Skin tags: causes, removal and when to see a GP

The NHS says the cause of skin tags is not always known, but they are sometimes caused by skin rubbing against skin. Anyone can get them and they cannot be prevented. You may be more likely to get them if you live with obesity or have skin folds that rub together, if you have type 2 diabetes (because severe insulin resistance is thought to cause more skin tags to grow), or if you are pregnant (because hormonal changes are thought to cause skin tag growth).

Patient's professional reference makes similar points: irritation and chafing, a possible role for insulin resistance, and skin tags being more common in people with type 2 diabetes and obesity, with an apparent association with the metabolic syndrome. A sudden crop of many skin tags is worth mentioning to a GP, who can decide whether any checks are needed.

The NHS lists being pregnant among the things that may make skin tags more likely, because hormonal changes are thought to cause skin tag growth.

The NHS advice is otherwise the same as for anyone else: skin tags do not need to be removed, and you should see a GP if one gets bigger, becomes painful, starts bleeding or develops into lots of skin tags. Do not try to remove one yourself unless a GP recommends it. The sources read do not say whether tags that appear in pregnancy go away afterwards, so ask a GP or midwife if you are unsure.

The NHS describes skin tags as usually the same colour as the surrounding skin or a little darker. They can look as if they are hanging off the skin, and they do not usually hurt. Patient professional guidance describes them as often pedunculated, meaning attached by a narrow stalk, though some are sessile, with a broader base.

The same guidance gives a typical diameter of 0.2 to 0.5 cm, while the NHS gives a wider range of about 2mm to 5cm. Synonyms include acrochordon, soft fibroma and fibroepithelial polyp.

They tend to appear where skin rubs together or there are folds, so the NHS lists the neck, armpits, eyelids, under the breasts and around the bottom.

The NHS says skin tags can be confused with warts or moles but are different. Warts are more common on the hands and feet, and most are firm, raised and rough. Moles are usually on sun-exposed skin, differ in colour from the surrounding skin, and are usually flat and round or oval.

Patient's professional article adds further lookalikes that clinicians consider.

The NHS says to see a GP if a skin tag gets bigger, becomes painful, starts bleeding or develops into lots of skin tags. A tag that rubs on clothing or jewellery and keeps getting irritated is also a common reason people ask about removal.

Patient's professional reference says skin tags do not have malignant potential. A growth that does not look like a typical soft skin tag, or one that changes, is a reason to have it looked at rather than assume it is a tag.

The NHS says skin tags do not need to be removed, but problem ones can be removed using heat, freezing or cutting with a surgical blade or scissors. Once removed, a tag does not usually return.

Patient's article adds detail for clinicians: small tags may be snipped with sharp scissors or tied off with a ligature round the base, needing no anaesthetic if the base is fine and causing little bleeding. Cryotherapy is sometimes used. Larger ones need local anaesthetic and can be removed by shave and cautery, or cutting cautery alone.

The NHS warns that removal can cause scarring or darkening of the skin, called hyperpigmentation, particularly on black or brown skin. These effects are usually temporary but can occasionally be permanent.

The NHS says not to try to remove a skin tag yourself unless a GP recommends it. The risks it names are infection, bleeding and scarring. Removing one yourself also means the growth is not examined by anyone, which matters because other lumps can look similar.

The NHS says removal by a professional can also cause scarring or darkening of the skin (hyperpigmentation), particularly on black or brown skin, so choosing a qualified professional matters. The NHS points to its guidance on choosing a professional to remove a skin tag.

The NHS says you cannot get a skin tag removed on the NHS because it is considered cosmetic, and that you will usually need to pay. Patient guidance likewise says removal for irritation or cosmetic reasons usually has to be done privately.

Private options include GPs with minor surgery skills, dermatology clinics and cosmetic practitioners. It is reasonable to ask about the technique, aftercare, scarring risk and whether any removed tissue will be sent for testing.