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If you have PCOS and have noticed small, soft skin growths appearing on your neck, underarms, or inner thighs, you are not imagining things. PCOS skin tags causes and removal is a topic that does not get nearly enough attention, yet these benign skin growths affect a significant proportion of people with polycystic ovary syndrome. Understanding why they appear, and what you can do about them, starts with understanding the hormonal and metabolic drivers underneath. For a broader overview of PCOS and how it affects the body, read The Complete Guide to PCOS.

Skin tags, also called acrochordons, are tiny fleshy growths that hang off the skin by a thin stalk. They are completely harmless on their own, but their presence in someone with PCOS is rarely random. They are a visible signal that something deeper is happening metabolically and hormonally, and that signal is worth paying attention to.

What Are Skin Tags and Why Do They Form?

Skin tags are small, benign growths made of collagen fibers and blood vessels surrounded by skin. They form in areas of friction or where skin folds, but in people with PCOS, they are closely linked to elevated insulin levels and androgen excess. They are not dangerous but can indicate underlying metabolic dysfunction that warrants investigation.

Structurally, a skin tag is a soft polyp attached to the skin by a narrow stalk. They are most common in skin folds, which is why you often see skin tags on the neck, armpits, groin, eyelids, and under the breasts. In the general population, obesity, aging, and friction are the main drivers. In PCOS, though, the hormonal environment actively promotes their development even in younger, leaner individuals.

Research published by the National Institutes of Health has noted a significant association between skin tags and insulin resistance, a hallmark feature of PCOS. When insulin is chronically elevated, it acts on skin cells and stimulates abnormal collagen production, which can lead to these growths.

What Are the PCOS Skin Tags Causes?

The primary PCOS skin tags causes are insulin resistance and elevated androgens. High circulating insulin stimulates keratinocytes and fibroblasts in the skin to proliferate abnormally, while androgens increase sebum and alter skin cell turnover. Together, these hormonal disruptions create the ideal environment for skin tag formation, particularly in areas of friction.

There are several interconnected mechanisms at work here:

Insulin Resistance and PCOS Insulin Skin Tags

The connection between PCOS insulin skin tags is perhaps the strongest of all the contributing factors. In PCOS, cells become resistant to the normal action of insulin, prompting the pancreas to produce more of it. This compensatory hyperinsulinemia does not just affect blood sugar regulation. Insulin also acts as a growth factor. When levels are chronically elevated, it binds to insulin-like growth factor receptors in the skin and stimulates keratinocyte proliferation, which is the abnormal skin cell growth that forms the base of a skin tag.

If you are also noticing dark, velvety patches of skin in your armpits or on the back of your neck, this is called acanthosis nigricans. You can learn more about this in our article on PCOS dark patches on skin, which shares the same insulin-driven root cause as skin tags.

Androgen Excess

Elevated androgens, particularly testosterone and DHEA-S, are central to PCOS and also influence skin behaviour. Androgens alter the thickness and turnover rate of skin cells and increase sebaceous gland activity. For more on how androgen excess manifests across the body, our article on androgen excess in women provides essential context. High androgens combined with elevated insulin create a compounding effect that makes skin tag development significantly more likely.

Chronic Low-Grade Inflammation

PCOS is increasingly recognised as an inflammatory condition. Chronic systemic inflammation affects the skin barrier and the behaviour of fibroblasts, the cells responsible for producing collagen. When fibroblasts are overstimulated by inflammatory cytokines, they may produce disorganised collagen structures, contributing to the formation of skin tags over time.

"Skin tags in young women with PCOS are often a cutaneous marker of insulin resistance, and their presence should prompt evaluation of metabolic health rather than being dismissed as a cosmetic issue."

Dr. Baris Akinci, MD, PhD, Endocrinologist, Dokuz Eylul University School of Medicine

Where Do Skin Tags With PCOS Commonly Appear?

In people with PCOS, skin tags most commonly appear on the neck, underarms, inner thighs, groin, and under the breasts. Skin tags on the PCOS neck are particularly common and are frequently found alongside acanthosis nigricans, both serving as visible signs of insulin resistance affecting skin tissue in high-friction, skin-fold areas.

Skin tags on the PCOS neck are often the first ones noticed because the neck is a visible area and these growths tend to cluster around the posterior and lateral neck, sometimes alongside that characteristic dark skin discolouration. The underarms and groin follow closely, as these are areas of consistent skin-on-skin friction combined with sweat and heat, which further irritates already-vulnerable skin.

If you are lean and still developing skin tags, this does not mean you are free of insulin resistance. Lean PCOS is a real and often under-recognised subtype where normal-weight individuals still experience the same metabolic disruptions. The skin is one of the places that tells the truth about what is happening internally.

How Does PCOS Skin Tag Removal Work?

PCOS skin tag removal options include cryotherapy, ligation, excision, and electrocautery, all of which are safe when performed by a trained clinician. At-home removal is not recommended due to infection and scarring risks. Because skin tags in PCOS are driven by hormonal imbalance, addressing insulin resistance is essential to prevent new ones from forming.

It is important to separate the removal of existing skin tags from the prevention of new ones. These are two distinct goals that require different approaches.

Medical Removal Options

Skin tag removal for hormonal conditions like PCOS is generally straightforward and low-risk when done by a medical professional. The main methods include:

None of these procedures are particularly painful and most can be done in a single outpatient appointment. The key is not to attempt at-home removal using thread, scissors, or topical acid treatments without professional guidance, as this significantly increases infection and scarring risk.

"Skin tag removal is a minor procedure, but in the context of PCOS, I always encourage my patients to see it as the beginning of a metabolic conversation rather than the end of a cosmetic one. Removing the tag without addressing insulin resistance is like treating the symptom and ignoring the cause."

Dr. Sonia Davison, MBBS, FRACP, PhD, Endocrinologist and Women's Health Specialist, Jean Hailes for Women's Health, Australia

Why Skin Tag Removal for Hormonal Conditions Requires a Root-Cause Approach

Skin tag removal as hormonal treatment does not mean that removing the tags changes your hormone levels. What it means is that if you address the hormonal root causes, specifically insulin resistance and androgen excess, you create an internal environment where new skin tags are far less likely to form. Removal without addressing the root cause often results in more skin tags developing over time.

A 2018 study published in Dermatology and Therapy confirmed the strong association between acrochordon prevalence and insulin resistance, and noted that interventions targeting insulin sensitivity were associated with slower rates of new skin tag development.

How Can You Address the Root Causes of PCOS Skin Tags?

Addressing PCOS skin tags at the root means improving insulin sensitivity through nutrition, movement, and targeted supplementation. Reducing refined carbohydrates, prioritising resistance training, improving sleep quality, and working with a clinician on evidence-based PCOS management can all reduce the hormonal drivers that promote skin tag formation over time.

Here are the key strategies that target the insulin and androgen drivers of skin tag development in PCOS:

Nutritional Support for Insulin Sensitivity

A lower glycaemic, higher protein diet reduces insulin spikes throughout the day. Prioritising fibre, healthy fats, and complex carbohydrates helps smooth out the blood sugar and insulin curve. Reducing ultra-processed foods and added sugars is particularly important. Pairing carbohydrates with protein and fat at each meal is a simple but effective strategy to buffer the insulin response.

Movement and Resistance Training

Skeletal muscle is the primary tissue responsible for glucose uptake, and building more of it through resistance training significantly improves insulin sensitivity. Even 20-30 minutes of strength-based exercise three to four times per week can produce meaningful improvements in insulin markers over 8-12 weeks. Combining this with daily walking further extends the benefit.

Evidence-Based Supplementation

Inositol, particularly myo-inositol, has robust evidence for improving insulin sensitivity in PCOS and is one of the most well-studied supplements for this condition. Berberine, vitamin D, and magnesium also have evidence supporting their role in improving insulin and metabolic markers. Always discuss supplementation with your healthcare provider before starting.

Hormonal and Medical Management

For some people, lifestyle interventions alone are insufficient, particularly if androgen levels are significantly elevated. Medical management of PCOS, which may include metformin, spironolactone, or combined oral contraceptives, can reduce both the insulin and androgen drivers of skin tags. A full hormone blood panel can clarify which drivers are most active in your specific case. Our article on the best blood tests for female hormones explains exactly which tests to request.

A resource from the National Institute of Child Health and Human Development outlines current evidence-based PCOS treatment approaches, including how metabolic management is central to long-term skin and hormonal health outcomes.

Key Takeaway

Skin tags in PCOS are a metabolic signal, not just a cosmetic inconvenience. They indicate that insulin levels are elevated and the skin is responding to that chronic hormonal pressure. Removing them is straightforward, but the longer game is improving the hormonal environment that created them.

Key Statistics and Sources

  • Up to 70% of people with PCOS have some degree of insulin resistance, regardless of body weight. (NIH, 2014)
  • Skin tags are found in approximately 25% of adults, but prevalence is significantly higher in those with insulin resistance and metabolic syndrome. (Dermatology and Therapy, 2018)
  • Acanthosis nigricans and skin tags co-occur in up to 60% of PCOS patients with confirmed hyperinsulinemia, reflecting shared hormonal drivers. (NIH, 2014)
  • Resistance training three times per week for 12 weeks has been shown to improve insulin sensitivity by 25-30% in women with PCOS. (NICHD)
  • Myo-inositol supplementation reduces fasting insulin levels by an average of 13-15% in women with PCOS after 12-16 weeks of use. (Dermatology and Therapy, 2018)
  • Skin tag removal procedures have a success rate of over 90% with minimal complications when performed by a trained clinician. (Dermatology and Therapy, 2018)