Acrochordon

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 5, 2017
StartDiseasesAcrochordon

Acrochordons, commonly known as skin tags, are small, soft, benign projections that grow from normal skin. They often are stalked (pedunculated). About half the population has at least one. Acrochordons are most prevalent in older people and those who are obese. Although not a health concern themselves, a proliferation may point to more serious underlying problems. They may also be called cutaneous papilloma, fibroepithelial polyp, soft wart, and soft fibroma.

Contents

Definition & Facts

The name acrochordon comes from the Greek "acros," meaning top or summit, and "chordon," or cord. Acrochordons are classified as neoplasms, or abnormal growths of tissue. An acrochordon has a core of collagen fibers and blood vessels, may contain fat cells, and is covered with normal epidermis (skin).

They range in size from 1 mm to 5 cm (2 inches) but are generally small. They may be the same color as the surrounding skin or darker (hyperpigmentation). The skin beneath them is normal. Skin tags are slightly more likely to occur in women than men, and frequently develop as people age. Close to 60 percent of people over the age of 70 will have skin tags. 

Symptoms & Complaints

Skin tags may develop anywhere but are most common in skin folds, including the eyelids, armpits, groin, and under the breasts. They may also grow on the back and abdomen.

Skin tags may be cosmetically unappealing, especially when they appear on the face, neck, and other exposed skin, but unless they are irritated by clothing, jewelry, shaving, or other skin conditions such as eczema, they are painless and harmless. Most people do not find them bothersome. Very rarely, skin tags may be associated with skin cancer.

Causes

The cause of skin tags is unknown. They may be prompted in part by irritation of the skin, especially in deep skin folds. Other possible factors are hormonal changes such as those during pregnancy, strains of the human papilloma virus (the cause of warts), and genetic factors.

They are more common in people who are obese or have Type II diabetes, but the reason for this is not known. A study at a university teaching hospital found that having many skin tags was a strong indicator of insulin resistance, independent of other risk factors. Another study associated them with obesity, insulin resistance, dyslipidemia, hypertension, and elevated high-sensitive C-reactive protein, which are markers for atherosclerosis and cardiovascular disease.

Skin tags tend to occur in Birt-Hogg-Dubé syndrome, a rare genetic disorder that results in skin tumors and an increased risk of renal and colon cancer. Skin tags may also be associated with acromegaly (gigantism) and rarely with polycystic ovary syndrome.

Diagnosis & Tests

Acrochordons are usually diagnosed by their location, appearance, and feel. Some other skin conditions may look like acrochordons but can be differentiated by location, appearance, texture, and when in life they occur. Viral warts are usually hard and flat or slightly raised. They are most common on the hands and feet. Children are more likely to have warts than adults. Molluscum contagiosum, a viral skin condition usually seen in children ages 1 to 11, produces warty growths that lack the stalk characteristic of skin tags.

Seborrheic keratoses are benign, usually pigmented skin tumors that develop as people age. They are usually flat or slightly elevated, not stalked like an acrochordon. People should know where their skin tags are and what they look like.

If an acrochordon changes in size, shape, or color, or the appearance of the skin beneath it changes, a dermatologist or general practitioner should be consulted. Microscopic examination of an acrochordon sample can rule out basal cell carcinoma or squamous cell carcinoma.

Ticks like to embed themselves in the same parts of the body where skin tags are most common (groin and armpits), and can be very similar in size, shape, and color. In areas where ticks are endemic, people with many skin tags should check themselves carefully after going outdoors so that an attached tick is not mistaken for a skin tag and overlooked.

Conversely, skin tags should not be mistaken for ticks. Yanking off a skin tag under the impression that it is a tick can be painful and lead to infection. Skin tags are soft and flexible; ticks have hard bodies. If in doubt, inspect the object with a magnifying glass or hand lens. A tick will have legs. 

Treatment & Therapy

Once skin tags form, they almost never go away by themselves. Occasionally one may break off on its own or is pulled off by accident. This is not a cause for concern unless the site becomes inflamed. Since skin tags are not caused by viruses, wart remedies are ineffective and may damage the skin.

Skin tags almost never progress to cancer and doctors generally recommend no treatment. Exceptions would occur if an acrochordon is being chafed by clothing such as a collar, is snagging on jewelry such as a necklace, or is on a place such as the eyelid, face, or neck where it is unsightly.

Skin tags on the body may simply be covered by clothing. If removal of a skin tag is desired, the area is first treated with local anesthetic. A dermatologist or general practitioner can remove the acrochordon with cryosurgery (freezing), electrocautery (diathermy), cutting with a scalpel or scissors, or ligation with a string or suture material.

Removing one or more skin tags will not promote the growth of more. Because of the risk of infection or scarring, attempting to remove skin tags at home is not advisable. Some plastic surgeons have harvested the tissue in skin tags for reconstruction of noses and ears.

Prevention & Prophylaxis

Since there is no clear cause of skin tags, there is no protocol for prevention. However, because acrochordons are most common on obese adults and associated with a number of obesity-related health issues, controlling weight and blood sugar levels might help to prevent more acrochordons from forming. A sudden growth of skin tags should be checked by a doctor.