|Year : 2013 | Volume
| Issue : 1 | Page : 18-21
Study of the possible relationship between skin tags and obesity in Egypt
Khaled M El-Zawahry, Mohamed A.R. Abdallah, Heba E Elmahdy
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
|Date of Submission||01-Apr-2013|
|Date of Acceptance||01-May-2013|
|Date of Web Publication||23-Jun-2014|
Khaled M El-Zawahry
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University, 15566 Cairo
Source of Support: None, Conflict of Interest: None
Skin tags have been investigated as a marker of type 2 diabetes mellitus; however, the relationship between skin tags and obesity is still a matter of controversy.
The aims of this study were to highlight the association between obesity and the presence of skin tags and to study the impact of carbohydrate intolerance on the prevalence of skin tags among patients attending the Dermatology Clinic in Cairo, Egypt.
This study included 170 patients with skin tags and 75 controls. We recorded age; sex; BMI; random blood glucose; and skin tag color, size, and number at different anatomical sites.
There was no correlation between the presence of skin tags and age (P>0.05). The prevalence of skin tags was detected more often among male (68%) than among female participants (32%); this was statistically significant (P<0.05). They were detected more often among obese (87%) than among nonobese (13%) participants; this was statistically significant (P<0.05). The mean number of skin tags was significantly higher among obese (1032 skin tags, 95%) than among nonobese (52 skin tags, 5%) participants; this was statistically significant (P<0.05). Skin tags were higher among diabetic (60.5%) than among nondiabetic (39.5%) participants; this was statistically significant (P<0.005).
Skin tags are commonly among male patients and their expression is believed to be correlated with obesity as most patients showed an increase in BMI and have hyperglycemia.
Keywords: BMI, diabetes mellitus, skin tags
|How to cite this article:|
El-Zawahry KM, Abdallah MA, Elmahdy HE. Study of the possible relationship between skin tags and obesity in Egypt. Egypt J Dermatol Venerol 2013;33:18-21
|How to cite this URL:|
El-Zawahry KM, Abdallah MA, Elmahdy HE. Study of the possible relationship between skin tags and obesity in Egypt. Egypt J Dermatol Venerol [serial online] 2013 [cited 2020 May 28];33:18-21. Available from: http://www.ejdv.eg.net/text.asp?2013/33/1/18/135109
| Introduction|| |
Skin tags are common cutaneous lesions of unknown etiology. They are small, flesh colored to dark brown, pinhead-sized, sessile or pedunculated papillomas commonly occurring on the neck. They are often seen in the axillae and on the eyelids and less often on the trunk or groin 1 2. Skin tags of the oral mucosa 1, vulvovaginal areas 2, and the foot may also be found 3. Both sexes have the same incidence, with nearly 60% of individuals acquiring them by the age of 60 years 4. Some studies have suggested that there is an association between skin tags and diabetes mellitus 5, hormonal imbalance 6, obesity 7, and an elevated lipid profile 8.
The incidence of obesity is increasing at an alarming rate not only in industrial countries but also in developing countries, where it coexists with malnutrition. The WHO considers obesity to be a global epidemic and a serious health problem. At least 300 million deaths every year in the USA alone can be linked to obesity 9. There are ∼350 million obese people and over 1 billion overweight people in the world according to the WHO. In Egypt, the prevalence of obesity is 46.6% in the age group 15–49 years according to a demographic and health survey 10. The effect of obesity on skin has received minimal attention, despite its high impact on clinical dermatology. In everyday practice, we have observed a relationship between the number and severity of skin tags; this is in accordance with previous studies such as the study by Motala et al. 11 and the study by Bhargara et al. 12; however, evidence for such a relationship is still lacking in the literature.
The aim of this study is to highlight the association between obesity and the presence of skin tags and to study the impact of carbohydrate intolerance on the prevalence of skin tags.
| Patients and methods|| |
A total of 170 patients with skin tags were recruited from the Dermatology Clinics of Ain Shams University Hospital and Kobry el Kobba Military Hospital after obtaining their consent to participate in this study. The patients were chosen at random, regardless of age; sex; or site, size, or number of skin tags. A total of 75 apparently normal individuals without any medical complaint, including medical staff and other hospital workers, were selected at random as controls. All participants were subjected to the following assessments:
- Full medical history taking, including name, age, sex, occupation, marital status, special habits (e.g. smoking, alcohol consumption), history of drug intake, and family history of obesity and skin disease.
- Anthropometric measurements, including measurement of BMI [calculated as body weight in kilograms (kg) divided by the square of the body height in meters (m2)]. A scale is used to measure body weight with an accuracy of ±100 g. Standing body height is measured using a commercial stadiometer to the nearest 0.5 cm.
- Dermatological clinical examination, including examination of the scalp, hair, nails, face, neck, flexures, trunk, and extremities.
- Measurement of random blood glucose after an overnight or 8-h fast.
| Statistical analysis|| |
Data were analyzed using SPSS (version 15; SPSS Inc., Chicago, Illinois, USA). The Mann–Whitney and Kruskal–Wallis tests were used for comparing data; the correlation between skin tags and other parameters was assessed using Spearman’s correlation test. P-value less than 0.05 was considered significant and P-value less than 0.0001 was considered highly significant.
| Results|| |
A total of 170 patients with skin tags were included in this study; their age ranged from 20 to 79 years, with a median [interquartile range (IQR)] of 42.105 (40.82–63.26) years. The study included 116 men and 54 women. The total number of skin tags in all participants was 1084, ranging from 1 to 21 skin tags in each patient [median (IQR) of 8 (4.00–10.00)]. The sites of presentation of skin tags are as follows: the neck (112 patients with 650 skin tags, 60%), the axillae (34 patients with 218 skin tags, 20%), under the breast (17 patients with 162 skin tags, 15%), and the back (seven patients with 54 skin tags, 5%). It was observed that skin tags are most common in the neck and the axillae as these are the most common sites for friction both in obese and nonobese individuals. The size of the skin tags ranged from 4 to 7 mm. None of the patients had a history of pruritus.
BMI ranged from 25 to 45, with a median (IQR) of 30 (27.25–35.00); 61patients (35%) were overweight and 88 (51%) were obese. There number of skin tags was higher in obese patients (590 skin tags, 55%) than in overweight (442 skin tags, 41%) or normal weight patients (52 skin tags, 4%).
Random blood glucose levels ranged from 70 to 330 mg/dl, with a median (IQR) of 141 mg/dl (101.75–257.75) [23 patients (13%) were prediabetic, with blood glucose levels of 100–125 mg/dl after an overnight or 8-h fast; 36 patients (21%) were diabetic, with random blood glucose levels >200 mg/dl; and 111 patients (65%) were normal]. Family history of skin tags was positive in 32 patients (18.82%), whereas it was negative in 138 patients (81.17%) [Table 1].
|Table 1: Distribution of patients according to different studied parameters|
Click here to view
As regards the presence of skin tags, there was no correlation between the presence of skin tags and age (P>0.05). Skin tags were more prevalent among men (116, 68%) than among women (54, 32%); this was statistically significant (P<0.05).
Skin tags were more prevalent among obese (149 patients, 87%) than among nonobese (21 patients, 13%) participants; this was statistically significant (P<0.05). The mean number of skin tags was significantly higher among obese (1032 skin tags, 95%) than among nonobese (52 skin tags, 5%) participants; this was statistically significant (P<0.05; [Table 2]. In addition, the prevalence of skin tags was significantly higher among diabetic (60.5%) than among nondiabetic participants (39.5%; P<0.005; [Table 3].
|Table 2: Correlation between the number of skin tags and BMI of the patients and controls|
Click here to view
|Table 3: Correlation between the presence of skin tags and random blood glucose levels of patients|
Click here to view
| Discussion|| |
Skin tags are small, flesh colored to dark brown, sessile or pedunculated papillomas commonly occur on the neck; they are frequently seen in the axilla and eyelids and are less often seen on the trunk and groin 13. They are usually asymptomatic and do not become painful unless inflamed or irritated 14. Adams and Mutasim 4 found skin tags to be histopathologically characterized by a hyperplastic epidermal covering, papillomatosis, hyperkeratosis, acanthosis, and the presence of upper dermal chronic inflammatory cellular infiltrate. The objective of our study was to detect a possible relationship between skin tags and obesity in the Egyptian society.
A total of 170 participants were subjected to full dermatological examination, BMI measurement, and random blood glucose estimation. Nearly 68% of skin tags in our study were detected in men compared with 32% in women, which indicates increased prevalence of skin tags among men than among women, although equal prevalence of skin tags among both men and women has been reported by Emir et al. 15.
The sites of presentation of skin tags, arranged in decreasing order of their frequency, are as follows: the neck (112 patients with 650 skin tags, 60%), the axillae (34 patients with 218 skin tags, 20%), under the breast (17 patients with 162 skin tags, 15%), and the back (seven patients with 54 skin tags, 5%). This frequency is in accordance with the findings of Carey and Bird 16, who reported that skin tags are most often found in intertriginous areas (e.g. axillae, neck, eyelids, trunk, groin, abdomen, and back).
Skin tags are usually asymptomatic; patients commonly complain of the tags themselves or pigmentation and/or itching 17. The main complaint of our patients was the skin tags; they had no history of pruritus.
In our study, the mean number of skin tags increased with age until it reached a peak value, it then declined (between 51 and 60 years in the diabetic and the nonobese groups and between 41 and 50 years in the nondiabetic group), except for in the obese group in which it continued to rise with age [Table 4]. The decline in the number of skin tags was also reported by Thappa 18 in a study carried out on 35 patients with skin tags. He reported that the risk of developing new skin tags increased with age and decreased after the fifth decade. In another study on skin tag incidence in 750 patients, Banik and Lubach 19 reported that age of 50 years appears to be the turning point at which a stagnation of increase is observed.
|Table 4: Correlation between the presence of skin tags and age of the patients|
Click here to view
A positive family history for skin tags was observed in 32 (18.82%) of our patients, which agrees with the results of Rasi et al. 20, who reported positive family history in 44% of patients with skin tags.
In our study, as regards BMI, 21 patients (25 tags) were of normal weight, 61patients (442 tags) were overweight, and 88 patients (590 tags) were obese. Skin tags could develop more commonly in overweight or obese people because of the increased skin-to-skin contact and friction, as indicated by Stoppler and William 21. This finding is in agreement with the results of Puneet and Deepak 12, who reported an association between skin tags and obesity; it is also in accordance with the results of Garcia-Hidalgo et al. 7, who studied 156 obese patients and found that the percentage of those with skin tags increased with severity of obesity. In addition our results are in accordance with the findings of Sari et al. 22, who found that 38/113 (33.6%) patients with skin tags were obese; in contrast, they contradict the results of Kahana et al. 23, who showed no association between skin tags and increased incidence of obesity, compared with the general population (as this was a single group study without controls). The number of skin tags was significantly related to the BMI: the number of skin tags in obese individuals was higher than that in nonobese individuals, as indicated by Puneet and Deepak 12.
The result of this study showed 21% of our patients were diabetic and 13% were prediabetic. These rates of incidence of diabetes are lesser than those reported in other studies (62% in the study by Thappa 18 and 75% in the study by Demir and Demir 5]. A relationship between skin tags and diabetes mellitus has been reported in a previous study by Bahgat and Safory 24, who reported that the tissue expression of insulin-like growth factor in skin tags of obese patients was 2093.3 ng/g, whereas it was 829.3 ng/g in skin tags of diabetic patients.
| Conclusion|| |
Skin tags seem to be associated with obesity as all our patients showed abnormally increased BMIs and were hyperglycemic. They are more common among men.
| References|| |
|1.||Nadershahi NA, Wescott WB, Egbert B.Birt-Hogg-Dube syndrome: a review and presentation of the first case with oral lesions.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:496–500. |
|2.|| Brun G.Vulvar tumefactions.Rev Prat 1997;47:1651–1654. |
|3.|| Menn JJ, Boberg J.Fibroepithelial polyps. An unusual case report.J Am Podiatr Med Assoc 1990;80:496–498. |
|4.|| Adams BB, Mutasim DF.Elastic tissue in fibroepithelial polyps.Am J Dermatopathol 1999;21:446–448. |
|5.|| Demir S, Demir Y.Acrochordon and impaired carbohydrate metabolism.Acta Diabetol 2002;39:57–59. |
|6.|| Ginarte M, García-Caballero T, Fernández-Redondo V, Beiras A, Toribio J.Expression of growth hormone receptor in benign and malignant cutaneous proliferative entities.J Cutan Pathol 2000;27:276–282. |
|7.|| García-Hidalgo L, Orozco-Topete R, Gonzalez-Barranco J, Villa AR, Dalman JJ, Ortiz-Pedroza G.Dermatoses in 156 obese adults.Obes Res 1999;7:299–302. |
|8.|| Crook MA.Skin tags and the atherogenic lipid profile.J Clin Pathol 2000;53:873–874. |
|9.|| World Health Organization. Obesity and Overweight Facts. Available at: http://www.who.int.diet physical activity/publications/facts/obesity/en/index.html [Accessed 12 June 2008]. |
|10.|| .WHO Global InfoBase Egypt. Most recent national survey(s) for chronic, non communicable disease risk factors 2005 WHO. |
|11.|| Motala AA, Pirie FJ, Gouws E, Amod A, Omar MA.High incidence of type 2 diabetes mellitus in South African Indians: a 10-year follow-up study.Diabet Med 2003;20:23–30. |
|12.|| Bhargava P, Mathur SK, Mathur DK, Malpani S, Goel S, Agarwal US, Bhargava RK.Acrochordon, diabetes and associations.Indian J Dermatol Venereol Leprol 1996;62:226–228. |
|13.|| Chiritescu E, Maloney ME.Acrochordons as a presenting sign of nevoid basal cell carcinoma syndrome.J Am Acad Dermatol 2001;44:789–794. |
|14.|| Rathbun ED.A method for removing the acrochordon (skin tag).Kans Med 1990;91:11–12. |
|15.|| Emir L, Ak H, Karabulut A, Ozer E, Erol D.A huge unusual mass on the penile skin: acrochordon.Int Urol Nephrol 2004;36:563–565. |
|16.|| Carey RI, Bird VG.Endoscopic management of 10 separate fibroepithelial polyps arising in a single ureter.Urology 2006;67:413–415. |
|17.|| Odom RB, James WD, Berger T Odom RB, James WD, Berger T.Skin disease diagnosis treatment.Andrews’ diseases of the skin: clinical dermatology 2000.Philadelphia:Saunders;473–525. |
|18.|| Thappa DM.Skin tags as markers of diabetes mellitus: an epidemiological study in India.J Dermatol 1995;22:729–731. |
|19.|| Banik R, Lubach D.Skin tags: localization and frequencies according to sex and age.Dermatologica 1987;174:180–183. |
|20.|| Rasi A, Soltani-Arabshahi R, Shahbazi N.Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case–control study.Int J Dermatol 2007;46:1155–1159. |
|21.|| Stoppler MC, Williams CS.Skin tags.eMedicine Health 2009;1081:1–53. |
|22.|| Sari R, Akman A, Alpsoy E, Balci MK.The metabolic profile in patients with skin tags.Clin Exp Med 2010;10:193–197. |
|23.|| Kahana M, Grossman E, Feinstein A, Ronnen M, Cohen M, Millet MS.Skin tags: a cutaneous marker for diabetes mellitus.Acta Derm Venereol 1987;67:175–177. |
|24.|| Bosseila M, Shaker O.The tissue expression of insulin-like growth factor (IGF-I) in acrochordons.J Egypt Women’s Dermatol Soc 2007;4:57–62. |
[Table 1], [Table 2], [Table 3], [Table 4]