They are most commonly found in the armpits and the neck, while frequent localization is also on the eyelids, the inframammary fold and the groin.
In the majority of cases the total number of lesions is low. In fewer patients the lesions are numerous.
Pathogenesis of skin tags is not known. There are several theories:
- It is argued that chronic skin irritation and friction may have some role in the formation of skin tags, a theory that justifies the increased incidence of these lesions in individuals with increased weight and greater skin folds.
- Another view claims that they are due to aging skin and disturbance in its elasticity.
- Hormonal factors appear to play a role, as they often occur after pregnancy or in cases of acromegaly.
- Other researchers believe that multiple lesions are associated with metabolic disturbances and insulin resistance, and that people with multiple lesions are at increased risk for developing non-insulin dependent diabetes mellitus. In a 2016 study, skin tags were associated with elevated levels of triglycerides and cholesterol in the blood.
- Inheritance does not seem to be a role; however, a family predisposition has been reported in cases with a large number of lesions.
- Some say that they are due to HPV human papillomaviruses. This has not been proven. Oncogenic HPV viruses predominantly cause common warts and condylomas.
Lesions are usually asymptomatic. Patients are often disturbed when they wear jewelry or certain garments. Injury, twisting, removal or thrombosis of the lesions makes them painful.
Skin tags are treated for aesthetic purposes with CO2 laser with excellent results.