office).

      Usually small tags may be removed easily without anesthesia, while larger growths may require some local anesthesia (injected Lidocaine) prior to removal. Application of a topical anesthesia cream (Betacaine cream or LMX 5% cream) prior to the procedure may be desirable in areas where there are a large number of tags.

      Dermatologists (skin specialist doctors), family physicians, and internal medicine physicians are the doctors who treat skin tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

      There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

      The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

      Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

      There is no evidence that removing tags causes more tags to grow. Rather, there are some people who may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

      Does medical insurance cover skin tag removal?

      Many if not all insurance carriers classify skin tags as cosmetic and therefore a self-pay treatment. In uncommon instances, documented medical necessity of suspicious growths or highly symptomatic growths may support payment for medical treatment of skin tags.

      Do any creams remove skin tags?

      There are no currently medically approved creams for the removal of skin tags. Skin tags are typically removed by physical methods like cutting off or tying off with dental floss. It is not advisable to use unapproved products like Dermasil, wart removers, tea tree oil, nail polish, toothpaste, or hair-removal creams like Neet or Nair. Trial uses of unapproved creams may cause irritation and possible secondary complications. 

      Should I worry about cutting my skin tag by shaving?

      No. Skin tags are frequently and inadvertently shaved off while removing hair from the armpit either with a razor or by waxing. There is typically no harm done when small skin tags are removed by shaving.

      Sometimes, even a small skin tag base may bleed for a while and require constant applied pressure for 10-15 minutes to stop bleeding. Skin infection is a rare possible complication of accidentally shaving off skin tags. 

      Do skin tags need to be sent for biopsy?

      Most typical small skin tags may be removed without sending tissue for microscopic examination or biopsy.

      However, there are some larger or atypical growths that may be removed and sent to a pathologist for examination under a microscope to make sure that the tissue is really a skin tag and nothing more. Additionally, skin bumps that have bled or rapidly changed may also need pathologic examination.

      Some common skin tag look-alikes include benign lesions such as seborrheic keratoses, common moles, warts, neurofibromas, and a fatty mole called nevus lipomatosus. While extremely rare, there are a few reports of skin cancers found in skin tags. Skin cancers like basal cell carcinoma, squamous cell carcinoma, and malignant melanoma may rarely mimic skin tags, as described above.

      What else could it be?

      While classic skin tags are typically very characteristic in appearance and occur in specific locations such as the underarms, necks, under breasts, eyelids and groin folds, there are tags that may occur in less obvious locations.

      Other skin growths that may look similar to a skin tag but are not tags include moles (dermal nevus), nerve and fiber-type moles (neurofibromas), warts, and "barnacles" or the so-called "Rice Krispies" (seborrheic keratoses).

      Warts tend to be rougher, with a "warty" irregular surface whereas skin tags are usually smooth. Warts tend to be flat whereas tags are more like bumps hanging from thin stalk. While warts are almost entirely caused by human papillomavirus (HPV), tags are only sometimes associated with HPV.

      Groin and genital lesions resembling skin tags may actually be genital warts or condyloma. A biopsy would help diagnose which of these growths are not skin tags. Very rarely, a basal cell skin or squamous cancer or melanoma may mimic a skin tag, but this is very uncommon.

      Are there vaginal skin tags?

      While typical skin tags are not usually seen in the vagina or in other moist, mucosal surfaces, there are other types of benign polyps that occur in these areas. Irritation polyps or soft fibromas may occur on vaginal areas, mouth, and anal skin. Skin tags most commonly occur on dry skin like the neck, armpits, and groin folds. Genital warts, which are growths caused by a sexually transmitted virus HPV, need to be considered in the possible diagnosis for growths in genital areas.

      Skin tags may infrequently occur at the external genitalia like the labia majora and labia minora. Again, sexually transmitted viral conditions like genital warts may need to be ruled out by tissue biopsy of growths in this area.

      Can you get skin tags on the penis and scrotum?

      Skin tags may occur at unusual sites like the penis, scrotum, and opening of the penis tip. Sexually transmitted viral conditions (HPV) like genital warts in the genital area can require a tissue biopsy for diagnosis.

      What happens when a skin tag suddenly turns purple or black?

      A thrombosed or clotted skin tag may suddenly change colors, becoming purple, black, and irritated when its blood supply is inadequate. Thrombosed skin tags typically may fall off on their own in three to 10 days and don't require additional treatment.

      Skin tags that have changed color or bleed may require your doctor's evaluation and reassurance. Rarely, thrombosed skin tags may be a sign of another condition and need to be biopsied.

      Is there another medical name for a skin tag?

      Medical terms your physician or dermatologist may use to describe a skin tag include fibroepithelial polyp, acrochordon, cutaneous papilloma, and soft fibroma. All of these terms describe skin tags and are benign (noncancerous), painless skin growths. Some people refer to these as "skin tabs" or warts. However, a skin tag is best known as a skin tag.

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