ArticlePDF Available

Metabolic Associations with Skin Tags

Authors:
  • Treatment.com Inc.

Abstract and Figures

p> Background: Skin tags are small, soft, pedunculated, often pigmented lesions, usually occurring on the eyelids, neck and axillae. There have been a few reports in the literature that the presence of skin tag is associated with different components of the metabolic syndrome. Objective: To evaluate the relationship between components of metabolic syndrome (atherogenic lipid, glucose level, hypertension, and waist circumference) and other metabolic associations with skin tags. Patients and Methods: A total of 51 patients with skin tags aged 16 to 64 years, 13 males (31.37%), 38 females (68.63%) with a mean age of (38.6 ± 12.1 SD); and 50 healthy controls aged 19 to 60 years, 13 males (30%) and 37 females (70%) with a mean age of (37.9 ± 9.4 SD) were examined in dermatology outpatient clinic of Kufa Medical School Teaching Hospital, Najaf, Iraq. Body Mass Index (BMI),waist circumference (WC),blood pressure (BP), fasting blood sugar (FBS), serum lipids including triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), liver enzymes (AST, ALT), alkaline phosphatase and serum uric acid were measured for both study groups. The study was approved by Ethics Committee of Kufa Medical School in Iraq. Results: There was no significant statistical difference in fasting blood sugar, serum uric acid, liver function tests, triglyceride, high density lipoprotein and very low density lipoprotein between the study groups. Patients group has showed significantly higher levels of total cholesterol and LDL, when compared with the healthy controls group (P < 0.01). Also patients group showed significantly higher values of BMI, blood pressure (BP), and Waist circumference (WC) compared with the healthy controls group (p = 0.0001), ( p = 0.001) and (P < 0.01) respectively. It has been found that 37 (72.5%) of the patients and 13 (26%) of the controls meet at least three of the criteria of metabolic syndrome. Conclusion: Total cholesterol and LDL serum levels should be checked in patients with skin tags. On the other hand, glucose, serum levels may not be as important as what is being considered in recent time.</p
Content may be subject to copyright.
International Journal of Dermatology and Clinical Research
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
003
• Single or multiple liform lesions of approximately 2 mm in
width and 5 mm in length occurring elsewhere on the body.
• Large, pedunculated tumor or nevoid, baglike, so bromas
that occur on the lower part of the trunk [7].
e most common site of skin tag is on the sides of the neck, where
they may be mixed with typical small, sessile, seborrheic keratoses [1].
ey are also seen frequently in the axillae, eyelids, and less oen on
the trunk and groins, where the so pedunculated growths oen hang
on thin stalks [2], perianal skin are also frequently involved [2,8] and
this has now been named infantile perianal pyramidal protrusions.
is occurs in young children usually girls, in the midline anterior to
the anus. is reduces with time and no treatment is necessary [2].
Skin tag may occur at unusual sites of the body. A huge skin tags
have been described on the penis [9]. A lymphedematous skin tag of
the glans penis unassociated with condom catheter use also has been
described [6]. Skin tags of the oral mucosa, anus, and vulvovaginal
areas may be found [7].
Skin tags are usually asymptomatic, but on occasion can become
painful secondary to irritation or torsion and infarction [5]. Patients
may complain of pruritus or discomfort when an acrochordon is
Introduction
Part 1 / skin tags
Synonyms: So warts, achrochordon[1], cutaneous tag, papilloma
colli, broma pendulum, cutaneous papilloma, broma molluscum,
templeton skin tags [2], broepithelial polyps, pedunculated so
bromas, liform so bromas [3].
Denition: Skin tags are common benign connective tissue tumors
of the dermis [4], composed of loose brous tissue [1], and presents
as a so skin colored to slightly hyperpigmented pedunculated papule
[5]. ese esh-colored tumors are oen raised from the surface of
the skin on a eshy stalk called a peduncle, and feel like small bags.
Skin tags may be single or multiple and are typically the size of a grain
of rice [2,6], but they may range in size from 1-2 mm papules on the
eyelids to 1-2 cm baggy polyps on the trunk [5]. e surface of a skin
tag may be smooth or irregular in appearance [6].
ree types of skin tags have been described:
• Small, furrowed papules of approximately 1-2 mm in width
and height, located mostly on the neck and the axillae.
Research Article
Metabolic Associations with Skin
Tags
Azar Hadi Maluki1-3* and Aala
Abidmuslim Abdullah4
1Department of Dermatology, College of Medicine,
University of Kufa, Iraq
2Supervisor in Al-Najaf Training Center, Council of
Arab Board for Medical Specializations, Iraq
3Supervisor in Kufa Training Center, Iraq Board for
Medical Specializations, Iraq
4Dermatology Resident, Al-Najaf Training Center,
Council of Arab Board for Medical Specializations,
Iraq
Dates: Received: 31 December, 2015; Accepted:
10 February, 2016; Published: 20 February, 2016
*Corresponding author: Prof. Dr. Azar H. Maluki,
P.O. Box (450), AL-Najaf Post Ofce, Iraq. Tel:
(+964)7802887712; E-mail:
www.peertechz.com
Keywords: Skin tag; Metabolic syndrome
Abstract
Background: Skin tags are small, soft, pedunculated, often pigmented lesions, usually occurring
on the eyelids, neck and axillae. There have been a few reports in the literature that the presence of
skin tag is associated with different components of the metabolic syndrome.
Objective: To evaluate the relationship between components of metabolic syndrome (atherogenic
lipid, glucose level, hypertension, and waist circumference) and other metabolic associations with skin
tags.
Patients and Methods: A total of 51 patients with skin tags aged 16 to 64 years, 13 males
(31.37%), 38 females (68.63%) with a mean age of (38.6 ± 12.1 SD); and 50 healthy controls aged
19 to 60 years, 13 males (30%) and 37 females (70%) with a mean age of (37.9 ± 9.4 SD) were
examined in dermatology outpatient clinic of Kufa Medical School Teaching Hospital, Najaf, Iraq. Body
Mass Index (BMI),waist circumference (WC),blood pressure (BP), fasting blood sugar (FBS), serum
lipids including triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL), low-density
lipoprotein cholesterol (LDL), liver enzymes (AST, ALT), alkaline phosphatase and serum uric acid
were measured for both study groups. The study was approved by Ethics Committee of Kufa Medical
School in Iraq.
Results: There was no signicant statistical difference in fasting blood sugar, serum uric acid,
liver function tests, triglyceride, high density lipoprotein and very low density lipoprotein between the
study groups. Patients group has showed signicantly higher levels of total cholesterol and LDL, when
compared with the healthy controls group (P < 0.01). Also patients group showed signicantly higher
values of BMI, blood pressure (BP), and Waist circumference (WC) compared with the healthy controls
group (p = 0.0001), ( p = 0.001) and (P < 0.01) respectively. It has been found that 37 (72.5%) of the
patients and 13 (26%) of the controls meet at least three of the criteria of metabolic syndrome.
Conclusion: Total cholesterol and LDL serum levels should be checked in patients with skin
tags. On the other hand, glucose, serum levels may not be as important as what is being considered
in recent time.
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
004
Maluki and Abdullah (2016)
snagged by jewelry or clothing [7]. Vulvovaginal skin tag may be
associated with itching without the symptom being the result of
fungal infection [10]. Skin tags are harmless, and may not grow or
change over time [6].
Incidence: e condition is very common, particularly in middle-
aged and elderly people [9-12] and their incidence increases with age,
and close to 46% - 50% of all individuals have at least one skin tag
[5,7], with nearly 60% of individuals acquiring them by the age of 69
years [2]. An equal prevalence of skin tags exists in males and females
[7], but some studies suggested that skin tags are common particularly
in middle age and elderly women [9-12], where they found together
with seborrheic keratosis [1].
Causes and precipitating factors: Frequent irritation in areas of
skin friction [11], seems to be an important causative factor, especially
in persons who are obese [4,13,14]. An opinion also exists that skin
tags are simply the eect of skin aging, with many factors responsible
for their development [15]. Hormone imbalances may facilitate the
development of skin tags (ex. high levels of estrogen and progesterone
during pregnancy, high levels of growth hormone in acromegaly).
Epidermal growth factor and alpha tissue growth factor have also
been implicated in the development of tumors such as these [15].
Whether any infective factors initiate acrochordon growth is still
not clear. Human papillomavirus types 6 and 11 DNA was found in
a high percentage of skin tag biopsy samples obtained from 49 white
patients. According to the authors of the study, viral infection should
be considered as a pathogenic cofactor [15].
Skin tags associated with brofolliculomas and trichodiscomas
have been described as components of Birt-Hugg-Dube syndrome,
an autosomal dominant disorder. ey have been reported to
accompany other neoplasms, especially tumors of the gastrointestinal
tract and kidneys. Neoplasms are suggested to produce and release
growth factors that cause skin tags growth in to the circulation [7],
whereas in Cowden disease the skin tags are sclerotic broma [5].
An association with type - 2 diabetes mellitus has been observed
[16-19]. A study of 118 research subjects with acrochordon reported
an incidence of 40.6% of either overt type - 2 diabetes mellitus
or impaired glucose tolerance. Reports exist suggesting that the
mechanism is through the eect of insulin and glucose starvation
[20-22]. e previous study showed no correlation between the
location, size, color, or number of skin tags with impairment of
glucose tolerance [7]. ey oen increase in number when the patient
is gaining weight or during pregnancy, and may be related to the
growth hormone-like activity of insulin.
In patients preselected for gastrointestinal complaints, skin
tags appear to be more prevalent in those with colonic polyps. is
association has not been proved for the general population [2,7].
A family history of acrochordon sometimes exists [7].
Observations of skin tags and obese people were the rst to indicate a
genetic correlation to skin tags. Scientists were looking for the reasons
why some patients had skin tags and other patients didn’t and noted
that skin tags were seen to consistently exist within families. A logical
conclusion was that there was a link in the DNA of aected people
[6].
e skin tags may represent a cutaneous sign for impaired
carbohydrate or lipid metabolism [9], liver enzyme abnormalities and
hypertension [15]. In one study report that skin tags are associated
with various components of the metabolic syndrome [9], no data in
the literature show that the presence of skin tags is associated with
serum high-sensitive C- reactive protein, uric acid, free fatty acid and
leptin level [23].
Mast cells and tumor necrosis factor ”TNF”-α may play a role in
the pathogenesis of skin tags following trauma to the skin, in the form
of friction, “TNF-related apoptosis-inducing ligand” is upregulated
and can induce mast cell migration into the skin through the release
of chemokines. Mast cells in turn release TNF-α. e latter, through
direct or indirect interactions with broblasts and keratinocytes
could initiate some of the changes that lead to the formation of skin
tags [24].
Part 2 / metabolic syndrom
Metabolic syndrome (syndrome X, insulin resistance syndrome)
refers to a cluster of known disorders that increase the risk for
morbidity and mortality from cardiovascular disease and type - 2
diabetes. Risk for type - 2 diabetes mellitus increases ve to nine fold
with metabolic syndrome [14].
Metabolic syndrome (Table1) is a complex cluster of several risk
factors within a single patient according to the National Cholesterol
Education Program / Adult Treatment Panel (ATP) lll, which are
directly related to the incidence of coronary heart disease [20,23].
Evolving perspectives on the denition of metabolic
syndrome
In addition to the ATP III clinical identication of the metabolic
syndrome (Table 1) various organizations have set forth clinical
criteria for its diagnosis [25]. Although similar in many aspects to
other guidelines, the World Health Organization clinical criteria
for the metabolic syndrome regard insulin resistance as a required
component for diagnosis of the syndrome [25-27]. Furthermore
any two of ve other risk factors are regarded as sucient to meet
the denition of metabolic syndrome. Requiring objective evidence
of insulin resistance may provide a stronger prediction of type - 2
diabetes mellitus than ATP lll; however, consistent with ATP lll
ndings, type - 2 diabetes mellitus does not exclude a diagnosis of the
metabolic syndrome [25].
e American Diabetes Association recently conducted an
Table 1: National Cholesterol Education Program (NCEP), Adult Treatment
Panel lll (ATP lll). Diagnosis of metabolic syndrome includes at least 3 of the
following: [24].
Large waist circumference < 102 cm (40 inches) for men, and < 88 cm (35
inches) for women.
Serum triglyceride (TG) levels ≥ than 150 mg/dl.
Level of high-density lipoprotein cholesterol (HDL-C) > 40 mg/dl for men,
and > 50 mg/dl for women.
Hypertension: Blood Pressure (BP) ≥ than 130/85 mmHg.
Fasting glucose level (FBS) ≥ than 110 mg/dl.
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
005
Maluki and Abdullah (2016)
extensive review of the literature relating to the metabolic syndrome
and uses the term metabolic syndrome to refer to a clustering
of specic cardiovascular disease risk factors whose underlying
pathophysiology is thought to be related to insulin resistance [27].
e American Diabetes Association acknowledges that certain
cardiovascular disease risk factors are prone to cluster. However,
their recommendation is that further research is needed (including
studies that investigate the pathogenesis of the metabolic syndrome)
and that clinicians should evaluate and treat all cardiovascular disease
risk factors without regard to whether a patient meets the criteria for
diagnosis of the metabolic syndrome [27].
World health organization criteria for metabolic syndrome:
[28,29]
Insulin resistance, identied by one of the following:
• Type - 2 diabetes mellitus
• Impaired fasting glucose
• Impaired glucose tolerance
• Or for those with normal fasting glucose levels (> 110 mg/
dL), glucose uptake below the lowest quartile for background
population under investigation under hyper-insulinemic or
eu-glycemic conditions.
Plus any two of the following:
• Antihypertensive medication and / or high blood pressure (≥
than 140 mm Hg systolic, or ≥ than 90 mm Hg diastolic).
• Plasma triglycerides ≥ than 150 mg/dL (1.7 mmol/L).
• High-density lipoprotein cholesterol > 35 mg/d (0.9 mmol/L)
in men, or > 39 mg/dL (1.0 mmol/L) in women.
• Body mass index of < 30 kg/m2 and/or waist to hip ratio of <
0.9 in men, or less than 0.85 in women.
• Urinary albumin excretion rate ≥ than 20 ~ tg/min or albumin
to creatinine ratio ≥ than 30 mg/g.
Atherogenic dyslipidemia clinically presents as elevated serum
triglyceride levels, increased small dense low-density lipoprotein
particles, and decreased levels of high density lipoprotein - cholesterol
[29,30]. All of these abnormalities have been implicated as being
independently atherogenic. e three abnormalities of elevated serum
triglycerides, increased small dense low-density lipoprotein particles,
and low high density lipoprotein - cholesterol have been termed the
atherogenic lipoprotein phenotype [31] or, more simply, the lipid
triad. is multiplex array of lipid abnormalities is a powerful risk
factor for coronary heart disease, dened as angina pectoris, unstable
angina, myocardial infarction, or coronary death [32,33].
Etiology: Risk factors for metabolic syndrome include family
history, poor diet, and inadequate exercise.
Metabolic syndrome is thought to be caused by adipose tissue
dysfunction and insulin resistance. Dysfunctional adipose tissue
also plays an important role in the pathogenesis of obesity-related
insulin resistance [34]. Both adipose cell enlargement and inltration
of macro-phages in to adipose tissue result in the release of pro
inammatory cytokines and promote insulin resistance [35]. Insulin
resistance appears to be the primary mediator of metabolic syndrome
[36]. Insulin promotes glucose uptake in muscle, fat, and liver
cells and can inuence lipolysis and the production of glucose by
hepatocytes [37]. Additional contributors to insulin resistance include
abnormalities in insulin secretion and insulin receptor signaling,
impaired glucose disposal, and pro inammatory cytokines. ese
abnormalities, in turn, may result from obesity with related increases
in free fatty acid levels and changes in insulin distribution (insulin
accumulates in fat). e distribution of adipose tissue appears to
aect its role in metabolic syndrome. Fat that is visceral or intra-
abdominal correlates with inammation, whereas subcutaneous fat
does not. Abdominal fat is known to produce potentially harmful
levels of cytokines, such as tumor necrosis factor, adiponectin, leptin,
resistin, and plasminogen activator inhibitor. Lifestyle factors such
as alcohol consumption, cigarette smoking, and physical activity
have been reported to aect an individual’s metabolic prole [37,38].
Studies have also reported an inverse relationship between physical
activity and certain components of metabolic syndrome such as
waist circumference, high density lipoprotein - cholesterol and blood
pressure [38].
Clinical Presentation of metabolic syndrome: may include the
following:
• Hypertension.
• Hyperglycemia.
• Hypertriglyceridemia.
• Reduced high-density lipoprotein cholesterol.
• Abdominal obesity.
• Chest pains or shortness of breath: Suggesting the rise of
cardiovascular and other complications.
• Acanthosis nigricans, hirsutism, peripheral neuropathy,
and retinopathy: In patients with insulin resistance and
hyperglycemia or with diabetes mellitus.
• Xanthomas or xanthelasmas: In patients with severe
dyslipidemia [39].
Diagnosis: According to guidelines from the National Heart,
Lung, and Blood Institute and the American Heart Association,
metabolic syndrome is diagnosed when a patient has at least 3 of the
following ve conditions:
• Fasting glucose ≥110 mg/dL (or receiving drug therapy for
hyperglycemia).
• Blood pressure ≥130/85 mm Hg (or receiving drug therapy
for hypertension).
• Triglycerides ≥150 mg/dL (or receiving drug therapy for
hypertriglyceridemia).
• High density lipoprotein – cholesterol <40 mg/dL in men or
< 50 mg/dL in women (or receiving drug therapy for reduced
high density lipoprotein – cholesterol).
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
006
Maluki and Abdullah (2016)
Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in)
in women; if Asian American, ≥90 cm (35 in) in men or ≥80 cm (32
in) in women [40].
Part 3 / association between skin tags and metabolic
syndrom
Multiple skin tags have been associated with abnormalities in the
glucose metabolism, specically type - 2 diabetes, hyperinsulinemia
and insulin resistance. Insulin resistance is a state in which a given
concentration of insulin produces a less than expected biological
eect. Obesity is the most common cause. is is followed by
compensatory hyperinsulinemia to maintain normal glucose and
lipid homeostasis [40,41].
Dierent methods are available for assessment of insulin resistance,
of which calculation of the homeostasis model assessment of insulin
resistance provides a useful approach [41,42]. Hypertension, diabetes
and metabolic syndrome were signicantly more frequent in patients
with acrochordons than the control group, according to the study
on a total of 192 patients with at least one skin tag and 104 controls
having no skin tag seen at an academic outpatient dermatology
clinic were involved. According to regression analysis, the number
of acrochordons increased in patients with higher body mass index
values, 2-h plasma glucose, triglyceride and low density lipoprotein
- cholesterol levels and lower high density lipoprotein - cholesterol
levels. ese results support the suggestion that acrochordons are
associated with the components of metabolic syndrome [42,43] and
the risk of atherosclerosis and cardiovascular disease [44]. One study
shows that the skin tags are not associated with increased incidence of
obesity compared to the general population. On the other hand, skin
tags are associated with impaired carbohydrate metabolism, and may
serve as means for identifying patients at increasing risk of having
diabetes mellitus [19], yet the relation of skin tags to obesity is still a
matter of controversy [45].
Clinical and metabolic glucose/insulin characteristics of men
with multiple (8 or more) skin tags on the neck were compared with
a control group with few or none. One-third of the study group had
acanthosis nigricans. Multiple skin tags were more sensitive than
acanthosis nigricans in identifying those with alterations in the
glucose/insulin metabolism, although less specic. Multiple skin tags
should raise suspicion of insulin resistance or hyperinsulinemia [46].
e possible association of skin tag with diabetes mellitus was
rst mentioned in 1951. Since then, a few clinical studies have
been conducted to examine this hypothesis with conicting results.
Diabetes or impaired glucose tolerance had greater number of skin
tags compared to normo-glycemic ones, but there was no signicant
dierence between number of skin tags in diabetes and impaired
glucose tolerance group, in addition, patients with more than 30 skin
tags (designated as high number) had signicantly higher incidence
of impaired carbohydrate metabolism than patients who had less
than 30 skin tags.
ere is no positive correlation between number of skin tags and
body mass index, similarly, the mean number of skin tags in obese,
over weight and normal weight was not signicantly dierent. No
correlation was found between the anatomical location of skin tag
and the presence of abnormal carbohydrate metabolism, except for
skin tags under the breast in women [47]. Specic dermatoses as skin
tags, striae distensae and plantar hyperkeratosis, could be considered
as a cutaneous stigma of severe obesity. Although the physiological
mechanisms are still unknown, nding has not been previously
described and that this may constitute new eld in the research on
obesity [48]. Acrochordons were found to be closely associated with
pseudo-acanthosis nigricans, seborrheic keratosis, obesity and non-
insulin dependent diabetes mellitus [4]. A study included irty-six
patients with skin tags and 22 healthy controls, the mean levels of
body mass index, homeostasis model assessment of insulin resistance,
and total cholesterol were signicantly higher in patients than in
controls.
So 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 benecial [49].
Aim of the study
To evaluate the possible relationship between components
of metabolic syndrome (atherogenic lipid, serum glucose level,
hypertention and waist circumference); and other metabolic
associations with the occurrence of skin tags .
Patients and Methods
A total of 51 patients and 50 healthy controls, matched in age
and sex, were included in the study. Patients and controls were
recruited from Dermatology Outpatient Clinic of Kufa Medical
School Teaching Hospital, Najaf, Iraq. All subjects were examined by
a dermatologist; patients were dened as persons with skin tags at
any body site and controls as persons having no skin tag. Skin tag
was diagnosed clinically as a eshy pedunculated so protrusion skin
colored or brownish, aecting the exural areas or face. Personal
history of hypertention, diabetes, hyperlipidemia, drug intake,
smoking, missed period in female, and family history of skin tags was
recorded for both groups.
Exclusion criteria from the study for both groups were:
• Patients receiving drugs with a known antihyperlipidemic
eect.
• Pregnant women.
• Patients who are known cases of hypertension or receiving
drugs with a known antihypertensive eect.
• Patients who are known cases of diabetes mellitus or receiving
drugs with a known hypoglycemic eect.
e height, weight, waist circumference (in inch) and body mass
index (BMI) of patients and controls were measured.
Body mass index “BMI” was calculated by dividing body weight
to height square (kg/m2). Patients were considered according to their
BMI:
• BMI ≤ 18 as thin.
• BMI between 19 and 25 as normal.
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
007
Maluki and Abdullah (2016)
• BMI between 26 and 29 as overweight.
• BMI ≥30 as obese.
Where the height of patients was measured by using a rubbery
tape measure and approximated to nearest 0.5 cm and weight of
patients was taken by weight measuring device. Waist circumference
was measured (in inch) by a rubbery tape measure, by nding the
top of hip bone and the bottom of the last rib, then ask the person to
breathe out normally and place the tape measure midway between
these points and wrap it around the waist. Blood preasure was
measured to both groups by sphygmomanometer.
All patients and controls were informed about the aim and
procedure of the study. Investigations were performed for both groups
in the study including liver function tests (Alanine transaminase
“ALT”, Aspartate transaminase “AST”, Alkaline phosphatase “ALP”)
and serum uric acid (by autoanalyzer device). Blood samples of
the patients and controls were taken aer (at least) an eight-hour
starvation, to measure fasting blood sugar, serum total cholesterol,
triglyceride, and High density lipoprotein – cholesterol values (by
autoanalyzer device).
Low density lipoproten chelesterol and very low density
lipoproten – chelesterol values were calculated according to the
following formulas:
• Very low density lipoproten – chelesterol = triglyceride /
(divided by) 5.
• Low density lipoproten – chelesterol = cholesterol – (minus)
(Very low density lipoproten – chelesterol + High density
lipoprotein – cholesterol).
Normal values (according to the standards of the Teaching
Hospital Laboratory) were as follows:
• Total cholesterol : 0-199 mg/dl.
• Triglyceride : 0-149 mg/dl.
• High density lipoproten : 40-60 mg/dl.
• Low density lipoproten : 100-129 mg/dl.
• Very low density lipoproten : 5-40 mg/dl.
• Uric acid : 3.50-7 mg/dl.
• Alanine transaminase “ALT”: 0-55U/L.
• Aspartate transaminase “AST”: 5-34U/L.
• Alkaline phosphatase “ALP”: 40-150U/L.
• Fasting blood sugar: 70-99 mg/dl.
According to Adult Treatment Panel III criteria of metabolic
syndrome (Table 1), those who met at least three criteria were
included in a group called (metabolic syndrome group).
Statistical analysis
All the results were expressed as means ± (Standard Deviation
“SD”) values. e signicance of the dierence between the groups
was assessed by unpaired Student’s t-test for continuous variables. e
chi-square test or Fischer’s Exact test was used for testing prevalence
between groups, Pie charts and Bar chart were used as needed. e
statistical analysis was performed using Statistical Package for the
Social Science “SPSS” Version 20 program, and P values of < 0.05
were considered as signicant.
Ethical approval
is study has been approved by the Ethics Committee of Kufa
Medical School, Iraq. All individuals in study groups have informed
signed consents.
Results
A total of 51 patients with skin tags with ages of 16 to 64 years,
including 13 males (31.37%) and 38 females (68.63%) with a mean age
of (38.6 ± 12.1 SD), (Figures1,2); in addition to 50 healthy controls
aged 19 to 60 years, 13 males (30%) and 37 females (70%), (Figure
3) with a mean age of (37.9 ± 9.4 SD); were examined in the present
study. A positive family history of skin tags was present in 50 (98%)
Table 2: Clinical characterestics of study groups.
Variables Patient
(mean ± SD) Control
(mean ± SD) P value
BMI 32.5±6.2 27.1±5.3 0.0001
Blood pressure Systolic 136.3±16.2 126.8±9.4 0.001
Diastolic 84.1±11.8 75±6.6 0.001
Waist Circumference Female 37.7±4.7 34.7±3.9 0.005
Male 39.7±3.8 34.8±3.2 0.001
Smoking Positive 5 (9.8%) 2 (4%) 0.25
Negative 46 (90.2%) 48 (96%)
Family history Positive 50(98%) 4(8%) 0.0001
negative 1(2%) 46 (92%)
Table 3: Liver function tests, fasting blood sugar and serum uric acid values in
study groups. Patients (mean ± SD) Controls(mean±SD) P value
AST 17.2±6.3 18.9± 8.4 0.263
ALT 21.2±9.4 20.9± 7.9 0.943
ALP 107.8±27.9 107.4±34.9 0.958
FBS 112.9±38.7 106.1±23.6 0.23
SUA 4.7±1.2 4.5±.83 0.28
Table 4: Lipid prole in study groups.
Patient (mean±SD) Control(mean±SD) P value
Cholesterol 204.5±43.7 177.02±35.8 0.001
TG 151.8±69.8 134.3± 59.9 0.215
HDL 34.3±11.5 37.04±8.7 0.178
VLDL 29.9± 10.7 27± 12.3 0.264
LDL 137.1±37.8 113.1±31.4 0.001
Table 5: Occurance of metabolic syndrome in study groups.
Group Total No. (%) P value
Patient No.
(%) Control
No. (%)
Metabolic syndrome Present 37(72.5%) 13(26%) 50(49.5%) 0.0001
Absent 14(27.5%) 37(74%) 51(50.5%)
Total 51(100%) 50(100%) 101(100%)
*Odd ratio=7.5.
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
008
Maluki and Abdullah (2016)
Patients group showed signicantly higher levels of total
cholesterol and low density lipoproten, when compared with the
healthy controls group (P = 0.001), while no signicant dierences in
triglyceride, high density lipoprotein and very low density lipoprotein
were present between the two groups (Table4) . Also patients group
showed signicantly higher values of body mass index, blood pressure
and waist circumferenceV when compared with the healthy controls
(p = 0.0001), ( p = 0.001) and (P < 0.01) respectively; (Figures4,5 and
Table2).
Depending on the Adult Treatment Panel III criteria for diagnosis
of metabolic syndrome that was mentioned (Table 1), it was found
that 37 (72.5%) of patients and 13 (26%) of controls met at least three
of the criteria of metabolic syndrome; while 14 (27.5%) of the patients
and 37 (74%) of controls failed to meet those criteria, with a p value of
(P = 0.0001) which was highly signicant (Table5).
Discussion
In the present study we found that (80.4%) of the patients were
above the age of 30 years, with the larger percentage occur between
(30 to 39) years of age, while (19.6%) of the patients were below the age
of 30 years, and they were mostly female (68.63%), and this support
the suggestion that skin tags are more common in women or may be
explained by the fact that women are seeking medical interference for
cosmetic purposes more than men .
Family history was positive in (98%) of the patients and in only
(8%) of controls; and this supports the role of genetic factor in the
pathogenesis of skin tags.
Multiple skin tags are frequently associated with non-insulin-
dependent diabetes mellitus and obesity [19]. Obesity is a factor
that has been associated with the development of skin tags [43].
In the present study, body mass index of patients was signicantly
higher than controls with a (P=0.0001); and patients were mostly
obese (68.63%), while (19.61%) were over weight and these results
support the suggestion of association of skin tags with obesity.
According to the study of Shaheen M.A. et al., which agrees with
older studies, a suggestion was made that android pattern of obesity
is to be more predictive of insulin resistance than body mass index,
and accordingly, waist circumference appears to be the most related
criteria of the metabolic syndrome that correlates positively with the
number of skin tags in dierent body mass index patients [46]. In
the present study we found the waist circumference which is one of
the components of metabolic syndrome is signicantly higher in the
patients group when compared with controls (P = 0.005 for females,
and P = 0.001 for males) . So we could conclud that skin tags show a
statistically signicant relationship with obesity.
A supposed relation is found between diabetes millettus and skin
tags. A study done by Rasi et al. [8], investigated oral glucose tolerance
test with 75g glucose and showed an increased risk of diabetes mellitus
in patients with skin tags . However, we could not nd this kind
of relationship in the present study where we found no signicant
statistical dierence in fasting serum glucose levels between the
groups ; and this might be due to the fact that we have not tested our
patients for oral glucose tolerance test. On the other hand, our result
is similer to that obtained from a study done by Gorpelioglu C et al.
Figure 1: Age distribution in patients group.
Figure 2: Sex distribution in patients group.
Figure 3: Sex distribution in controls.
of patients and 4 (8%) of controls. On the other hand, 5 (9.8%) of
patients and 2 (4%) of controls were smokers (Table2). ere was no
signicant dierence in fasting blood sugar, serum uric acid or liver
function tests between the two groups (Table3).
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
009
Maluki and Abdullah (2016)
[9], but in their study the patients and controls had a similar body
mass index (28.7 ± 7.9) ; therefore, they thought that the relationship
between skin tags and diabetes mellittus might be associated with the
patients having obesity and obesity related glucose intolerance, while
in the present study the body mass index is signicantly higher in the
patients when compared with controls group (p > 0.0001). Similarly,
in another study, Marthur et al., estimated insulin resistance in 10
patients with multiple skin tags and 10 control subjects matched
for age, sex and body weight. ey concluded that skin tags are not
markers of insulin resistance and it is possible that epidermal growth
factor or other growth factors may play a role in the pathogenesis of
skin tags [21].
ere are only few studies about the relationship between skin tags
and atherogenic lipid prole. Crook investigated serum lipid prole
in four patients with skin tags and found increased serum triglyceride
and decreased HDL cholesterol [50]. Erdogan et al., found increased
total cholesterol in 36 patients with skin tags, when compared with 22
healthy controls [51]. Gorpelioglu C et al. [9], found total cholesterol
levels and low density lipoproten serum levels were higher in patients
with skin tags, when compared with the healthy control group. e
last two studies meet the results of the present study, that showed
the total serum cholesterol and low density lipoproten serum levels
were signicantly higher in patients with skin tags in comparison
to healthy controls (P = 0.001) for both, however, there was no
statistically signicant dierence in the serum triglycerides, high
density lipoproten, very low density lipoproten serum levels in both
groups (P= 0.215, P=0.178, P= 0.264) respectively.
Skin tags could represent a cutaneous sign for impaired
carbohydrate or lipid metabolism, liver enzyme abnormalities and
hypertension [52,53].
Insulin resistance syndrome or metabolic syndrome is a collection
of health risks that increases the chance of developing heart disease,
stroke and diabetes. Various risk factors have been included and the
factors generally accepted as being characteristic of this syndrome
include abdominal obesity, raised blood pressure, atherogenic
dyslipidaemia and insulin resistance with or without glucose
intolerance [54]. Hypertension, diabetes and metabolic syndrom were
signicantly more frequent in patients with skin tags than the control
group, according to the study on a total of 192 patients with at least
one skin tag and 104 controls having no skin tag seen at an academic
outpatient dermatology clinic were involved . e acrochordon group
showed signicantly higher values of body mass index, higher levels
of aspartate amino transferase, alanine amino transferase, gamma-
glutamyl transferase, alkaline phosphatase, triglycerides, triglycerides
and low density lipoproten – cholesterol and signicantly lower levels
of high density lipoproten – cholesterol when compared with the
control group. e number of skin tags is increased in patients with
higher body mass index values, 2-h plasma glucose, triglycerides and
low density lipoproten – cholesterol levels and lower high density
lipoproten – cholesterol levels.
ese results support the suggestion that skin tags are associated
with the components of metabolic syndrome, and with the risks of
atherosclerosis and cardiovascular disease [55].
In the present study the summery of results that explain the
associations between skin tags and components of metabolic
syndrome includes: Waist circumference and blood pressure were
signicantly higher in patients with comparison to controls group.
While the triglycerides, high density lipoproten, fasting blood
sugar, showed no statistically dierences between the two groups.
But generally, we found 37 (72.5%) of the patients and 13 (26%) of
controls meet at least three of the criteria of metabolic syndrome.
ese results are also in agreement with a study proposed that skin
tags are cutaneous ndings frequently associated with the risk factors
for metabolic syndrom and heart disease, and recommended that
these patients should be carefully evaluated for metabolic syndrom
and heart disease (24). Our results showed no association between
skin tags and liver enzymes abnormalities or serum uric acid, and
there were no signicant dierences between the values of liver
enzymes (Aspartate transaminase “AST”, Alanine transaminase
“ALT” and Alkaline phosphatase “ALP”) between the patient and
control groups (p=0.263, p=0.943, p=0.958) respectively.
Conclusions and Recommandations
We may propose that skin tags may be one of the important
skin markers of metabolic disorders and may attract physicians and
dermatologist for further investigation as it is proved to be not just a
cosmetic problem .
Figure 4: BMI distribution in patients group.
Figure 5: BMI distribution in controls.
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
Maluki and Abdullah (2016)
010
e results of this study advice the screening of patients with
skin tags for hypercholesterolemia, increased level of low density
lipoproten (when positive, other components of metabolic syndrome
are preferably to be measured).
is leads us to recommend the change of life style of patients
with skin tags and / or hyperlipidemia, as stopping active smoking and
prevention of passive smoking, regular exercises, weight reduction,
changing carbohydrate diets into high protein diets.
Knowing that diets rich in polyunsaturated fatty acids as olive oil,
omega 3, 6 and 9 fatty acids supplementation can decrease the risk of
coronary atherosclerosis, we recommend their use for patients with
skin tags and/or hyperlipidemia.
Because our study consisted of a limited number of patients and
controls from asingle population, further studies done with larger
patient groups will be benecial in elucidating the relationship
between skin tags and atherosclerotic risk factors.
References
1. Burns T, Breathnach SM, Cox NH, Grifths C (2010) Non-Melanoma Skin
Cancer and Other Epidermal Skin Tumours. Rook’s Textbook of Dermatology.
8th ed. 3: 52.40 -52.41.
2. James WD, BergerTG, Elston DM (2011) Andrews’ Diseases of The Skin :
clinical dermatology. 11th ed. Chapt 29: Epidermal Nevi, Neoplasms, and
Cysts, 601-602.
3. Habif TP (2009) Chap 20: Benign skin tumors. Clinical Dermatology. 5th ed.
Philadelphia, Mosby Elsevier.784-808.
4. Bhargava P, Mathur SK, Mathur DK, Malpani S, Goel S, et al. (1996)
Acrochordon, diabetes and associations. Indian J Dermatol Venereol Leprol
62: 226-228.
5. Jean L Bolognia, Joseph L Jorizzo, Ronald P Rapini (2008) ed. neoplasm
of skin. Dermatology, 2nd ed. Kamino H., Meehan S. and Pui J. section 18:
1813.
6. Allegue F, Fachal C, Pérez-Pérez L (2008) Friction Induced Skin Tags.
Dermatol Online J 14: 18.
7. Rasi A, Soltani-Arabshahi R, Shahbazi N (2007) Skin tag as a cutaneous
marker for impaired carbohydrate metabolism: a case-control study. Int J
Dermatol 46: 1155-1159.
8. Gorpelioglu C, Erdal E, Ardicoglu Y, Adam B, Sarifakioglu E (2009) Serum
leptin, atherogenic lipids and glucose levels in patients with skin tags. Indian
J Dermatol 54: 20-22.
9. El Safoury O, Rashid L, Ibrahim M (2010) Astudy of androgen and estrogen
receptors alpha, beta in skin tags. Indian J Dermatol 55: 20-24.
10. Garcia-Hidalgo L, Orozco-Topete R, Gonzalez-Barranco J, Villa AR, Dalman
JJ, et al.(1999) Dermatoses in 156 obese adults. Obes Res 7: 299-302.
11. El Safoury O, Abdel Hay R, Fawzy M, Kadry D, Amin E, et al. (2011) Skin
tags, leptin, metabolic syndrome and change of the life style. Indian J
dermatol venereol and leprol 77: 577-580.
12. Senel E, Salmanoglu M, Solmazgül E, Berçik Inal B (2011) Acrochordons as
a cutaneous sign of impaired carbohydrate metabolism, hyperlipidemia, liver
enzyme abnormalities and hypertension: a case-control study. J Eur Acad
Dermatol Venereol.
13. Levine N (1996) Brown patches, skin tags on axilla. Are this patient’s velvety
plaques related to his obesity and diabetes? Geriatrics 51: 27.
14. Thappa DM (1995) Skin tags as markers of diabetes mellitus: an
epidemiological study in India. J Dermatol 22: 729-731.
15. Mathur SK, Bhargava P (1997) Insulin resistance and skin tags. Dermatology
195: 184.
16. Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL (2010) Pattern of
cutaneous manifestations in diabetes mellitus. Indian J Dermatol 55: 39-41.
17. Sari R, Akman A, Alpsoy E, Balci MK (2010) The metabolic prole in patients
with skin tags., Clin Exp Med 10: 193-197.
18. El Safoury OS1, Fawzy MM, Hay RM, Hassan AS, El Maadawi ZM, et al.
(2011) The possible role of trauma in skin tags through the release of mast
cell mediators, Indian J Dermatol 56: 641-646.
19. Austin MA, King MC, Vranizan KM, Krauss RM (1990) Atherogenic lipoprotein
phenotype. A proposed genetic marker for coronary heart disease risk.
Circulation 82: 495-506.
20. Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (2001) Executive Summary of the Third Report of the
National Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation and Treatment of High Blood Cholesterol in Adults. (Adult
Treatment Panel III). JAMA 285: 2486-2497.
21. Wilson PW, Anderson KM, Castelli WR (1991) Twelve-year incidence of
coronary heart disease in middle-aged adults during the era of hypertensive
therapy: The Framingham Offspring Study. Am J Med 90: 11-16.
22. Vega GL (2004) Management of atherogenic dyslipidemia of the metabolic
syndrome: Evolving rationale for combined drug therapy. Endocrinol Metab
Clin North Am 33: 525-544.
23. Wyszynski DF, Waterworth DM, Barter PJ, Cohen J, Kesäniemi YA, et al.
(2005) Relation between atherogenic dyslipidemia and the Adult Treatment
Program-III denition of metabolic syndrome (Genetic Epidemiology of
Metabolic Syndrome Project). Am J Cardiol 95: 194-198.
24. Hanley AJ, Karter AJ, Festa A, D’Agostino R Jr, Wagenknecht LE, et al.
(2002) for the Insulin Resistance Atherosclerosis Study Group. Factor
analysis of metabolic syndrome using directly measured insulin sensitivity:
The Insulin Resistance Atherosclerosis Study. Diabetes 51: 2642-2647.
25. Meigs JB, D’Agostino RB Sr, Wilson PW, Cupples LA, Nathan DM, et al.
(1997) Risk variable clustering in the insulin - resistance syndrome. The
Framingham Offspring Study. Diabetes 46: 1594-1600.
26. Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, et al. (2005) Prognostic
impact of body weight and abdominal obesity in women and men with
cardiovascular disease. Am Heart J 149: 54-60.
27. Ford ES, Mokdad AH, Giles WH (2003) Trends in waist circumference among
US adults. Obes Res 11: 1223-1231.
28. Han TS, Williams K, Sattar N, Hunt KJ, Lean ME, et al. (2002) Analysis of
obesity and hyperinsulinemia in the development of metabolic syndrome: San
Antonio Heart Study. Obes Res 10: 923-931.
29. Boden G, Chen X, Ruiz J, White JV, Rossetti L (1994) Mechanisms of fatty
acid induced inhibition - of glucose uptake. J Clin Invest 93: 2438-2446.
30. Havel PJ (2002) Control of energy homeostasis and insulin action by
adipocyte hormones: Leptin, acylation stimulat ing protein, and adiponectin.
Curr Opin Lipidol 13: 51-59.
31. Matsuzawa Y, Funahashi T, Nakamura T (1999) Molecular mechanism of
metabolic syndrome X: Contribution of adipocytokines adipocyte-derived
bioactive substances. Ann NY Acad Sci 892:146-154.
32. Grundy SM (2004) Genetics, obesity, and the metabolic syndrome: The
Professor Donald S. Fredrickson Memorial Lecture. Proceedings of the 13th
International Symposium. International Congress Series 1262: 19-24.
33. Goossens GH (2008) The role of adipose tissue dysfunction in the
pathogenesis of obesity-related insulin resistance. Physiol Behav 94: 206-
218.
34. Bhanushali CJ, Kumar K, Wutoh AK, Karavatas S, Habib MJ, et al. (2013)
Association between Lifestyle Factors and Metabolic Syndrome,among
African Americans in the United State. J Nutr Metab 516475.
35. Freiberg MS, Cabral HJ, Heeren TC, Vasan RS, Curtis Ellison R, et al. (2004)
Citation: Maluki AH, Abdullah AA (2016) Metabolic Associations with Skin Tags. Int J Dermatol Clin Res 2(1): 003-011.
Maluki and Abdullah (2016)
011
Alcohol consumption and the prevalence of the metabolic syndrome in the
U.S. A cross-sectional analysis ofdata from the Third National Health and
Nutrition Examination Survey, Diabetes Care 27: 2954-2959.
36. Klatsky AL (2004) Alcohol-associated hypertension when one drinksmakes a
difference. Hypertension 44: 805-806.
37. Kong C, Nimmo L, Elatrozy T, Anyaoku V, Hughes C, et al. (2001) Smoking
is associ-ated with increased hepatic lipase activity, insulin resistance,
dyslipidaemia and early atherosclerosis in Type 2 diabetes. Atherosclerosis
156: 373-378.
38. Burns DM (2003) Epidemiology of smoking-induced cardiovascular disease.
Prog Cardiovasc Dis 46: 11-29.
39. Rennie KL, McCarthy N, Yazdgerdi S, Marmot M, Brunner E (2003)
Association of the metabolic syndrome with both vigorous and moderate
physical activity. Int J Epidemiol 32: 600-606.
40. Waller K, Kaprio J, Kujala UM (2008) Associations between long-term
physical activity, waist circumference and weight gain: a 30-year longitudinal
twin study. Int J Obes 32: 353-361.
41. Fung TT, Hu FB, Yu J, Chu NF, Spiegelman D, et al. (2000)
Leisuretimephysical activity, television watching, and plasma biomarkers of
obesity and cardiovascular disease risk. Am J Epidemiol 152: 1171-1178.
42. Skoumas J, Pitsavos C, Panagiotakos DB, Chrysohoou C, Zeimbekis A, et
al. (2003) Physical activity, high density lipoprotein cholesterol and other
lipids levels, in men and women from the ATTICA study. Lipids in Health and
Disease 2: 3.
43. Foster GD, Wadden TA, Vogt RA (1997) Resting Energy expenditure in
obese africanamerican and caucasian women. Obes Res 5: 1-8.
44. Jakicic JM, Wing RR (1998) Differences in resting energy expenditure in
African-American vs Caucasian overweight females. Int J Obes 22: 236-242.
45. El Safoury OS, Ibrahim M (2011) A clinical evaluation of skin tags in relation
to obesity, type 2 diabetis mellitus, age, and sex. Indian J Dermatol 56: 393-
397.
46. Paffenbarger RS Jr, Jung DL, Leung RW, Hyde RT (1991) Physical activity
and hypertension: an epidemiological view. Ann Intern Med 23: 319-327.
47. Burke GL, Savage PJ, Manolio TA, Sprafka JM, Wagenknecht LE, et al.
(1992) Correlates of obesity in young black and Caucasian women: the
CARDIA Study. Am J Public Health 82: 1621-1625.
48. Wolff K, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy
S. Paller, David J. Leffell (2008) -ed. Epidermal and Appendageal Tumors .
Fitzpatrick’s Dermatology in General Medicine. 7th Ed, 1: 1055.
49. Wu DM, Shen MH, Chu NF (2001) Relationship between plasma leptin levels
and lipid proles among school children in Taiwan-the Taipei Children Heart
Study. Eur J Epidemiol 17: 911-916.
50. Crook MA (2000) Skin tags and atherogenic lipid prole. J Clin Pathol 53:
873-874.
51. Erdogan BS, Aktan S, Rota S, Ergin S, Evliyaoglu D (2005) Skin tags and
atherosclerotic risk factors. J Dermatol 32: 371-375.
52. Garg A (2004) Regional adiposity and insulin resistance. J Clin Endocrinol
Metabol 89: 4206-4210.
53. Yaffe K (2007) Metabolic syndrome and cognitive decline. Curr Alzheimer
Res 4: 123-126.
54. Akpanar F, Derves E (2011) Association between acrochordons and the
components of metabolic syndrome. Eur J Dermatol 22: 106-110.
55. Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL (1983) Physical activity and
incidence of hypertension in college alumni. Am J Epidemiol 117: 245-257.
Copyright: © 2016 Maluki and Abdullah. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
... These results are comparable to those of Shenoy et al, Maluki et al. 22,24 However, other studies have found significantly higher fasting plasma glucose in cases compared to controls at significant level. 16,25 In the present study, the prevalence of hypertension was significantly higher in patients with skin tags which is comparable with the results by Sari et al and Senel et al. 25,26 However, Safoury et al, did not observe such difference. 23 The lipid profile status in the study showed significantly higher cholesterol and TG levels and lower HDL levels in cases compared to controls, similar to the observations made by Safoury et al, Sari et al, and Senel et al. 23,26,25 Rasi et al found a positive correlation between the total number of skin tags and the mean fasting plasma glucose. ...
... These results are comparable to those of Shenoy et al, Maluki et al. 22,24 However, other studies have found significantly higher fasting plasma glucose in cases compared to controls at significant level. 16,25 In the present study, the prevalence of hypertension was significantly higher in patients with skin tags which is comparable with the results by Sari et al and Senel et al. 25,26 However, Safoury et al, did not observe such difference. 23 The lipid profile status in the study showed significantly higher cholesterol and TG levels and lower HDL levels in cases compared to controls, similar to the observations made by Safoury et al, Sari et al, and Senel et al. 23,26,25 Rasi et al found a positive correlation between the total number of skin tags and the mean fasting plasma glucose. ...
... 16,25 In the present study, the prevalence of hypertension was significantly higher in patients with skin tags which is comparable with the results by Sari et al and Senel et al. 25,26 However, Safoury et al, did not observe such difference. 23 The lipid profile status in the study showed significantly higher cholesterol and TG levels and lower HDL levels in cases compared to controls, similar to the observations made by Safoury et al, Sari et al, and Senel et al. 23,26,25 Rasi et al found a positive correlation between the total number of skin tags and the mean fasting plasma glucose. 27 Not found any significant association between various skin tag characteristics such as colour, localization, and length with metabolic syndrome on statistical analysis. ...
Article
Full-text available
Background: Metabolic syndrome is a constellation of several clinical and laboratory cardiovascular risk factors that have been linked with numerous medical and dermatologic conditions. Recent evidence suggests a strong association between skin tags and insulin resistance and obesity, yet there is a paucity of data on relation of skin tags with metabolic syndrome as a whole. Aim of the study was to evaluate the strength of association between skin tags and metabolic syndrome.Methods: 70 patients with skin tags and an equal number of age and gender matched controls were enrolled in a hospital-based case control study. Anthropometric measures, blood pressure, fasting glucose, high density lipoprotein cholesterol and triglycerides were measured. Metabolic syndrome was diagnosed by the presence of 3 or more of the south Asian modified national cholesterol education program’s adult panel III criteria. Statistical analysis was performed using chi square test, and odds ratio was calculated. P≤0.05 were considered significant.Results: Metabolic syndrome was significantly more common in patients with skin tags than in controls (70% vs. 26%, p<0.001). Triglycerides and waist circumference values were significantly increased in cases as compared to controls (p<0.05). There was no statistically significant difference in the high-density lipoprotein levels, fasting blood glucose levels and presence of hypertension among cases and controls.Conclusion: Skin tags when present in multiple could be an early warning sign for Metabolic syndrome. They serve a cutaneous marker to initiate early detection and intervention of at-risk patients for cardiovascular disorders.
... Acrochordons, commonly known as skin tags (ST) are common, small, soft, benign connective tissue tumors of the dermis containing loose fibrous connective tissue. 1 They are usually skin coloured or brownish pedunculated papules, which may be single or multiple, with smooth or irregular surface and range from 1 mm to 20 mm in diameter and are usually asymptomatic. 1 The commonest area involved is the neck and the axillae, the less common areas are the eyelids and major flexors of the body. 1 They have anequal incidence in both sexes, with 59 % of the population manifesting them by the age of 70 years. ...
... Acrochordons, commonly known as skin tags (ST) are common, small, soft, benign connective tissue tumors of the dermis containing loose fibrous connective tissue. 1 They are usually skin coloured or brownish pedunculated papules, which may be single or multiple, with smooth or irregular surface and range from 1 mm to 20 mm in diameter and are usually asymptomatic. 1 The commonest area involved is the neck and the axillae, the less common areas are the eyelids and major flexors of the body. 1 They have anequal incidence in both sexes, with 59 % of the population manifesting them by the age of 70 years. 4 The mechanism of ST developing inType 2 Diabetes Mellitus (T2DM)ishyperinsulinemia, which increases insulin-like growth factor-1(IGF-1), thereby causing keratinocyte and fibroblastproliferation. 6 Patients with T2DM or Impaired Glucose Tolerance (IGT)are reported to have a greater number of skin tags as compared to the general population. 2 T2DM is a metabolic disease characterized by hyperglycaemia from a defect in insulin regulation. ...
... 1 The commonest area involved is the neck and the axillae, the less common areas are the eyelids and major flexors of the body. 1 They have anequal incidence in both sexes, with 59 % of the population manifesting them by the age of 70 years. 4 The mechanism of ST developing inType 2 Diabetes Mellitus (T2DM)ishyperinsulinemia, which increases insulin-like growth factor-1(IGF-1), thereby causing keratinocyte and fibroblastproliferation. 6 Patients with T2DM or Impaired Glucose Tolerance (IGT)are reported to have a greater number of skin tags as compared to the general population. 2 T2DM is a metabolic disease characterized by hyperglycaemia from a defect in insulin regulation. ...
Article
Full-text available
INTRODUCTION- Acrochordons [Skin Tag (ST)], are common, small, soft, benign connective tissue tumors of the dermis containing loose fibrous connective tissue. They are usually skin colored or brownish pedunculated papules, may be single or multiple, with smooth or irregular surface, ranging 1 mm to 20 mm in diameter. The ST developing in diabetes mellitus (DM) is due to hyperinsulinemia that is increase in insulin-like growth factor-1 (IGF-1) which leads to keratinocyte and fibroblast proliferation. MATERIALS AND METHODS- Patients presenting with skin tags to the dermatology OPD in Era’s Lucknow Medical College and Hospital from a period of December 2018 to May 2019 were taken into account, 110 cases were enrolled whereas same no. of controls were included in the study. The details of the study were explained to all subjects and informed consent was taken. Detailed history taking and examination was done. The site and number of skin tags was recorded and fasting blood glucose levels of both groups were measured to screen them for DM by WHO criteria (Normal Range <126mg/dl) by venous blood sample taken overnight fasting of 8 hrs. RESULT AND DISCUSSION- Total no. of subjects were 220 (110 cases and 110 controls), out of which 63.6% were males and 36.4% were females with average age of 44.05 yrs. Duration of skin tags ranged from 6 months to 180 months however 85.5% cases had a single skin tag. Multiple skin tags were common in males (21.4%). Family history of skin tags was higher in cases (41.8%) than in controls. Family history of diabetes mellitus was seen in 15.6% cases and 13.6% controls. FBG levels ranged from 68mg/dl to 220mg/dl in cases, and 65mg/dl to 178mg/dl in controls, with a mean value of 123mg/dl (cases) and 115mg/dl(controls). CONCLUSION- Association of Type 2 Diabetes Mellitus (high fasting blood glucose levels) and skin tags was positive in our study. We should encourage patients with skin tags to get their blood glucose levels checked to rule out diabetes mellitus. KEY WORDS- Acrochordons, Skin tags, Diabetes Mellitus
... Agmia et al. and Safoury et al. in contrast to our study, found significant association of skin tags with high TG levels and low HDL levels. [11,13] In the univariate analysis of components of metabolic syndrome, higher waist circumference, high TGs, and low HDL were observed among cases compared to controls (P < 0.05), similar to Shah et al., Safoury et al., and Agamia et al. [10,11,13] Although mean fasting plasma glucose was higher in cases when compared to controls, the difference was not statistically significant which is in accordance with the study by Shenoy et al., Maluki et al.,and Wali et al.[12,14,15] However, other studies have found significantly higher fasting plasma glucose in cases compared to controls at significant level. ...
Article
Full-text available
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Abstract Background:
... Agmia et al. and Safoury et al. in contrast to our study, found significant association of skin tags with high TG levels and low HDL levels. [11,13] In the univariate analysis of components of metabolic syndrome, higher waist circumference, high TGs, and low HDL were observed among cases compared to controls (P < 0.05), similar to Shah et al., Safoury et al., and Agamia et al. [10,11,13] Although mean fasting plasma glucose was higher in cases when compared to controls, the difference was not statistically significant which is in accordance with the study by Shenoy et al., Maluki et al., and Wali et al. [12,14,15] However, other studies have found significantly higher fasting plasma glucose in cases compared to controls at significant level. [10,11,13,16] The prevalence of hypertension was significantly higher in patients with skin tags, in accordance with the results by The lipid profile status in this study showed significantly higher cholesterol and TG levels and lower HDL levels in cases compared to controls similar to the observations made by Safoury et al., Sari et al., and Senel et al. [7,11,16] In contrast, Gorpelioglu et al. found significantly higher total cholesterol and LDL levels in cases compared to controls (P < 0.01). ...
Article
Full-text available
Background Skin tags are benign polyps, usually found in the natural folds of the skin. Some studies have found an association of skin tags with obesity, diabetes, hypertension, and atherogenic lipid profile. Metabolic syndrome refers to co-occurrence of these cardiovascular risk factors such as insulin resistance, obesity, dyslipidemia, and hypertension. Aims and Objectives To find out any possible association of skin tags with metabolic syndrome and its components. Materials and Methods A case–control study was conducted including 140 participants. Seventy patients with skin tags were considered cases, and 70 age- and sex-matched patients without skin tags were considered as controls. Various anthropometric and biochemical parameters were compared and analyzed between the two groups. Results Univariate analysis revealed significantly higher waist circumference, high triglyceride, and low high-density lipoproteins (HDLs) in cases compared to controls. The prevalence of diabetes, hypertension, and metabolic syndrome was significantly higher in patients with skin tags, and risk of developing metabolic syndrome was 11.13 times higher in cases compared to controls (P < 0.05). Multivariate logistic regression analysis revealed high waist circumference and low serum HDL had significant association with skin tags. Conclusion Risk of development of metabolic syndrome is significantly higher in patients with skin tags. Among the various components of metabolic syndrome, only high waist circumference and low serum HDLs are significantly associated with skin tags.
Article
Objectives To determine the association of acrochordons with metabolic syndrome and its components. Materials and Methods A cross-sectional study was conducted in 100 patients with acrochordon and 100 age- and gender-matched controls who attended the dermatology outpatient department of a tertiary care center in South India from January 2017 to December 2017. A detailed dermatological examination was carried out in cases with respect to distribution, number, color, and morphology of acrochordons. Blood pressure (BP), pulse rate, waist circumference, height, weight, and body mass index were recorded in all cases and controls. Fasting lipid profile, fasting blood sugar, liver function test, and renal function test were done in all study participants. A diagnosis of metabolic syndrome was made based on the International Diabetes Federation metabolic syndrome worldwide definition specified for the Asian population. Statistical analysis was done using Pearson’s Chi-square test. Results There were 52 females and 48 males in each group. About 80% of patients belonged to the age group of 20–50 years. A significantly higher number of cases had metabolic syndrome ( P < 0.001). Acrochordons showed a significant association with the components of metabolic syndrome such as high BP ( P < 0.001), high fasting plasma glucose levels ( P < 0.001), and low levels of high-density lipoprotein cholesterol ( P = 0.04). Comparison of cases showed that patients with acrochordons limited to axilla were less likely to have metabolic syndrome in comparison to those who had acrochordons on other body sites with or without involvement of axilla ( P = 0.008). Patients who manifested only sessile lesions were less likely to have metabolic syndrome when compared to those who manifested pedunculated/filiform/pedunculated and filiform lesions ( P < 0.001). Limitations A cross-sectional study design and study carried out in a tertiary referral center were the limitations. Conclusion A significant association was noted between acrochordons and metabolic syndrome.
Article
Full-text available
Background/Aim. Diabetes mellitus (DM) can be associated with numerous skin diseases. This study aimed to determine the pattern and incidence of skin manifestations in patients with type 2 DM and their link to glycemic control. Methods. This cross-sectional study was conducted at the Skin and Venereal Diseases Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, from January 2016 to January 2018. Adult patients of both genders suffering from type 2 DM and cutaneous manifestations participated in the study. Glycemic control was assessed according to the values of glycated hemoglobin (HbA1c) of 7%. Results. The mean age of 105 study participants (46% m ale and 5 4% female) was 6 8.4 ? 10 years, while the mean HbA1c was 8.3 ? 1.6%. Unsatisfactory glycemic control was found in 74.3% of patients with the mean HbA1c at 8.9 ? 1.4%, while satisfactory glycemic control was found in 25.7% of patients, with the mean HbA1c at 6.7 ? 0.2% (p
Article
Full-text available
Background. Although there is a reported association between lifestyle factors and metabolic syndrome, very few studies have used national level data restricted to the African Americans (AAs) in the United States (US). Methods. A cross-sectional evaluation was conducted using the National Health and Nutrition Examination Survey from 1999 to 2006 including men and nonpregnant women of 20 years or older. Multiple logistic regression models were constructed to evaluate the association between lifestyle factors and metabolic syndrome. Results. AA women had a higher prevalence of metabolic syndrome (39.43%) than AA men (26.77%). After adjusting for sociodemographic factors, no significant association was found between metabolic syndrome and lifestyle factors including alcohol drinking, cigarette smoking, and physical activity. Age and marital status were significant predictors for metabolic syndrome. With increase in age, both AA men and AA women were more likely to have metabolic syndrome (AA men: OR(adj) = 1.05, 95% CI 1.04-1.06, AA women: OR(adj) = 1.06, 95% CI 1.04-1.07). Single AA women were less likely to have metabolic syndrome than married women (OR(adj) = 0.66, 95% CI 0.43-0.99). Conclusion. Lifestyle factors had no significant association with metabolic syndrome but age and marital status were strong predictors for metabolic syndrome in AAs in the US.
Article
Full-text available
Skin tags (STs) have been investigated as a marker of type 2 diabetes mellitus (DM), yet the relation of STs to obesity is still a matter of controversy. The aim of the study is to explore the relation of number, size and color of STs to obesity, diabetes, sex and age in one study. The study included 245 nondiabetic (123 males and 122 females) and 276 diabetic (122 males and 154 females) subjects. We recorded age, sex, body mass index (BMI), relevant habits, STs color, size, and number in different anatomical sites. The presence and the mean number of STs was more in obese than nonobese participants (P = 0.006 and P < 0.001, respectively) and was not affected by sex. However, the number increased significantly with age. The presence of mixed-color STs was related to obese (P < 0.001) participants. Multivariate logistic regression revealed that only BMI was significantly associated with the mixed-color STs (OR = 3.5, P < 0.001). The association of DM (OR = 1.7) with mixed-color STs was nonsignificant (P = 0.073). Neither age nor sex had any association with mixed-color STs. Within cases that developed mixed-color STs, the multivariate analysis showed that only BMI had a significant correlation to the number of STs (beta = 0.256, P = 0.034). The study showed that not only the number but also the presence of mixed-color ST was related to obesity, but not to diabetes. The presence of mixed-color STs in nondiabetic subjects needs close inspection of BMI.
Article
The sixth edition of this wellknown textbook contributes significantly to clinical dermatology and represents a major effort by one author to catalogue and discuss approximately 1,400 skin diseases. It is considerably changed, enlarged, and improved over the fifth edition published in 1963. Most impressive are the numerous black and white photographs of excellent quality (899 of which are new to the text), which will aid both novice and experienced dermatologists in disease identification. Accompanying descriptions of diseases vary significantly in quality and detail. Major ailments are generally well covered, although sometimes burdened by ponderous detail and archaic descriptive terminology. Minor conditions and syndromes are often reduced to barest essentials necessary for identification. All diseases are expanded by plentiful references, current to 1969, which are listed by subject at the end of each chapter. Careful and complete indexing aids rapid identification. Organization of the book follows the format of earlier editions
Article
The metabolic syndrome consists of a clustering of metabolic risk factors in one individual. These risk factors consist of atherogenic dyslipidemia (high triglycerides, high apolipoprotein B [apo B], small LDL particles, and low HDL), elevated blood pressure, insulin resistance±elevated plasma glucose, a prothrombotic state, and a proinflammatory state. Although the metabolic syndrome is increasingly common around the world and represents an important cause of cardiovascular disease (CVD), its pathogenesis is not well understood. The two major underlying causes appear to be obesity or other disorders of adipose tissue and insulin resistance. There is little doubt that genetic susceptibility plays an important role in the development of the metabolic syndrome. This paper addresses the question of the interaction between obesity and genetic susceptibility in the etiology of the metabolic syndrome. Genetic susceptibility appears to exist at three levels: within adipose tissue itself, in insulin signaling pathways, and in regulation of individual risk factors. A major research challenge for the future is to unravel the complex genetic architecture that gives rise to the metabolic syndrome once a person becomes obese.
Article
Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S. We used data from 15,454 participants >/=20 years old in National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994) and 4024 participants >/=20 years old from National Health and Nutrition Examination Survey 1999 to 2000. The unadjusted waist circumference increased from 95.3 (age-adjusted, 96.0 cm) to 98.6 (age-adjusted, 98.9 cm) cm among men and from 88.7 (age-adjusted 88.9 cm) to 92.2 (age-adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and >/=70 years old, and women who were Mexican American or of "other" race or ethnicity. These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesity-associated morbidity and mortality in the U.S. can be expected to increase substantially in future years.
Article
Syndrome X is a clinical syndrome in which multiple risks cluster in an individual, and it is a common basis of vascular disease in the industrial countries. The molecular basis of Syndrome X, however, has not been elucidated. We have analyzed body fat distribution using CT scan and have shown that people who have accumulated intra-abdominal visceral fat frequently have multiple risks and vascular diseases. Thus, “visceral fat syndrome” is a clinical entity compatible with Syndrome X. To clarify the molecular mechanism of the disorders in visceral fat syndrome, we analyzed the expressed genes in adipose tissue by a large-scale random sequencing. Unexpectedly, visceral fat expressed a variety of the genes for secretory proteins including various bioactive substances; we designated them adipocytokines. One of them, plasminogen activator inhibitor-1, was overproduced in accumulated visceral fat and might contribute to the development of vascular disease. We have also cloned a novel adipose-specific gene named adiponectin. Adiponectin is a collagen-like plasma protein which has an inhibitory effect on proliferation of vascular smooth muscle cells; its plasma levels are paradoxically decreased in obesity. Adipocytokines may play important roles in the development of the disorders in Syndrome X.
Article
LR: 20061115; JID: 7501160; 0 (Antilipemic Agents); 0 (Cholesterol, HDL); 0 (Cholesterol, LDL); 57-88-5 (Cholesterol); CIN: JAMA. 2001 Nov 21;286(19):2401; author reply 2401-2. PMID: 11712930; CIN: JAMA. 2001 Nov 21;286(19):2400-1; author reply 2401-2. PMID: 11712929; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712928; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712927; CIN: JAMA. 2001 May 16;285(19):2508-9. PMID: 11368705; CIN: JAMA. 2003 Apr 16;289(15):1928; author reply 1929. PMID: 12697793; CIN: JAMA. 2001 Aug 1;286(5):533-5. PMID: 11476650; CIN: JAMA. 2001 Nov 21;286(19):2401-2. PMID: 11712931; ppublish
Article
Skin tags (ST) are common benign tumors of the skin but their etiopathogenesis is not well understood. STs arise in sites subjected to trauma. It was proved that mast cells are recruited to sites of skin trauma and increase their tumor necrosis factor-α (TNF-α) content. STs are linked to obesity and frictional sites, but this has not been studied at the molecular level. We hypothesized that mast cells, TNF-α and its family member, TNF-related apoptosis-inducing ligand (TRAIL) might play a role in the pathogenesis of STs as a response to trauma. A study was done on 15 patients with STs. Two STs and a snip of normal skin were obtained in each subject. We counted the mast cells after Toluidine blue staining. Enzyme-linked immunosorbant assay was used to measure TNF-α level while reverse transcriptase polymerase chain reaction was used to evaluate the level of TRAIL mRNA expression. Mast cell count in all STs was significantly higher than that in control (P=0.0355). There was a highly significant increase in the level of TNF-α in all STs as compared to its level in controls (P<0.0001). Expression of TRAIL mRNA was significantly higher in STs as compared to its expression in controls (P<0.0001). Our study suggests that mast cells, TNF-α and TRAIL may play a role in the pathogenesis of STs.
Article
Background  Acrochordons are common and benign skin tumours. A few studies with contradictory results have been reported regarding the abnormalities of carbohydrate and/or lipid metabolisms in patients with acrochordons. Objectives  We aimed to determine if the presence of acrochordons could be a marker of diabetes, hyperlipidemia, liver enzyme abnormalities and hypertension by comparing with a control group. Methods  A total of 110 patients having two or more acrochordons and age- and gender-matched 110 controls were included in the study. Localization, size and the total number of acrochordons were recorded in the patient group. Fasting plasma glucose (FPG), serum lipids and liver enzyme levels were tested in patient and controls. All participants underwent a standard 2-h oral glucose tolerance test with 75 g glucose. Diabetes mellitus and impaired glucose intolerance were diagnosed according to the American Diabetes Association criteria. Arterial blood pressures were measured in two groups. Results  A total of 56 patients and 10 controls were diagnosed with overt DM. Thirteen per cent of the patients and 9% of controls had an impaired glucose tolerance test. The difference was statistically significant for the diagnosis of DM and not significant for the impaired glucose tolerance. The mean levels of FPG, total cholesterol, LDL cholesterol, triglyceride, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase were significantly higher in patients than those in controls. Furthermore, serum levels of HDL were less in patients. Patients with acrochordons had higher systolic and diastolic blood pressures than controls. Conclusions  The results of our study suggest that acrochordons may represent a cutaneous sign for impaired carbohydrate or lipid metabolism, liver enzyme abnormalities and hypertension.
Article
The aim of this study was to investigate the relationship between acrochordons and the components of metabolic syndrome (MS). A total of 192 patients with at least one skin tag and 104 controls having no skin tag seen at an academic outpatient dermatology clinic were involved. Body mass index (BMI), waist circumference, blood pressure, total cholesterol (TC), triglyceride (TG), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) values were measured. Oral glucose tolerance testing was performed. Patients with acrochordons were 64.6/35.4% female/male. The number of acrochordons was below 10 in 77.1% cases. The most frequent localization was the neck (72.4%). Acrochordons were smaller than 3 mm in 64.1% of the cases. Hypertension, diabetes and MS were significantly more frequent in patients with acrochordons than the control group. The acrochordon group showed significantly higher values of BMI, higher levels of TC, TG and LDL-C and significantly lower levels of HDL-C when compared with the control group. According to regression analysis, the number of acrochordons increased in patients with higher BMI values, 2-h plasma glucose, TC and LDL-C levels and lower HDL-C levels. These results support the suggestion that acrochordons are associated with the components of MS.