Acrochordon Clinical Presentation

Updated: Jun 02, 2017
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Acrochordons are flesh-colored pedunculated lesions that tend to occur in areas of skin folds. A family history sometimes exists of acrochordons. These tumors are usually asymptomatic, and they do not become painful unless inflamed or irritated. Patients may complain of pruritus or discomfort when an acrochordon is snagged by jewelry or clothing.

Acrochordons may occur at unusual sites of the body. A huge acrochordon has been described on the penis. [8] A lymphedematous acrochordon of the glans penis unassociated with condom catheter use also has been described. [9] Another large one was noted on vaginal labia of a 27-year-old woman. [10] An acrochordon may be associated with vulval itching without the symptom being the result of fungal infection. [11] Endoscopy may reveal FEPs arising in a ureter. [12]

Multiple skin tags are often linked with type 2 diabetes mellitus and with obesity, prompting a study of 58 people with skin tags. It showed that people with skin tags had significantly higher serum cholesterol and lower density lipoprotein levels, but not serum leptin levels, when compared with a healthy control group lacking skin tags. [13]

Acrochordons show a statistically significant relationship with obesity. [14]

Acrochordons have been linked with the components of the metabolic syndrome, [15, 16] representing a cutaneous sign for impaired carbohydrate or lipid metabolism, liver enzyme abnormalities, and hypertension. [17] One survey from 2016 linked acrochordons with elevated serum triglyceride, low-density lipoprotein, very-low density lipoprotein, and leptin levels. [18] It was suggested that people with multiple acrochordons should be encouraged to reduce their weight, stop smoking, and practice healthy dietary habits.

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Physical Examination

Skin tags may occur singly or multiply, and they are most often found in intertriginous areas (eg, axillae, neck, eyelids) (see the image below). They are also commonly located on the trunk, the groin, the abdomen, and the back.

A 53-year-old man with multiple, small, axillary s A 53-year-old man with multiple, small, axillary skin tags.

FEPs of the oral mucosa, anus, and vulvovaginal areas may be found. These lesions may be flesh colored or hyperpigmented. Pedunculated lesions may become twisted, infarcted, and fall off spontaneously.

Three types of acrochordons are described, as follows:

  • Small, furrowed papules of approximately 1-2 mm in width and height, located mostly on the neck and the axillae
  • Single or multiple filiform lesions of approximately 2 mm in width and 5 mm in length occurring elsewhere on the body
  • Large, pedunculated tumor or nevoid, baglike, soft fibromas that occur on the lower part of the trunk

Giant acrochordons garner considerable attention, producing considerable discomfort for patients when located in the axillae and genital regions. [24, 25, 26]

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Causes

Frequent irritation seems to be an important causative factor, especially in persons who are obese. An opinion also exists that acrochordons are simply the effect of skin aging, with many factors responsible for their development. Hormone imbalances may facilitate the development of acrochordons (eg, high levels of estrogen and progesterone during pregnancy, high levels of growth hormone in acromegaly). Epidermal growth factor (EGF) and alpha tissue growth factor (TGF) have also been implicated in the development of tumors such as these. Whether any infective factors initiate acrochordon growth is still not clear.

Human papillomavirus (HPV) types 6/11 DNA were 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. [19]

Acrochordons associated with fibrofolliculomas and trichodiscomas have been described as components of BHD syndrome, an autosomal dominant disorder. They 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 acrochordon growth into the circulation. The results of a recent study refute the theory that an association of acrochordons and colonic polyps actually exists.

An association with type 2 diabetes mellitus has been observed. [20, 21, 22] 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 effect of insulin and glucose starvation. [23] The previous study showed no correlation between the location, size, color, or number of acrochordons with impairment of glucose tolerance.

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