PCOS Skin Tags: Why They Cluster Where They Do and What Removes Them

Why skin tags cluster where they do

Skin tags — acrochordons — appear overwhelmingly in one place. A study comparing 192 people with at least one acrochordon against 104 people with none found the neck was the most frequent site, accounting for 72.4% of cases, with most people (77.1%) having fewer than ten tags and most individual tags (64.1%) smaller than 3mm. The same folds that develop acanthosis nigricans — neck, armpits, groin — are where skin tags cluster too, because the mechanism overlaps: elevated insulin and insulin-like growth factor stimulate fibroblast and keratinocyte growth, and friction-prone, moist skin folds are where that stimulated growth becomes visible fastest.

Is a skin tag actually a sign of insulin resistance?

Yes, and the association holds up across more than one study design. A cross-sectional study comparing 98 people with more than five neck or armpit skin tags against 103 controls found skin tags were associated with elevated HOMA-IR — the standard insulin resistance measure with an odds ratio of 1.4 overall, rising to an odds ratio of 7.5 for markedly elevated HOMA-IR above 3.8, independent of diabetes status, age, or family history. A separate 2025 study of 150 people with acrochordons found a statistically significant association with diabetes mellitus (p=0.0073), with an odds ratio of 1.89 — meaning a person with skin tags carried close to double the odds of having diabetes compared with a matched person without them. The original 192-person acrochordon study found hypertension, diabetes and metabolic syndrome all significantly more common in the group with tags than in the tag-free control group.

Why they show up specifically with PCOS

A study evaluating androgen-dependent skin findings in PCOS patients recorded skin tags alongside acne, hirsutism, androgenic alopecia and acanthosis nigricans as part of the same cluster of cutaneous findings tied to PCOS’s hormonal and metabolic profile. The two skin findings most often travel together: someone who develops acanthosis nigricans in a fold frequently develops skin tags in the same fold within the following months, because both are downstream of the identical elevated-insulin signal acting on the same patch of skin.

This does not mean every PCOS phenotype gets skin tags at the same rate. Insulin resistance is more pronounced in some PCOS presentations than others, and skin tags track with the degree of insulin resistance itself rather than with a PCOS diagnosis as a single category. A lean PCOS phenotype with mild insulin resistance may have none at all, while a phenotype with marked hyperinsulinemia can have dozens clustered at the neck alone — which is exactly why the number and location of tags is a more useful clue to discuss with a doctor than whether you have PCOS at all.

What actually removes them

A skin tag does not resolve on its own the way a temporary skin irritation might, and removal is a procedural decision, not a skincare one. The two most directly compared methods in a randomized trial are scissor excision and laser.

The trial’s own conclusion favored scissor excision as the higher-healing, lower-pain, more-preferred option overall, despite the laser’s bloodless, dressing-free procedure being a real advantage for some patients — its drawback was that treated tags could stay visibly necrotic for up to three weeks before fully clearing. Cryotherapy and electrodesiccation are the other two standard in-office options a dermatologist may offer; both work in minutes but carry a higher risk of temporary hypopigmentation or scarring than a clean scissor excision.

What removal will not fix

Removing a skin tag is a cosmetic and comfort decision — it does not touch the metabolic picture behind it. It will not lower a HOMA-IR score, does not substitute for a fasting insulin or glucose test, and does not reduce future diabetes risk on its own. If you have several tags clustered at your neck or armpits, that pattern is worth mentioning alongside a request for the insulin resistance panel rather than treating it as a purely cosmetic finding — and if acanthosis nigricans is showing up in the same folds, both are pointing at the same underlying number.

Your next step

If the tags themselves bother you, a dermatologist’s scissor excision is the option with the strongest healing and satisfaction data behind it. If the real question is what having several of them means, insulin resistance and what actually moves it is the more useful page to read next — the tags are a symptom worth noticing, not the problem worth treating in isolation.