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.
Aim:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
Keywords: Age, diabetes mellitus, obesity, sex, skin tags
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Introduction
Obesity and impaired glucose tolerance (IGT) are high risk factors for developing diabetes mellitus (DM). IGT is characterized by plasma glucose response to an oral glucose challenge that is above normal but not at the level defining DM. Individuals with IGT manifest abnormalities in both insulin action and early insulin secretion, similar to those seen in patients with type 2 DM.[1] Obesity and a high fat diet may contribute to the development of both insulin resistance and insulin secretory dysfunction in susceptible individuals.[1] Currently, there are no clear parameters to identify the patients with IGT or obesity who proceed on to DM.
Skin tags (STs), soft fibromas, fibroepithelial polyps, or acrochordons are all alternative terms to describe a common benign skin condition, which consists of a bit of skin projecting from the surrounding skin.[2] Histologically, STs is a polypoid lesion with overlying mildly acanthotic epidermis, a loose, edematous fibrovascular core exhibiting mild chronic inflammation and a nerveless dermis.[3] They often develop in areas of skin friction.[4] STs have been reported to be associated with many diseases including type 2 DM[5–7] and obesity.[8,9] STs have been investigated as a cutaneous marker for type 2 DM and obesity by measuring glucose curve, body mass index (BMI)[5,10] and insulin level.[11,12]
Although the relation of STs to insulin resistance and type 2 DM was established in previous studies,[11] further studies are warranted in the area of obesity and STs.[13] Thus, to explore this area, the relation of the number, size and color of STs to obesity, diabetes, sex and age will be analyzed in one study.
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Material and Methods
This study was conducted in a university hospital. The total number of participants was 521. The nondiabetic group included 245 participants from the outpatient clinic of dermatology [123 (50.2%) males and 122 (49.8%) females]. The diabetic group, including 276 participants (type II DM receiving oral hypoglycemic tablets), were from outpatient clinic of DM (122 (44.2%) males and 154 (55.8%) females.
History taking highlighted age, sex, marital status, family history of diabetes, and history of cardiac, hepatic, gastrointestinal or endocrinal disorders, other than DM. Individuals with an associated medical condition were excluded from the study (including pregnant women). Fasting blood glucose for the nondiabetic group was estimated to exclude occult diabetes. BMI was calculated for all cases according to the following equation:[14] BMI = [weight (kg)] / [height(m)]2. The internationally accepted range for BMI is as follows: underweight <18 .5="" 18.5="" 25.0="" 30.0="" and="" extreme="" normal="" obesity="" overweight="">40.
Number, size, site and color of STs were examined and evaluated in all the participants [Table 1]. The following classification parameters were used (modified from Kahana et al.).[5] Number: Few (1–4), moderate (5–10) and many (>10). Size: Very early (visible not felt), small (projection of <0 .5="" and="" cm="" large="" medium="">1 cm). Site: Eyelids (right–left), neck (right–left), axilla (right–left), trunk (right–left). Color: Flesh color, hyperpigmented or of a mixed color. Mixed-color STs means the presence of both colors, i.e., flesh and hyperpigmented STs in the same anatomical area as in the neck, or in the axillae [Figure 1].
Table 1
Table 1
Number and percent of the studied population including males, females, nonobese, obese, nondiabetics, diabetics, STs prevalence and STs color
Figure 1
Figure 1
The mixed-color STs in neck
These parameters of STs were compared in the diabetics and obese versus the nondiabetics, nonobese. Data were statistically described in terms of range, mean ± standard deviation (±SD), frequencies (number of cases) and relative frequencies (percentages). Comparison of quantitative variables between the study groups was done using Student's t test for independent samples. For comparing categorical data, Chi square (χ2) test was performed. Exact test was used instead when the expected frequency was less than 5. Correlation between various variables was done using Pearson moment correlation equation. A probability value (P value) less than 0.05 was considered statistically significant. All statistical calculations were done using the computer programs “Microsoft Excel 2003” (Microsoft Corporation, NY, USA) and “SPSS” (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 15.
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Results
In order to explore the controversy in literature concerning the relation of STs to obesity, the relation of the number, size and color of STs to obesity, diabetes, sex and age was analyzed. The basic characteristics studied are presented in Table 1.
Relation of skin tags to age and sex
The mean number of STs in the studied group was 5.36 ± 11.920, while the mean age of the studied group was 45.30 ± 12.540. In this study, the number of STs correlated significantly with age (P = 0.002). There were no significant differences in prevalence and mean number of STs between males and females groups (P = 0.555 and P = 0.358, respectively). Also, there was no significant difference in the prevalence of STs colors (flesh, dark and mixed) between males and females groups (P = 0.313).
Relation of skin tags to obesity
The prevalence of STs was detected more often among obese participants 199/310 (64.2%) compared to nonobese participants 110/211 (52.1%). This was statistically significant (P = 0.006). The mean number of STs was significantly higher among obese participants (7.11 ± 14.998) in comparison to the nonobese (2.92 ± 4.957, P < 0.001). The prevalence of mixed-color STs was significantly more among obese participants [81 (42.2%)] compared to nonobese [18 (17.6%], P < 0.001). On the other hand, the prevalence of flesh-color [58 (56.9%)] and hyperpigmented [26 (25.5%)] STs was higher in the nonobese group in comparison to the obese group [75 (39.1%)], and 36 (18.8%), respectively]
