Skin tags aren't just friction. If clusters are forming, insulin resistance may be the cause. 4 clinical factors explained — and when to get bloodwork.
By MedFoundationNC.org Editorial Team | Skin Health | Published April 20, 2026
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Skin tags and other skin growths should be evaluated by a qualified healthcare provider or dermatologist before any removal attempt. MedFoundationNC.org is an independent editorial publication — not a medical practice, hospital, or healthcare provider.
What Causes Skin Tags? The Short Answer and the Real Answer
The short answer is friction. Skin rubs against skin or clothing, and a small benign growth forms. That's the explanation most websites give you, and it's not wrong. But it's incomplete in a way that matters — because if friction were the only cause, every person with skin folds would develop skin tags, and they don't.
The real answer involves at least four intersecting biological factors: insulin signaling, mechanical friction, hormonal fluctuation, and genetic predisposition. Understanding which of these factors applies to your situation changes what you do about it — and whether the skin tags you are seeing are likely to keep appearing even after removal.
This article breaks down the clinical evidence behind each cause, explains what distinguishes a skin tag from other growths that look similar, and outlines when a dermatologist visit is necessary rather than optional.
What a Skin Tag Actually Is — At the Cellular Level
Skin tags, known clinically as acrochordons or fibroepithelial polyps, are benign growths composed of a core of loose collagen fibers and blood vessels surrounded by a thin layer of epidermis. They're not tumors. They're not viral growths like warts. They contain no abnormal cells. Under a microscope, the collagen fibers in a skin tag appear loosely arranged and swollen compared to the tightly packed collagen in surrounding skin. Small capillaries run through the center, which is why skin tags can bleed disproportionately when torn or cut — a detail that surprises people who expect such a small growth to be bloodless.
Most skin tags range from 1 to 5 millimeters, though some grow larger. They typically attach to the skin by a narrow stalk called a peduncle, which is what gives them their characteristic hanging appearance. The peduncle is also what makes certain removal methods feasible — ligation (cutting off blood supply at the base) works because the stalk is narrow enough to constrict.
Skin tags are extraordinarily common. Roughly 46 percent of the general population develops at least one during their lifetime, and prevalence increases with age. They appear most frequently in areas where skin experiences repeated friction: the neck, armpits, under the breasts, the groin and inguinal folds, and the eyelids.
The Insulin Connection — The Cause Most People Miss
The single strongest documented association with skin tag formation is insulin resistance. This connection is well-established in dermatological literature and is the reason dermatologists sometimes view a cluster of new skin tags as a clinical clue worth investigating.
Here is the mechanism. Insulin, beyond its role in blood sugar regulation, is a growth factor. When cells become resistant to insulin's metabolic signals, the body compensates by producing more insulin — a state called hyperinsulinemia. Elevated circulating insulin stimulates fibroblast proliferation and epidermal growth factor receptor activity in the skin. The result is accelerated growth of the loose connective tissue that forms skin tags.
This is why skin tags appear more frequently in people with type 2 diabetes, prediabetes, metabolic syndrome, and polycystic ovary syndrome — all conditions characterized by insulin resistance. It is also why a sudden increase in skin tag formation in someone without a prior history can be a signal worth discussing with a physician. Fasting insulin levels and hemoglobin A1C testing can identify whether insulin dysregulation is contributing.
The practical implication: addressing insulin sensitivity through diet modification, physical activity, body composition improvement, and — where indicated — medical intervention may slow or reduce new skin tag formation. This doesn't cause existing skin tags to disappear, but it addresses one of the root drivers rather than just the visible symptom.
Friction — The Mechanical Trigger
Chronic mechanical friction is the most visible contributing factor. Skin tags cluster in areas where skin contacts skin or where clothing, jewelry, and accessories create repetitive rubbing: the sides and back of the neck (necklace and collar zones), axillary folds (underarms), inframammary folds (beneath the breasts), inguinal creases (groin), and the inner thighs.
Friction alone does not create skin tags in everyone. But in a person whose insulin levels or genetic predisposition have already primed the skin for excess connective tissue growth, friction provides the localized trigger. Think of it as the match, not the fuel. The metabolic environment provides the fuel.
That's also why weight gain increases skin tag prevalence through two pathways simultaneously: it increases skin fold friction, and it worsens insulin resistance. The two factors compound each other.
Hormonal Factors — Pregnancy, Menopause, and Beyond
Skin tags frequently appear or multiply during pregnancy, particularly during the second and third trimesters. The hormonal shifts involved — elevated estrogen, progesterone, and human placental lactogen — create an environment of increased growth factor activity in the skin. Many pregnancy-related skin tags resolve partially after delivery as hormone levels normalize, though some persist.
Menopause and perimenopause represent another window of increased skin tag formation. Shifting estrogen and progesterone levels, combined with the metabolic changes that often accompany this life stage (increased central adiposity, declining insulin sensitivity), create conditions that favor acrochordon development.
Hormonal conditions beyond pregnancy and menopause also correlate with skin tag frequency. Acromegaly, a condition involving excess growth hormone production, is associated with widespread skin tag development — to the point where multiple large skin tags can serve as a clinical sign prompting endocrine evaluation.
Genetic Predisposition — The Family Pattern
Skin tag tendency runs in families. If your parents developed multiple skin tags, your probability of developing them increases independently of your metabolic status or body composition. The genetic component likely involves inherited variations in collagen production pathways and fibroblast growth factor receptor sensitivity that predispose certain skin to forming excess connective tissue in response to friction and growth factor stimulation.
Research has also identified a possible connection to the HLA-DRB1 gene, which is involved in immune system regulation. This does not mean skin tags are an immune condition — it suggests that the genetic factors involved in tissue growth regulation overlap with immune-related genes in ways researchers are still mapping.
Are Skin Tags Caused by HPV?
Some early studies suggested a link between human papillomavirus (HPV) and skin tags after detecting HPV DNA in a small percentage of biopsied specimens. However, subsequent larger studies have produced inconsistent results, and the majority of dermatologists do not consider HPV a primary or significant cause of common skin tags.
Skin tags are not warts. Warts are caused by HPV infection and have a distinctly different cellular structure — they show epidermal hyperplasia (thickened skin layers), koilocytosis (specific viral cell changes), and prominent blood vessel patterns visible as black dots. Skin tags show none of these features. If a growth has a rough, cauliflower-like texture or contains dark pinpoint spots, it is more likely a wart than a skin tag and warrants professional evaluation.
Why Do I Suddenly Have So Many Skin Tags?
A rapid increase in skin tag development is worth paying attention to. In most cases, the explanation is metabolic: rising insulin levels driven by weight gain, dietary changes, decreased physical activity, or the onset of prediabetes. In women, it may correlate with pregnancy, perimenopause, or polycystic ovary syndrome.
In rare cases, a sudden eruption of numerous skin tags — sometimes called the sign of Leser-Trélat — can be associated with an internal malignancy, particularly gastrointestinal cancers. This is uncommon, and the Leser-Trélat sign more typically involves seborrheic keratoses (a different type of benign growth) rather than true skin tags. However, the dermatological literature documents cases of both. A sudden burst of new skin growths of any type warrants a dermatologist evaluation.
If you are noticing more skin tags than usual, these are reasonable steps before considering any removal approach. Request bloodwork: fasting insulin, fasting glucose, hemoglobin A1C, and a thyroid panel. These tests can identify whether a metabolic driver is present. Addressing the driver — through lifestyle changes or medical management — is more productive long-term than repeatedly removing growths while the underlying cause continues producing new ones.
Can Losing Weight Stop Skin Tags From Forming?
Weight loss can reduce new skin tag formation through two mechanisms: it improves insulin sensitivity (reducing the growth factor stimulus) and reduces skin fold friction (removing the mechanical trigger). Both effects are well-supported in clinical literature.
What weight loss does not do is cause existing skin tags to disappear. Once a skin tag has formed, it is a physical structure of collagen and blood vessels that requires removal — it does not reabsorb. The value of addressing body composition is preventive, not curative.
For individuals whose skin tags correlate primarily with friction (athletes, people who wear tight collars or heavy necklaces, individuals with redundant skin folds after significant weight change), reducing the friction source can also slow new formation. Moisture-wicking fabrics, anti-chafing products, and properly fitted clothing address the mechanical component.
When a Skin Tag Is Not Actually a Skin Tag
This is the section that matters most from a safety perspective. Several other skin conditions can resemble skin tags, and some of them require medical attention.
Seborrheic keratoses are benign growths that can look similar to large skin tags but are structurally different — they are epidermal growths with a waxy, stuck-on appearance. They are harmless but often mistaken for skin tags or moles.
Neurofibromas are soft tumors of nerve tissue that can feel like skin tags but are associated with neurofibromatosis, a genetic condition requiring medical management. Multiple soft, flesh-colored bumps appearing along nerve paths warrant evaluation.
Molluscum contagiosum is a viral skin infection that produces small, dome-shaped bumps that can be mistaken for skin tags in early stages. Unlike skin tags, molluscum lesions are contagious and typically have a central dimple.
Melanoma is rare in this context, but an irregularly colored or rapidly changing growth that is assumed to be a skin tag could, in uncommon cases, be a melanocytic lesion requiring biopsy. This is the primary reason dermatologists advise against self-removing any skin growth without professional evaluation — even if it looks clearly benign to you. A visual exam by a trained clinician takes minutes and can distinguish a harmless acrochordon from something that requires further testing.
The ABCDEs of concerning features: Asymmetry, irregular Borders, uneven Color, Diameter greater than 6mm, and Evolution (change over time). Any growth exhibiting these features is not a skin tag and needs a dermatologist.
When Should I See a Dermatologist About a Skin Tag?
See a dermatologist if any of the following apply. The growth changes color — skin tags are typically flesh-colored or slightly darker, and color change is unusual. The growth bleeds spontaneously without being caught or pulled. The growth increases in size rapidly. The growth has an irregular border or feels hard rather than soft. You develop many new growths in a short period. The growth is in a location where you cannot see it clearly (back, scalp) and cannot assess its characteristics yourself.
For growths that are clearly benign skin tags — soft, pedunculated, flesh-colored, stable — professional removal by a dermatologist is still the safest and most effective option. Dermatological removal methods include snip excision (scissors), cryotherapy (liquid nitrogen), and electrocautery (heat). These are quick in-office procedures, typically take less than five minutes, and many are covered by insurance when medically indicated (skin tags causing pain, bleeding, or functional impairment).
For readers evaluating their options, our guides cover how professional and at-home skin tag removal methods compare in 2026, including the safety profile of each approach. We also cover why skin tags keep coming back after removal and what can be done about the recurrence pattern. If you take prescription medications, our medication interaction safety guide covers which removal methods are appropriate for your situation.
Consumers considering at-home topical products should be aware that the FDA has documented 38 injury cases from unapproved skin tag removers, including products containing bloodroot — the same ingredient found in several serums currently marketed online. For a detailed evaluation of one of the most-searched products in this category, see our clinical analysis of Natura Pro Skin Tag Remover.
This content was independently prepared by the MedFoundationNC.org Editorial Team for educational purposes. It does not constitute medical advice or product endorsement. Skin tags and other skin growths should be evaluated by a qualified healthcare provider before any removal attempt. MedFoundationNC.org is an independent editorial publication — not a medical practice, hospital, or healthcare provider.