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SHORT COMMUNICATION
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 50-52

Skin tags are not merely cosmetic: A study on its association with metabolic syndrome


Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India

Date of Web Publication13-Jan-2016

Correspondence Address:
Manjunath Mala Shenoy
Department of Dermatology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.173882

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  Abstract 

Background: Skin tags (STs) are common benign lesions composed of loose fibrous tissue and occur mainly on the neck and flexures as small, soft protrusions. They are common and are merely considered as a cosmetic problem. However, they have been associated with various clinical conditions and that with metabolic syndrome (MetS) has been a matter of special concern. Objective: To investigate the prevalence of MetS in patients with STs and healthy controls. Materials and Methods: We performed a hospital-based case-control study on 30 adult patients with STs and 30 controls. MetS was diagnosed by the presence of 3 or more of the South Asian Modified National Cholesterol Education Program's Adult Panel III criteria. Results: MetS was significantly more common in STs patients than in controls (70% vs. 30%, P = 0.0019). Psoriatic patients also had a higher frequency of triglyceridemia and abdominal obesity (P < 0.05) There was no significant difference in the fasting blood sugar, high density lipoprotein levels, and presence of hypertension among patients with psoriasis and controls. Conclusion: STs could be considered as a warning sign for MetS and their presence may help in the early detection of at-risk patients for cardiovascular morbidities.

Keywords: Abdominal obesity, metabolic syndrome, skin tags, triglycerides


How to cite this article:
Shenoy C, Shenoy MM, Krishna S, Pinto M. Skin tags are not merely cosmetic: A study on its association with metabolic syndrome. Int J Health Allied Sci 2016;5:50-2

How to cite this URL:
Shenoy C, Shenoy MM, Krishna S, Pinto M. Skin tags are not merely cosmetic: A study on its association with metabolic syndrome. Int J Health Allied Sci [serial online] 2016 [cited 2019 Sep 18];5:50-2. Available from: http://www.ijhas.in/text.asp?2016/5/1/50/173882


  Introduction Top


Skin tags (STs), also known as soft fibromas, fibroepithelial polyps, or acrochordons, are soft, small, skin-colored to dark brown sessile, or pedunculated papillomas commonly occurring on the neck, frequently seen on the axilla and eyelids, and less often on the trunk and groin.[1],[2] The definite etiology of STs is still unknown. Variations in estrogen levels and trophic hormones are believed to be involved in its genesis and development.[3] STs are benign, common, and generally ignored or merely considered as a cosmetic problem. Various methods such as scissors, electrocautery, and lasers are used to excise these lesions. However, they have been found to be associated with various conditions such as acromegaly, colonic polyps, Crohn's disease, diabetes mellitus (DM), and acanthosis nigricans.[4],[5],[6] The metabolic syndrome (MetS) is a cluster of risk factors including obesity, atherogenic dyslipidemia, hypertension, glucose intolerance, and a proinflammatory and prothrombotic state predisposing the patients to cardiovascular diseases (CVD), type 2 DM, renal failure, and stroke.[7] Some studies have shown an association between STs and MetS.[1],[8],[9] As per our knowledge, there are only a few studies and only one Indian study reported till date.[4] Hence, the present study is a preliminary study designed to evaluate the presence of MetS in patients with STs and healthy controls, guided by the South Asian Modified National Cholesterol Education Programme Adult Treatment Panel III (SAM-NCEP ATP III) criteria.[10]


  Materials and Methods Top


The study was conducted in the Department of Dermatology, Yenepoya Medical College hospital, Yenepoya University, Deralakatte, Mangalore, Karnataka, India, after the study was approved by the University Ethics Committee.

Sampling

It was a hospital-based case-control study. Thirty patients with STs above the age of 18 years, and 30 age- and sex-matched participants who had no STs at the time of examination and had no prior history of having STs (control) were studied. Patients with acute febrile illness, active systemic diseases/events, and individuals with prior history of taking medications for DM or dyslipidemia were excluded from the study.

Clinical assessment

An informed consent was taken from the patients and controls willing to participate in the study. The detailed history was taken. Number, size, and site of STs was examined and evaluated in all the patients. Clinical examination included measurement of height, weight, waist circumference, and blood pressure. All patients and controls underwent the following laboratory tests, which included serum fasting glucose levels and lipid profile after overnight fasting.

MetS was diagnosed using the SAM-NCEP ATP III criteria.[10],[11] According to the criteria, if three or more of the following were present, the patient was diagnosed as having MetS: Abdominal obesity (definition of abdominal obesity was modified using the Asia Pacific World Health Organization guidelines as waist circumference ≥90 cm for males and ≥80 cm for females), blood pressure ≥130/85 mmHg, fasting blood glucose ≥100 mg/dl, hypertriglyceridemia >150 mg/dl, or low high density lipoprotein (HDL) cholesterol (<40 mg/dl for males and <50 mg/dl for females).

Statistical analysis

Student's unpaired t-test was used for the comparison of groups and Chi-square test for comparison of proportions. P < 0.05 was considered significant.


  Results Top


The number of STs in our study ranged from 2 to 35. They were mostly found on the neck, axillae, back, and less often on the eyes and face. The mean values of the components of MetS for the control and STs patient groups were found as presented in [Table 1]. Serum triglyceride and waist circumference were found to be significantly higher in ST group than in control group (P < 0.05). Fasting blood sugar levels were higher, and serum HDL levels were lower in the patient group compared to controls but were not statistically significant.
Table 1: Comparisons of components of MetS between controls and ST patients group

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We also analyzed the individual components of MetS in patients with STs and in the control group. Individual components of MetS such as hypertriglyceridemia and abdominal obesity were also more prevalent in cases than in controls (P < 0.05) [Table 2]. MetS was statistically more prevalent in patients with STs when compared to the controls. In the STs group, 21 (70%) patients had MetS, whereas in the control group, only 9 (30%) had MetS (P = 0.0019) [Table 3].
Table 2: Analysis of components of MetS between control and STs groups

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Table 3: MetS in cases and controls

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  Discussion Top


STs are considered as a part of aging process and are commonly found on the neck and in the axillae. They might reflect insulin resistance states.[12] Obesity has been associated with STs, and their prevalence is correlated positively with the severity of the obesity.[13] MetS is a strong predictor of CVD, diabetes, and stroke and significantly increases the risk of cardiovascular mortality compared with the individual factors.[7] There is increasing interest to obtain a greater understanding of the modifiable factors that may mitigate or moderate the progression of MetS leading toward its development.[14]

Insulin resistance is an important risk factor in the development of MetS. Hyperinsulinemia and insulin resistance has also been found to be significantly higher in STs patients compared with controls. There have been studies in the literature on the association between STs, atherogenic lipid profiles, and MetS. However, these results are conflicting.[1],[14],[15] A case-control study from India by Shah et al. on acrochordons as a marker of MetS on 110 patients and 110 age- and gender-matched controls showed that acrochordons may represent a cutaneous sign for MetS. However, MetS was diagnosed using the International Diabetes Federation criteria in the study.[4] In our study, we found a higher prevalence of MetS in cases than in controls with P < 0.0019. Individual components of MetS such as hypertriglyceredemia and abdominal obesity were also significantly more common in cases than in controls [Table 2]. When the mean values of the components of MetS for the control and ST patient groups were compared, we found that serum triglyceride and waist circumference were found to be significantly higher in ST group than in control group (P < 0.05) [Table 1].

The prevalence of MetS is about 30–40% in the Indian population, with a higher prevalence in South India.[11] As per our knowledge, this is the first study on the association of MetS in the South Indian patients with STs and the second such study from India.[4]


  Conclusion Top


Significantly higher prevalence of MetS in patients with STs in our study, suggests that STs could be considered as a warning sign for MetS and their presence may help in the early detection of at-risk patients with the possibility of early diagnosis and treatment. However, further studies with a larger sample size are warranted in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Agamia NF, Gomaa SH. Assessment of serum leptin, atherogenic lipids, glucose level, insulin resistance and metabolic syndrome in patients with skin tags. Egypt J Dermatol Venerol 2014;34:58-64.  Back to cited text no. 1
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El Safoury OS, Ezzat M, Abdelhamid MF, Shoukry N, Badawy E. The evaluation of the impact of age, skin tags, metabolic syndrome, body mass index, and smoking on homocysteine, endothelin-1, high-sensitive C-reactive protein, and on the heart. Indian J Dermatol 2013;58:326.  Back to cited text no. 2
    
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Tamega Ade A, Aranha AM, Guiotoku MM, Miot LD, Miot HA. Association between skin tags and insulin resistance. An Bras Dermatol 2010;85:25-31.  Back to cited text no. 3
    
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Shah R, Jindal A, Patel N. Acrochordons as a cutaneous sign of metabolic syndrome: A case-control study. Ann Med Health Sci Res 2014;4:202-5.  Back to cited text no. 4
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Kahana M, Grossman E, Feinstein A, Ronnen M, Cohen M, Millet MS. Skin tags: A cutaneous marker for diabetes mellitus. Acta Derm Venereol 1987;67:175-7.  Back to cited text no. 6
    
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Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case-control study. Br J Dermatol 2007;157:68-73.  Back to cited text no. 7
    
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Shaheen MA, Abdel Fattah NS, Sayed YA, Saad AA. Assessment of serum leptin, insulin resistance and metabolic syndrome in patients with skin tags. J Eur Acad Dermatol Venereol 2012;26:1552-7.  Back to cited text no. 8
    
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El Safoury OS, Abdel Hay RM, Fawzy MM, Kadry D, Amin IM, Abu Zeid OM, et al. Skin tags, leptin, metabolic syndrome and change of the life style. Indian J Dermatol Venereol Leprol 2011;77:577-80.  Back to cited text no. 9
    
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Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: A population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr 2007;2:267-75.  Back to cited text no. 10
    
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Madanagobalane S, Anandan S. Prevalence of metabolic syndrome in South Indian patients with psoriasis vulgaris and the relation between disease severity and metabolic syndrome: A hospital-based case-control study. Indian J Dermatol 2012;57:353-7.  Back to cited text no. 11
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Sari R, Akman A, Alpsoy E, Balci MK. The metabolic profile in patients with skin tags. Clin Exp Med 2010;10:193-7.  Back to cited text no. 12
    
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Idris S, Sunitha S. Assessment of BMI, serum leptin levels and lipid profile in patients with skin tags. J Clin Diagn Res 2014;8:CC01-3.  Back to cited text no. 13
    
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Xiao J, Huang JP, Xu GF, Chen DX, Wu GY, Zhang M, et al. Association of alcohol consumption and components of metabolic syndrome among people in rural China. Nutr Metab (Lond) 2015;12:5.  Back to cited text no. 14
    
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Rasi A, Faghihi A, Rahmanzadeh Y, Hassannejad H. A comparison study of lipid profile levels between skin tags affected people and normal population in Tehran, Iran. Adv Biomed Res 2014;3:109.  Back to cited text no. 15
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  [Table 1], [Table 2], [Table 3]



 

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