Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study

BACKGROUND: Skin tags are common benign skin tumors usually occurring on the neck and major flexors of older people. A possible association with impaired carbohydrate metabolism has been suggested in previous studies, but the results are not conclusive. OBJECTIVE: To investigate and compare the prevalence of diabetes and impaired glucose tolerance (IGT) in patients with skin tag and a control group. PATIENTS AND METHODS: A case-control study was conducted in individuals over 15 years old, comparing cases (n = 104) with at least three skin tags and age-, sex-, and body mass index (BMI)-matched controls (n = 94) without skin tag. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. All patients underwent a standard 2-h oral glucose tolerance test with 75 g glucose. RESULTS: Patients with skin tag had higher frequency of diabetes than the control group (23.07% vs. 8.51%, chi(2)-test, P = 0.005). The difference in the frequency of IGT was not significant (13.46% vs. 10.63%, chi(2)-test, P = 0.543). There was a positive correlation between the total number of skin tags and the mean fasting plasma glucose (Pearson correlation, r = 0.260, P = 0.031); patients with more than 30 skin tags were particularly at an increased risk of diabetes (52.0%). No correlation was found between the number of skin tags and BMI. We did not find any correlation between the anatomical localization of skin tags and impaired carbohydrate metabolism, except for skin tags under the breast in women. CONCLUSION: These results show an increased risk of diabetes mellitus in patients with multiple skin tags. With regard to the importance of early diagnosis of diabetes, we recommend a high level of suspicion for impaired carbohydrate metabolism in patients with skin tag.     

Assessment of serum leptin,insulin resistance and metabolic syndrome in patients with skin tags

Background Skin tags are common cutaneous lesions with an indefinite aetiology. Objectives To assess serum leptin, insulin resistance and metabolic syndrome in different body mass index (BMI) patients with skin tags. Methods Three equally distributed groups of patients with multiple skin tags: 30 normal BMI, 30 overweight and 30 obese were included. Controls were age‐, gender‐ and BMI‐matched healthy subjects. Serum leptin, insulin resistance based on homeostasis model assessment of insulin resistance (HOMA‐IR) and metabolic syndrome were assessed in all groups. Results Number and extent of skin tags increase with the increase in BMI. Highest leptin levels were found in obese patients, with significant differences when compared to normal BMI and overweight patients. Similar findings existed in controls. Significantly higher leptin levels were found in obese patients compared to obese controls. HOMA‐IR was significantly higher in all groups of patients compared to BMI‐counterpart controls. Seventy‐one per cent of patients fulfilled criteria of metabolic syndrome. Number of skin tags, leptin and HOMA‐IR were significantly higher in patients with metabolic syndrome compared to patients without the syndrome. Positive correlations were found between serum leptin and HOMA‐IR in obese patients and obese controls. Positive correlations were also found between number of skin tags and waist circumference in all groups of patients. Conclusions Serum leptin displays an association with obesity and insulin resistance. Assessment of HOMA‐IR in patients with skin tags may serve as a useful approach for diagnosis of insulin resistance. Waist circumference is the only criteria of metabolic syndrome that correlates with number of skin tags.     

Soft skin fibromas: study of their importance and diagnostic significance for colonic neoplasms

The aims of this study were (a) to examine the association of skin tags and colonic polyps and (b) to identify factors influencing skin tags. Therefore, a consecutive series of 157 medical ward patients with gastrointestinal symptoms who underwent colonoscopy underwent dermatological examination. Skin tags were found in 52% of these patients regardless of sex. (a) There was a statistically significant association between skin tags and colonic polyps (P = 0.33). This association, however, was based solely on an age effect. (b) Influencing factors were weight and age for the number of skin tags and the interaction between sex and the concentration of triglycerides for their size. At any given triglyceride concentration, men had larger skin tags.     

The detection of human papillomavirus DNA in skin tags

Human papillomavirus (HPV) is associated with benign cutaneous or mucosal lesions and with malignant tumours, but none of the HPV types has so far been related to skin tags. Skin biopsy specimens from 49 Caucasian patients suffering from the presence of multiple soft fibromas were analysed by means of dot blot hybridization and by polymerase chain reaction assays aimed at detecting all known HPV types. The results revealed the presence of HPV DNA type 6/11 in 88% of the skin tags examined. This result supports the hypothesis that HPV plays a part in the progression of cutaneous soft fibromas, as previously reported for laryngeal papillomas.     

Cutaneous stigmata associated with insulin resistance and increased cardiovascular risk

Certain cutaneous conditions have been reported to be associated with diabetes mellitus, insulin resistance, and metabolic syndrome. In this novel review paper, the evidence linking various cutaneous phenomena (e.g. skin tags, acanthosis nigricans, ear lobe creases, and xanthelasma) and metabolic syndrome and cardiovascular disease is examined, and explanations for these associations are proposed.     

QUANTITATION OF MAST CELLS AND COLLAGEN FIBERS IN SKIN TAGS

Background:

Skin tags are common benign skin tumors usually occurring on the neck and major flexors of elder people.

Aims:

The aim of this study is to perform quantitation of mast cells and collagen fibers in skin tags and normal skin in diabetics and nondiabetics, to find a possible correlation between mast cells and collagen fibers in the pathogenesis of skin tags.

Methods:

Thirty participants with skin tags were divided into two groups (15 diabetic and 15 nondiabetic). Three biopsies were obtained from one anatomical site: A large skin tag, a small skin tag, and adjacent normal skin. Mast cells stained with Bismarck brown were counted manually in ten different fields of each section with magnification ×1000 and the average count was correlated with the percentage of mean collagen area in five fields done by the image analyzer.

Results:

A statistically significant correlation between mast cell count and percentage of collagen mean area was detected in both studied groups (except in large skin tags of the nondiabetic group).

Conclusion:

The positive correlation between mast cell count and percentage of collagen mean area suggests the critical role of mast cells in the etiogenesis of skin tags through its interaction with fibroblasts.     

Melanin Pigment Uptake Within Paget Cells

Cutaneous leiomyosarcoma typically presents as solitary, well‐circumscribed, firm plaques or nodules. We describe a case of cutaneous leiomyosarcoma clinically presenting as a skin tag on the thigh of a 50‐year‐old male. Histological examination of the lesion revealed a dome‐shaped tumor with interlacing fascicles of smooth muscle with pleomorphism, cellular atypia and multiple mitoses. Malignant tumors may rarely present as a skin tag, and these are most frequently basal cell carcinomas. We are unaware of previously reported leiomyosarcoma clinically presenting as a skin tag. This case suggests that solitary, wide‐based, papilloma‐like lesions or skin tags should be submitted for histologic examination to rule out malignancy.     

DISSEMINATED DERMATOFIBROSIS AND SKIN TAGS WITH MICROSCOPIC CYST FORMATION

SUMMARY.— The case is reported of a woman aged 35 with disseminated dermatofibrosis associated with skin tags, some of which showed microscopic cyst formation. There was no evidence of osteopoikilosis. The patient's mother is said to have similar lesions.     

Friction induced skin tags

Skin tags are common benign neoplasm located predominantly in intertriginous skin. Generally of cosmetic concern, they can be easily treated with cryotherapy, electrodessication or snip-excision. Despite their high incidence data about their etiopathogenesis are scarce in the medical literature. We describe a patient who developed multiple skin tags arranged in a linear fashion suggesting an etiopathogenic role for friction.     

Skin tags: localization and frequencies according to sex and age

The relevant literature does not contain detailed numerical data about skin tags. We found 46% skin tag carriers in 750 unselected persons (25% males and 21% females). The risk of getting skin tags increases with age. The age of 50, however, seems to be a turning point, at which a stagnation of the increase is observed. The majority of the carriers had no more than 3 tags per localization; the most frequent localization was the axilla, followed by the neck. This study supplies objective data for the evaluation of skin tags as markers for colonic polyps and may provide standard values for future studies.     

Surgical pearl: tissue forceps as a simple and effective instrument for treating skin tags

Skin tags are one of the most common, benign, disfiguring tumors on the flexural aspects of the body of advanced aged and obese people, with higher incidences in females. Various treatment modalities have been advocated for the tags. Even a simple, noninvasive and fast cryotechnique requires approximately 1-3 min for a single skin tag. To hasten the treatment of the tags, tissue forceps have been used as an effective, fast, simple instrument. By utilizing the tissue forceps, 37 skin tags at different parts of body have been treated successfully without cosmetic defects or recurrences at the sites.     

Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck

Multiple skin tags appear associated with abnormalities in glucose/insulin metabolism. Clinical and metabolic glucose/insulin characteristics of men with multiple (8 or more) skin tags on the neck were compared with a control group with few or none. Both groups were divided in two subgroups according to normal or abnormal laboratory findings. In the study subgroup with normal laboratory findings the number of skin tags varied from 8–33, whereas in those with abnormal laboratory findings the range was 9–65. Eight or more skin tags were related with statistically significant laboratory glucose/insulin abnormalities: basal hyperinsulinemia (p<0.002), postprandial hyperinsulinemia (p<0.003), and postprandial hyperglycemia (p<0.01). In the multiple skin tag group 77 % had diverse laboratory abnormalities, including insulin resistance, basal hyperinsulinemia, postprandial hyperinsulinemia, glucose intolerance or type 2 diabetes, in contrast with the control group, where only 33 % showed laboratory abnormalities. One‐third of the study group had acanthosis nigricans. Only 15 % of patients with metabolic abnormalities did not show any cutaneous expression of glucose/insulin alterations (9 or more skin tags on the neck, acanthosis nigricans, or waist circumference greater than 95 cm). Multiple skin tags were more sensitive than acanthosis nigricans in identifying those with alterations in the glucose/insulin metabolism (77 vs. 32 % respectively), although less specific (68 vs.100%). Multiple skin tags should raise suspicion of insulin resistance or hyperinsulinemia.     

Skin tags and atherosclerotic risk factors

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty-six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL-cholesterol levels were measured. LDL-cholesterol and VLDL-cholesterol ratios and HOMA-IR and body mass indices were calculated. The mean levels of body mass index, HOMA-IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow-up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.     

Perianal skin tags in a patient with Crohn disease and a subclinical rectal stricture

A 21-year-old female-to-male transgender individual with a history of Crohn disease presented with enlarging perianal papules that initially were misdiagnosed as condyloma acuminatum. A biopsy specimen demonstrated granulomatous inflammation characteristic of Crohn disease. Although the patient's Crohn disease had been quiescent for years, a subsequent evaluation revealed the presence of a rectal stricture that was then dilated. Perianal skin tags with granulomatous inflammation are one of many perianal manifestations of Crohn disease. Increasing numbers or size of these lesions may herald worsening of more proximal Crohn disease, as in our patient. We review the epidemiology, classification, and management of perianal skin tags in patients with Crohn disease.     

What's new in the treatment of actinic keratoses?

The accessory tragus is a relatively common benign congenital anomaly. The tragus is a cartilaginous projection that normally occurs anterior to the external auditory meatus. Although aberrancy of the tragus may occur in isolation and is exclusively derived from the first branchial arch, it may occasionally signal a defect in the first or second branchial arches. Thus it may be a sign of other syndromes, such as oculoauricularvertebral dysplasia (Goldenhar syndrome). In fact, accessory tragus is a constant feature of this syndrome and may be associated with other syndromes. Accessory tragi are polypoid and should be distinguished from acrochordon (skin tags), as the shave excision commonly employed for skin tags may expose cartilage and cause slow healing or chondrodermatitis nodularis chronica helicis.     

Association between acrochordons and colonic polyps

Fifty-four male and female patients with suspected colonic disease were examined for the presence of acrochordons prior to colonoscopy. Thirty-five of these patients (65%) had skin tags and twenty-six (48%) were found to have colonic polyps. In this study patients with acrochordons were significantly (p less than 0.005) more likely to have adenomatous polyps; thus, skin tags may be good markers for the presence of polyps in patients with suspected colonic disease. However, any association between colonic polyps and acrochordons in the general population requires further examination.     

Skin manifestations in acromegaly

Cutaneous changes in acromegaly result from excess GH and IGF-1 action on skin cells and adnexae. Skin puffiness due to dermal glycosaminoglycan accumulation and edema are most prominent in the face, hands and feet. Oily skin with large pores, hypertrichosis, and excessive sweating are common features. Pigmented skin tags, acanthosis nigricans, and psoriasis are also encountered. Alteration in skin capillaries produce increased vasoconstriction. Discerning these changes contributes to early diagnosis and treatment of this high-morbidity disorder. Controlling GH and IGF-1 over-secretion alleviates most cutaneous manifestations of acromegaly; however, regression may be incomplete.     

Molluscum contagiosum may affect primarily the epidermis without involving hair follicles

Lesions of molluscum contagiosum occur on palms and in skin tags. Their origin in places where there are no hair follicles proves that the epidermis itself may be infected by the causative poxvirus. The central umbilications of lesions are therefore not necessarily related to acrotrichia.     

Is there any relation between serum insulin and insulin‐like growth factor‐I in non‐diabetic patients with skin tag?

Background Skin tags are common benign lesion occurring mainly on the neck and major flexures as a small soft pedunculated protrusion. This study evaluate insulin and insulin‐like growth factor‐I (IGF‐I) in non‐diabetic ones. Methods and materials A case–control study was conducted in non‐diabetic persons. Comparing insulin and IGF‐I between matched cases (n = 40) and controls (n = 40) by radioimmunoassay test. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. Results The insulin level in patients with skin tags was significantly higher than controls (P = 0.00) but IGF‐I level was not significantly different (P = 0.43). Conclusion These results show an increased insulin level in non‐diabetics ones and overall importance of insulin effect in pathogenesis of skin tags.