Skin Tags: Causes, Locations, and Removal Options

You've probably noticed them on yourself or someone else: small, soft growths that hang off the skin, usually flesh-colored or slightly darker, appearing where skin rubs against skin or clothing. They're harmless, they don't hurt, and yet they keep showing up. You might wonder why they form in the first place, whether they signal something deeper, or if that one that's suddenly itchy or irritated is cause for concern.

Key Takeaways

• Skin tags are benign growths made of collagen and blood vessels, not cancerous.
• They form where skin rubs against skin or clothing, driven by friction.
• Multiple skin tags can signal insulin resistance or metabolic syndrome, not just aging.
• An itchy skin tag may indicate irritation or infection, not cancer.
• Milia are firm white cysts filled with keratin; skin tags are soft and hang.
• Hormonal shifts during pregnancy or with PCOS increase skin tag formation.
• Removal is cosmetic unless a tag bleeds, changes, or becomes persistently irritated.

What Skin Tags Actually Are and Where They Start

A skin tag, medically called an acrochordon, is a benign growth that protrudes from the skin's surface. It's composed of collagen fibers, blood vessels, and a thin layer of epidermis. Unlike warts (caused by viral infection) or moles (which involve pigment-producing cells), skin tags are simply extra tissue that forms where the skin experiences repeated friction.

They typically appear in areas where skin folds or rubs:

• The neck, where necklaces and collars create constant contact
• Armpits, where arm movement generates friction
• Groin, where skin-on-skin contact is frequent
• Under the breasts, particularly where bra bands sit
• Eyelids, where blinking creates repetitive motion

The mechanical stress of skin-on-skin contact or clothing rubbing against the skin triggers localized cell proliferation. Over time, this results in a small, pedunculated (stalk-like) growth. Most skin tags are a few millimeters in size, though some can grow larger. They are not contagious and don't spread from person to person. Their appearance is driven by a combination of mechanical friction, genetic predisposition, and metabolic factors.

How Skin Tags Connect to Insulin, Hormones, and Metabolic Health

Skin tags aren't just a byproduct of friction. Research has identified a strong association between multiple skin tags and insulin resistance, the condition in which cells become less responsive to insulin, leading to elevated blood sugar and compensatory hyperinsulinemia. High circulating insulin levels stimulate growth factors, including insulin-like growth factor 1 (IGF-1), which can promote skin cell proliferation.

This connection explains why skin tags are more common in people with type 2 diabetes, prediabetes, and metabolic syndrome. A study published in Metabolic Syndrome and Related Disorders found that individuals with multiple skin tags were more likely to have abnormal lipid profiles, elevated fasting glucose, and increased waist circumference. The presence of numerous skin tags, particularly in younger individuals, may warrant metabolic screening.

Hormonal fluctuations also play a role:

• Pregnancy triggers skin tag formation due to elevated estrogen and progesterone levels combined with weight gain and increased skin friction
• PCOS, characterized by insulin resistance and androgen excess, increases risk significantly
• The hormonal and metabolic overlap between PCOS and skin tag formation is significant enough that dermatologists sometimes consider skin tags a clinical marker worth investigating further

Obesity amplifies these mechanisms. Excess body weight increases skin folds and friction, while adipose tissue itself is metabolically active, secreting hormones like leptin and adiponectin that influence insulin sensitivity and inflammation. The combination of mechanical stress and metabolic dysregulation creates an environment conducive to skin tag development.

What Triggers Skin Tag Formation and Why Some People Get More

Friction is the most direct cause. Skin tags develop where skin rubs against skin or fabric: necklaces irritating the neck, bra straps under the breasts, or skin folds in the armpits and groin. This repeated mechanical stress stimulates localized tissue growth.

But friction alone doesn't explain why some people develop dozens of skin tags while others develop none:

• Genetics play a role (if your parents or siblings have skin tags, you're more likely to develop them)
• Certain genetic variants may predispose individuals to increased collagen production or altered skin cell turnover in response to friction
• Age is another factor (skin tags become more common after age 40 due to cumulative friction exposure, changes in skin elasticity, and age-related metabolic shifts)
• Younger individuals with insulin resistance or obesity may develop skin tags earlier

Human papillomavirus (HPV) has been investigated as a potential contributor, though the evidence remains inconclusive. Some studies have detected HPV DNA in skin tag tissue, but the virus's role in skin tag formation, if any, is not well understood.

Why the Same Condition Looks Different in Different People

Not all skin tags are created equal. Some people develop a single small tag on the neck that remains unchanged for years. Others develop clusters of tags in multiple locations, with new ones appearing regularly. This variation reflects differences in genetics, metabolic health, and environmental exposures.

Several factors influence appearance and frequency:

• Skin type and melanin content (in individuals with darker skin tones, skin tags may appear more pigmented, sometimes mistaken for moles or other growths)
• Post-inflammatory hyperpigmentation can occur if a skin tag becomes irritated or inflamed
• Hormonal baseline matters (women with higher baseline androgen levels, such as those with PCOS, may develop more skin tags than women with typical hormone profiles)
• Men with low testosterone and elevated estrogen may also be at increased risk, though this association is less studied
• Microbiome composition may influence local immune responses and inflammation, affecting skin tag formation rates

When Skin Symptoms Point to Something Systemic

A single skin tag is rarely cause for concern. But multiple skin tags, particularly in someone under 40 or without obvious risk factors like obesity, may signal underlying metabolic dysfunction. Insulin resistance, prediabetes, and metabolic syndrome often present with few overt symptoms in their early stages. Skin tags can be one of the first visible signs.

Skin tags have also been associated with dyslipidemia, particularly elevated triglycerides and low HDL cholesterol. A study in the Journal of Clinical and Aesthetic Dermatology found that individuals with multiple skin tags had significantly higher triglyceride levels and lower HDL levels compared to controls, independent of body mass index.

Cardiovascular risk is another consideration. Metabolic syndrome (which includes insulin resistance, hypertension, dyslipidemia, and abdominal obesity) is a major risk factor for heart disease. Skin tags, as a potential marker of metabolic syndrome, may indirectly signal increased cardiovascular risk. It's worth noting that skin tags themselves are not dangerous. They are benign and do not become cancerous. However, their presence in large numbers or in younger individuals may warrant a deeper metabolic workup, particularly if other symptoms like fatigue, weight gain, or irregular menstrual cycles are present.

Distinguishing Skin Tags from Other Growths

Skin tags are often confused with other skin lesions, particularly milia and warts. Understanding the differences can help you determine whether a growth warrants medical evaluation.

Milia vs skin tag

Milia are small, firm, white or yellowish bumps that form when keratin becomes trapped beneath the skin's surface. Unlike skin tags (which are soft and hang from the skin), milia are hard to the touch and do not have a stalk. They commonly appear on the face, particularly around the eyes, nose, and cheeks. Milia have no opening and cannot be squeezed out like a whitehead. Attempting to extract them at home can cause bruising and scarring. Skin tags, by contrast, are soft, flesh-colored or slightly darker, and typically appear in areas of friction like the neck, armpits, and groin. The distinction between milia vs skin tag is important for determining appropriate treatment approaches.

Skin tag itchy

Most skin tags are asymptomatic. However, if a skin tag becomes itchy or irritated, it's usually due to friction from clothing, jewelry, or repeated rubbing. An itchy skin tag may also indicate inflammation or infection, particularly if the area becomes red, swollen, or tender. In rare cases, a skin tag can become twisted, cutting off its blood supply. This causes the tag to turn dark or black and may result in pain or discomfort. If a skin tag changes color, bleeds, or becomes persistently itchy, it's worth having it evaluated by a dermatologist to rule out other conditions.

Skin tag cancer

Skin tags are benign and do not become cancerous. However, other skin growths can mimic the appearance of a skin tag, including seborrheic keratoses, dermatofibromas, and (in rare cases) skin cancer. Basal cell carcinoma and squamous cell carcinoma can occasionally present as small, flesh-colored growths. Melanoma, the most serious form of skin cancer, typically appears as an irregularly shaped, asymmetrical lesion with color variation, but atypical presentations can occur. If a growth that looks like a skin tag changes rapidly in size, bleeds without trauma, or has an irregular border, it should be examined by a dermatologist. The key difference: skin tags remain stable in size and appearance over time, while cancerous growths tend to evolve. Understanding the relationship between skin tag cancer risk helps clarify when medical evaluation is necessary.

Removal Options and When to Consider Them

Skin tags don't require treatment unless they become irritated, interfere with daily activities, or are cosmetically bothersome. Removal is straightforward and can be performed in a dermatologist's office using several methods:

• Cryotherapy involves freezing the skin tag with liquid nitrogen, causing it to fall off within a few days (quick and effective for small tags)
• Electrocautery uses heat to burn off the skin tag
• Excision involves cutting the tag off with a scalpel or surgical scissors (for larger tags, a local anesthetic may be used to minimize discomfort)

Over-the-counter skin tag removal products, including topical solutions and ligation bands, are available but should be used with caution. Improper use can lead to infection, scarring, or incomplete removal. Attempting to cut off a skin tag at home is not recommended, as it can result in bleeding and infection. If a skin tag becomes irritated, bleeds, or changes in appearance, it's best to have it evaluated before attempting removal. A dermatologist can confirm the diagnosis and recommend the safest removal method.

What Biomarkers Can Tell You When Skin Tags Keep Appearing

If you're developing multiple skin tags, particularly in areas of high friction, it may be worth investigating the metabolic drivers. A comprehensive metabolic panel can surface underlying insulin resistance, dyslipidemia, or early signs of type 2 diabetes.

Key markers to consider include:

• Fasting insulin and fasting glucose to assess insulin resistance
• Hemoglobin A1c for long-term glucose control
• Triglyceride-glucose index, a calculated marker of insulin resistance
• Lipid markers including triglycerides, HDL cholesterol, and apolipoprotein B for cardiovascular risk insight
• High-sensitivity C-reactive protein to indicate systemic inflammation

For women with multiple skin tags and irregular menstrual cycles, testing total testosterone, free testosterone, sex hormone-binding globulin, and LH/FSH ratio can help identify PCOS. Tracking these markers over time, rather than reacting to individual skin tag appearances, provides a clearer picture of metabolic health.

Using Biomarkers to Understand What's Driving Your Skin

Skin tags are common, benign, and usually harmless. But when they appear in clusters or in younger individuals, they can signal metabolic shifts worth investigating. If you're developing multiple skin tags despite maintaining a stable weight and healthy lifestyle, Superpower's biomarker panel can help you identify the hormonal and metabolic drivers behind them. Measuring insulin, glucose, lipids, and inflammatory markers gives you a clearer picture of what's happening beneath the surface, so your next step is based on data, not guesswork.