Skin Tags and Metabolic Syndrome

Skin tags are common, benign, unremarkable, and best left alone – but like the Rodney Dangerfield of clinical observations, I think they deserve some respect.

I have come to view skin tags as markers for metabolic syndrome, basically a visible warning system. Also called acrochordons or pedunculated fibromas, these small forgettable protuberances most commonly appear on the upper body in areas subject to friction and moisture (axillary, under the collar, at the bra line), so it’s easy to dismiss them as the body’s response to repeated irritation, and let it go at that.

For example, one case study from Spain entered the medical literature when a woman developed dozens of skin tags, linearly arranged beneath her bra line, after she started a new job that required her to move her arms up and down hundreds of times each day. In that case, the doctors excised the skin tags and sent her on her way, pausing briefly to document the striking visual pattern and the coincidence with her new job. But they had the good sense to raise an important question: “Our patient did not have overt diabetes mellitus, but we cannot exclude impaired carbohydrate metabolism, because we did not perform a glucose tolerance test or insulin level” [emphasis mine]. So there were two red flags in this case: not only was the woman obese, but there is a documented correlation between skin tags and metabolic syndrome or carbohydrate dysmetabolism. She should have been tested when all those skin tags showed up.

In study after study, mostly from Europe and Middle East, skin tags have been shown to be markers for various aspects of the metabolic syndrome: elevated cholesterol and LDL, basal hyperinsulinemia, reactive hypoglycemia, elevated fasting plasma glucose, postprandial hyperglycemia, and overt diabetes mellitus type 2. One study from Turkey was especially striking: 88 of 120 patients with skin tags were found to have diabetes mellitus, and another 10 patients were on their way to diabetes with reactive hypoglycemia or glucose intolerance – an impressive 98 out of 120 patients, all told. Conversely, another study from the Netherlands pointed out that, of the subjects with abnormal lab results, only 15% of them failed to exhibit cutaneous markers (skin tags, acanthosis nigricans, and enlarged waistline). So it’s possible we might be looking at as many as 80% of patients with visible skin tags who also have some degree of metabolic syndrome, up to and including diabetes.

Just to clinch the observation, it seems the number of skin tags is correlated with the severity of the carbohydrate dysmetabolism – the greater the number of skin tags, the greater the probability of abnormal labs and the greater the severity of findings upon deeper investigation. A study from Iran noted that more than 30 skin tags was a marker for full-blown diabetes (52%).

And I saved the worst for last: In a study from the UK, three out of four patients with skin tags plus abnormal lipid profiles turned out to have coronary artery disease. Yikes, now we’ve got skin tags as predictors of heart disease. I’ll say it again; I think that skin tags deserve more respect!

-Dr. Deborah McKay
Naturopathic Physician

http://jcp.bmjjournals.com/cgi/content/abstract/53/11/873
http://www.ncbi.nlm.nih.gov/pubmed/18397315
http://www.e-ijd.org/article.asp?issn=0019-5154;year=2009;volume=54;issue=1;spage=20;epage=22;aulast=Gorpelioglu
http://dermatology.cdlib.org/143/case_presentations/skintags/allegue.html
http://www.ncbi.nlm.nih.gov/pubmed/17988334?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/12120914