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.     

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.     

Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis

BACKGROUND: Eruptive vellus hair cysts are uncommon developmental anomalies of vellus hair follicles that are observed in young patients. Two patients were evaluated for asymptomatic flesh-coloured papules appearing on the chest, abdomen and axillae. Lesions of both patients were diagnosed histologically as eruptive vellus hair cyst, which is a disorder with no standard treatment option. OBJECTIVE: To introduce an alternative treatment and diagnostic technique for eruptive vellus hair cysts and to evaluate this technique's effectiveness histopathologically. MATERIALS AND METHODS: We treated the lesions by using cautery and a standard dissecting forceps under topical anaesthesia. After puncturing the overlying skin in the centre using the sharp-tipped cautery point, we grasped the base of the cyst using a standard dissecting forceps and we extracted the cysts out. In patient 1, extracted cysts were sent for histopathological examination; in patient 2, microscopic examination of the extracted material was performed in potassium hydroxide preparations. RESULTS: Over 150 cysts were extracted with this technique in two patients. The technique was simple, quick and tolerated well. No lesion recurrence was observed after 4 months. On histopathological examination, extracted cysts were observed to have cyst walls. In patient 2, the diagnosis was made within minutes by microscopic examination of the potassium hydroxide preparations of the extracted material. CONCLUSION: Our extraction technique is a simple and effective treatment option for these cysts. It can be regarded as curative since the cyst walls were also extracted. Microscopic examination of the potassium hydroxide preparation of the extracted cysts suggests that this technique can also be used as a simple diagnostic procedure.     

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.     

Nonablative lasers and nonlaser systems in dermatology: current status

Nonablative lasers and nonlaser systems are newer systems used for skin rejuvenation, tightening, body sculpting, and scar remodeling. DEVICES: Different technologies such as lasers, Intense Pulsed Light (IPL), and radiofrequency have been introduced. Most nonablative laser systems emit light within the infrared portion of the electromagnetic spectrum (1000-1500 nm). At these wavelengths, absorption by superficial water containing tissue is relatively weak, thereby effecting deeper tissue penetration. A detailed understanding of the device being used is recommended. INDICATIONS: Nonablative technology have been used for several indications such as skin tightening, periorbital tissue tightening, treatment of nasolabial lines and jowl, body sculpting/remodeling, cellulite reduction, scar revision and remodeling and for the treatment of photodamaged skin. FACILITY: Nonablative laser and light modalities can be carried out in a physician treatment room or hospital setting or a nursing home with a small operation theater. PREOPERATIVE COUNSELING AND INFORMED CONSENT: The dermatologic consultation should include detailed assessment of the patient's skin condition and skin type. An informed consent is mandatory to protect the rights of the patient as well as the practitioner. All patients must have carefully taken preoperative and postoperative pictures. CHOICE OF THE DEVICE AND PARAMETERS: Depends on the indication, the area to be treated, the acceptable downtime for the desired correction, and to an extent the skin color. ANESTHESIA: These lasers are mostly pain-free and tolerated well by patients but may require topical anesthesia. In most cases, topical cooling and numbing using icepacks is sufficient, even in an apprehensive patient. POSTOPERATIVE CARE: The nonablative lasers, light sources and radiofrequency systems are safe, even in darker skin types, and postoperative care is minimal. Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. Postoperative sun avoidance and use of sunscreen is mandatory.     

ZWG-B型系列光子氧辐射液体治疗在皮肤病的应用和护理体会

目的：评价ZWG-B型系列光子氧辐射液体治疗在皮肤病的应用和护理体会。方法：对62例皮肤病患进行光子氧辐射液体治疗，了解其应用和护理方法。结果：该治疗方法操作简单，适合多种皮肤病的辅助治疗。结论：ZWG-B型系列光子氧辐射液体治疗皮肤病方法简单、方便，副作用小。     

特应性皮炎的部位异质性

特应性皮炎（AD）是一种高度异质性皮肤病,以往在年龄、严重度、炎症模式等方面的分型较为成熟,而对不同部位皮损特征的关注较少。最近发现不同部位AD对度普利尤单抗治疗的应答存在差异,表明不同部位皮损可能具有不同的炎症模式。因此本文提出AD部位异质性的概念,结合生理条件下不同部位皮肤的细胞生物学和微生态特点,分析不同部位AD...     

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.     

Pluripotent stem cells as a cellular model for skin: relevance for physiopathology,cell/gene therapy and drug screening

The skin represents the largest tissue in the human body. Its external part, the epidermis, accomplishes vital functions such as barrier protection, thermoregulation and immune function. The mammalian skin epidermis has been for decades the paradigm for studying the molecular events that occur in tissue homeostasis and repair. Many genes and signaling pathways have been identified by the use of manipulated transgenic and KO mice. However, despite numerous elegant transgenic mice experiments, absence of an appropriate in vitro model system has hampered the molecular study of the early events responsible for epidermal and dermal commitments, stages at which congenital genetic alterations are responsible for hundreds of rare skin diseases. For most of them, etiology and treatment are still missing. Here we review the last decade of studies aimed at designing cellular models from pluripotent stem cells (PSC) that recapitulate in vitro the main molecular steps of skin formation. As described below, PSC-based models are powerful tools to (i) clarify early molecular events that occur during epithelial/mesenchymal interactions, (ii) produce in large amount skin cells that could become an alternative for cell/gene therapies and (iii) screen for therapeutic compounds to treat genodermatoses.     

Fractional resurfacing

Fractional resurfacing produces a distinctive thermal damage pattern by creating discrete columns of thermal damage referred to as microthermal treatment zones. It characteristically spares the tissue surrounding each microthermal treatment zone leading to fast epidermal repair. Fractional resurfacing has been successfully used in treating a variety of skin conditions including melasma, dyschromia, lentigenes, wrinkles, and acne scars with minimal downtime. It is safer to use off the face and in darker skin types.     

Rhabdomyomatous mesenchymal hamartoma presenting as a sacral skin tag in two neonates with spinal dysraphism

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital malformation involving the dermis and subcutaneous tissue, of which there were 62 reported cases through 2014. We report RMH in two neonates presenting as a sacral skin tag. In both cases, magnetic resonance imaging (MRI) of the spine showed evidence of spinal dysraphism, including a lipomyelomeningocele and a tethered cord. Surgical repair of the defects was performed. Histopathologic examination of the skin tags showed a haphazard arrangement of mature skeletal muscle fibers and adnexal elements, consistent with RMH. The second patient also had a hemangioma on the sacrum and was diagnosed with LUMBAR (lower body hemangioma and other cutaneous defects, urogenital anomalies/ulceration, myelopathy, bony deformities, anorectal/arterial anomalies, and renal anomalies) syndrome, an association between cutaneous infantile hemangiomas of the lower body and regional congenital anomalies. The apparent association of paraspinal RMH with spinal dysraphism suggests that aberrant migration of mesodermally derived tissues (including skeletal muscle fibers) during neural tube development may be responsible for the pathologic findings in the skin. Additional study of patients with spinal dysraphism and congenital cutaneous lesions may further support this hypothesis.     

Treatment of skin laxity of the lower face and neck in older individuals with a broad-spectrum infrared light device.

BACKGROUND: Non-ablative approaches with infrared and radiofrequency energy sources have been shown to reduce skin laxity, but studies have focused on individuals with early-stage, mild-to-moderate degenerative dermal changes. OBJECTIVE: The purpose of this prospective study was to evaluate the safety and efficacy of an infrared light device for the treatment of skin laxity in patients with soft tissue ptosis of the lower face and neck characteristic of the sixth decade of life and beyond. MATERIALS AND METHODS: Thirteen females, aged 58-83 years old (average: 64 years), were treated with a filtered 1100-1800 nm infrared light-based device. All individuals presented with ptotic soft tissue, but varied in the extent of skin laxity from no visible laxity to having pendulous excess skin. Two treatment sessions were provided at monthly intervals. The individuals returned for follow-up visits at 1, 3 and 6 months after the second treatment. Twelve of the individuals completed the study. RESULTS: Changes were dramatic for those individuals in whom the skin envelope appeared to drape separately from deeper soft tissue. No treatment complications were noted. CONCLUSION: Infrared light source-induced skin tightening may be induced even in older individuals.     

Multiple fibroepithelial basal cell carcinoma of Pinkus associated with seborrheic keratosis in a nevoid distribution

We describe a patient with multiple fibroepithelial basal-cell carcinoma (FEBCC) associated with seborrheic keratosis distributed in a neviform fashion on the left side of the body and clinically resembling 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.     

A simple surgical technique for the treatment of steatocystoma multiplex

BACKGROUND: Since steatocystoma multiplex is an uncommon disorder, its treatment has not been discussed in detail in the textbooks and surgical excision is the most commonly mentioned method. In this article, we describe a very simple surgical technique, which was developed by modifying previous reports. METHODS: A 29-year-old woman, diagnosed clinically and histologically as steatocystoma multiplex, was treated with this modified technique. We punctured the cysts under local anesthesia with a sharp-tipped cautery point and evacuated the contents by squeezing the cyst with a fine forceps. Then, the cyst wall was grasped by the forceps and the sacs were extracted through small holes. More than 50 cysts were treated. RESULTS: The treatment was well tolerated by the patient. No complications developed during or after the procedure. After 14 months follow up no recurrences were observed and the results were cosmetically excellent. CONCLUSIONS: This modified technique is very simple and time saving. Its cosmetic and long-term results are successful. We believe that it must be considered as the treatment of choice for steatocystoma multiplex.     

Dermatological complications of obesity

Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity.     

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.     

Giant skin tags: report of two cases

Skin tags are skin-colored, pedunculated tumors with a smooth surface. Histologically are composed by loose collagen fibers and dilated capillaries. Giant skin tags are reported rarely in the literature. We present the case of two giant skin tags on labium majus. To our knowledge, these are the largest skin tags reported.     

A multicenter study of cellulite treatment with a variable emission radio frequency system

Radio frequency (RF) systems have been reported as producing electrothermally mediated and subcutaneous effects. The present study evaluates a new approach to treat cellulite with a bipolar RF device. The buttocks of 50 patients were treated, 10 from each of five multinational centers with a novel bipolar RF technology set at 6 J/cm³, which changes its frequency between 0.6 and 2.4 MHz according to impedance of tissue. Twelve weekly sessions were given for 12 minutes on each buttock, with a treatment end point of 42°C external skin temperature. Cellulite changes and tissue condition were assessed before and immediately after the first session, before the final 12th session, and 2 months thereafter. The patient Satisfaction Index was recorded. Objective evaluation involved clinical photography, three-dimensional optical skin surface measurement, and histological findings. Almost all patients noted improvement of cellulite and body silhouette at the final session, which slightly decreased at the 2-month assessment. Improved skin appearance was objectively detected. Histological findings following the first session showed reactive edema and lysis of adipocyte membranes, possibly implicated in the final effects achieved. The RF technology used in the present multicenter study improved the general aspect of skin and cellulite, with high patient Satisfaction Index. Maintenance sessions might lead to even better and longer-lasting results.