The Serum Lipid Profile of Patients with Skin Tag

in Dr. Mohammad Hoesin General Hospital Palembang

Khairani

,Yuli Kurniawati

, Mutia Devi

, Kemas Yakub Rahadiyanto

Department of Dermatology and Venereology Faculty of Medicine Sriwijaya University/Dr. Moh. Hoesin General

Hospital Palembang, Jendral Sudirman Street Km 3.5, Palembang,South of Sumatera, Indonesia

Medical Division of Bioethics and Humanitarian, Department of Clinical Pathology, Faculty of Medicine Sriwijaya

University, Dr. Mohammad Ali Street, Palembang,South of Sumatera, Indonesia

Keywords: skin tag, obesity, body mass index, serum lipid profile.

Abstract: Skin tag is common benign lesion composed of loose fibrous tissue which present mainly on the neck and

major flexures as small soft pedunculated papule. Recent study suggest that the presence of skin tag is

associated with abnormal serum lipid profile. This study is to describe the serum lipid profile of patients

with skin tag. This is descriptive study which was conducted from October to December 2017 at the Tumor

and Dermatosurgery outpatient Department of Dr. Mohammad Hoesin General Hospital Palembang. A total

of 36 patients with skin tag who met the inclusion criteria were included in the study. Demographic data,

body mass index (BMI), and serum lipid profile including triglycerides, total cholesterol, HDL and LDL

cholesterol were measured. Abnormal serum lipid profile (83.3%) and obesity (61.1%) were observed. The

mean of LDL and total cholesterol levels of skin tag patients were shown to be elevated, but not in

triglycerides and HDL levels. Abnormal serum lipid profile in patients with skin tag may associated with

metabolic syndrome.

1 INTRODUCTION

Skin tag commonly found on skin foldssuch as neck,

axillae, eyelids, and inguinal (Thmas et al, 2012;

Kutzner et al, 2016). Skin tag remains asymptomatic

unless they become inflamed or irritated (Wali et al,

2016).

The incidence of skin tag is common among

adult population over 40 years old and increase at 70

years old (Tamega et al, 2010).

The etiology of skin

tag is still unknown (Wali et al, 2016).

Several

factors such as family history, pregnancy, impaired

glucose metabolism, obesity, and friction were

associated with skin tag (Tamega t al, 2016; Tosson

et al, 2013). Skin tag may associated with metabolic

syndrome (De et al, 2017).

Recent studysuggested

that the presence of skin tag is associated with

abnormal serum lipid profile (Eldaiem, 2016; Idris et

al, 2014).

Abnormal serum lipid profile may be a

sign of abnormal fat metabolism, which may

increase adipose deposition and increase leptin

production (Sari et al, 2010; Erkek et al, 2011).

Leptin is a protein synthesized by adipose tissue.

Elevatedserum leptin is associated with elevated fat

mass. The mechanism of skin tag formation is

through the activation of leptin receptor in the

dermis and epidermis which stimulate the

differentiation and proliferation of keratinocytes and

fibroblast (Idris et al, 2014; Erkek et al, 2011; Jusuf

et al, 2017). Several study suggested there is an

association between serum lipid profile and skin tag,

however other study were still different result

(Eldaiem, 2016; Idris et al, 2014; Rasi et al, 2014).

Hence, researcher are interested to analysed the

serum lipid profile of patients with skin tag in Dr

Mohammad Hoesin General Hospital Palembang.

2 METHODS

This is a descriptive study which was conducted

from October to December 2017at the Tumor and

Dermatosurgery outpatient Department of Dr

Mohammad Hoesin General Hospital Palembang.

The study was approved by the ethics committee.

Sample study was obtained with consecutive

sampling.The inclusion criteria was patient of age

26–70 years old with skin tag at any location who

agree to participate in the study. Exclusion criteria

was diagnosed patients with secondary dyslipidemia

240

Khairani, ., Kurniawati, Y., Devi, M. and Rahadiyanto, K.

The Serum Lipid Proﬁle of Patients with Skin Tag in Dr. Mohammad Hoesin General Hospital Palembang.

DOI: 10.5220/0008154802400244

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 240-244

ISBN: 978-989-758-494-7

such as diabetes melitus, nephrotic syndrome,

chronic renal insufficiency, liver disease, thyroid

dysfunction and Cushing’s disease; who received

hormonal contraceptive pills, systemic

corticosteroid, and anti-dyslipidemia; pregnant and

lactating patients. A total of 37 patients with clinical

diagnosis of skin tag were informed concent and

lesion were obtained for histopathological

examination.Thirty six patients whom

histopathological diagnosis as skin tag were

included.Demographic data were collected and

blood were drawn to measure the serum lipid profile

including triglyceride, total cholesterol,LDL

cholesterol, and HDL cholesterol levels.

Classification of patients’ BMI based on

International Association for The Study of Obesity

WHO 2000, in which underweight <18.5 kg/m

normal 18.5–22.9 kg/m

, at risk 23-24.9kg/m

obesity 125-29.9kg/m

, and obesity II ≥30 kg/m

(WHO, 2006)

3 RESULTS

The majority age groups in this studywere late adult

30.6%. Female patientswere higherthan male

patients with ratio3:1. Multiple skin tag lesions were

noted in 25 patients (69.4%) and solitary lesion was

noted in 11 patients (30.6%) (Table 1).

Table 1. Demographic and skin tag characteristic of patients.

Variable n (%)(n= 36)

Age

Early adult (26-35 years old)

Late adult (36-45 years old)

Early elderly (46-55 years old)

Late elderly (56-65 years old)

Ver

late elderl

(

>65

ears old

)

10 (27.8)

11 (30.6)

10 (27.8)

4 (11.1)

(

2.8

)

Gender

Male

Female

9 (25)

27 (75)

Education

Senior high school

Diploma-Doctor

8 (22.2)

34 (54.9)

Occupation

Unemployment

Non-government/public

Government employee

Labo

5 (13.9)

3 (8.3)

23 (63.9)

5 (13.9)

Family history of skin tag

Not present

Present

23 (63.9)

13 (36.1)

Body mass index

Normal

At risk

Obesity 1

Obesit

7 (19.4)

14 (38.9)

(

22.2

)

Number ofskin tag

Solitary

Multi

11 (30.6)

(

69.4

)

Type ofskin tag

Filiformis (± 2 mm of width and ±5 mm of length)

Lar

e ba

-like

rotuberances

(

≥ 1cm of len

)

32 (88.9)

(

11.1

)

The Serum Lipid Proﬁle of Patients with Skin Tag in Dr. Mohammad Hoesin General Hospital Palembang

241

In this study,30 patientshad abnormal serum lipid

profile (83.3%) dan 6 patientshad normal range of

serum lipid profile(16.7%) (Figure 1). Obese

patients were 61.1%, in which obesity 1 38.9% and

obesity 2 22.2%. The mean number of skin tag

was5.22±4.39. The mean serum lipid profile level in

study patients as follows, triglyceride was

121.69±78 mg/dl; total cholesterol was

202.69±40.28 mg/dl; LDL cholesterol was

125.89±35.88 mg/dl; and HDL cholesterol was

51.97±11.28mg/dl (Table 2).

Figure 1.The distribution of abnormal serum lipid profile in patients.

Table2. The percentase of serum lipid profile in patients

Variable N % Mean±SD

Triglyceride

Normal

77.8

121.69±78

Borderline high

13.9

8.3

Total cholesterol

Normal

Borderline high

High

52.8

27.8

19.4

202.69±40.28

HDL cholesterol

Low

Normal

63.9

11.1

125.89±35.88

LDL cholesterol

Normal

Near optimal

Borderline high

High

Ver

22.2

41.7

13.9

8.3

51.97±11.28

4 DISCUSSION

One of the most common benign fibrous lesions of

the skin is skin tag. Although it remains

asymptomatic but most patients are not aware that

skin tag may be a sign of an abnormal serum lipid

profile that may lead to metabolic syndrome (Maluki

et al, 2016). In the present study we found that

83.3% patients had abnormal serum lipid profile and

61.1% obesity. Hence in this present study we

83.3

16.7

Percen

Normal serum lipid

profile

Abnormal serum lipid

profile

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

242

analysed the serum lipid profile was altered in

patients with skin tags, mainly of LDL and total

cholesterol levels. This result was also supported

from a study conducted by Maluki AH and

Gorpelioglu C et al (Maluki et al, 2019; Gorpelioglu

et al, 2009). Abd Eldaiem et alfoundsignificant

different serum lipid profile in 60 patients with skin

tag in compare to the 60 control group (Eldaiem,

2016).

Another study by Wali V et alalso supported

a significant different serum lipid profile in 63

patients with skin tag in compare to the 60 control

group (Wali et al, 2016).

According to a study by Jusuf NK et al, there is

plausible mechanisms that explain pathogenesis of

skin tags in elevated fat mass caused increased level

of leptin. Abnormal serum lipid profile may cause

increase fat mass.The concentration of leptin is

correlated with fat mass, obesity individuals often

had elevated levels of leptin. Leptin is a growth

hormone that suggests active in the process of

proliferation and differentiation keratinocytes and

fibroblast (Jusuf et al, 2017). An in vivo study

showed that leptin has an ability to induce

proliferation of keratinocytes together with other

growth factor (Erkek et al, 2011).

The limitationof this study, leptin level was not

measured, the study was done in a single centre with

small sample size population. Future studies with

multi center and larger sample size population were

needed to further support the association serum lipid

profile with skin tag.

5 CONCLUSION

Abnormal serum lipid profile was found in almost

all patients with skin tag, mainly of LDL and total

cholesterol. Abnormal serum lipid profile in patients

with skin tag may associated with metabolic

syndrome. Life style modification of weight

reduction and alteration of dietary habits should be

encourage in patients with skin tag.

ACKNOWLEDGEMENT

The authors would like to thank the Department of

Dermatology and Venereology, and Faculty of

Medicine of Sriwijaya University and all those who

assist in the effort of this research.

REFERENCES

De, D., Biswas, M., Pal, D., Biswas, T., 2017. Can

acrochordons be a marker of metabolic syndrome?.

JEMDS, 6(56), pp. 4183-4187.

Eldaiem, R.A., 2016. Assessment of lipid profile among

patient with skin tags in Khartoum State-Sudan.

EJBPS, 3(8), pp. 45-48.

Erkek, E., Kisa, U., Bagci, Y., Sezikli, H., 2011. Leptin

resistance and genetic predisposition as potential

mechanisms in the development of skin tags. Hong

Kong Journal of Dermatology and Venereology 19,

pp. 108–114.

Gorpelioglu, C., Erdal, E., Ardicoglu, Y., Adam, B.,

Sarifakioglu, E., 2009. Serum leptin, atherogenic

lipids and glucose levels in patients with skin tags.

Indian Journal of Dermatology 54, pp. 20–22.

doi:10.4103/0019-5154.48980.

Idris, S., Sunitha, S., 2014. Assessment of BMI, Serum

Leptin Levels and Lipid Profile in Patients with Skin

Tags. Journal of clinical and diagnostic research

JCDR 8, CC01-3.

doi:10.7860/JCDR/2014/10350.4853.

Jusuf, N.K., Putra, I.B., Kartayana, J., 2017. The

correlation between body mass index with the

occurrence of skin tag. Macedonian Journal of

Medical Sciences 5, pp. 271–274.

doi:10.3889/oamjms.2017.061

Kutzner, H.H., Kamino, H., Reddy, V.B., Pui, J., 2018.

Fibrous and fibrohistiocytic proliferations of the skin

and tendons. In: Bolognia JL, Schaffer JV, Cerroni L,

editors. Dermatology. 4

ed. New York: Elsevier

Limited;. p.2068-2085.

Maluki, A.H., & Abdullah, A.A., 2016. Metabolic

associations with skin tags. International Journal of

Dermatology Clinical Research, 2(1), pp. 003-11.

Rasi, A., Faghihi, A., Rahmanzadeh, Y., Hassannejad, H.,

2014. A comparison study of lipid profile levels

between skin tags affected people and normal

population in Tehran, Iran. Advanced biomedical

research 3, pp. 109. doi:10.4103/2277-9175.129709.

Sari, R., Akman, A., Alpsoy, E., Balci, M.K., 2010. The

metabolic profile in patients with skin tags. Clinical

and experimental medicine 10, pp. 193–197.

doi:10.1007/s10238-009-0086-5.

Tamega, A. de A., Aranha, A.M.P., Guiotoku, M.M.,

Miot, L.D.B., Miot, H.A., 2010. [Association between

skin tags and insulin resistance]. Anais brasileiros de

dermatologia 85, pp. 25–31. doi:10.1590/S0365-

05962010000100003.

Thomas, V.D., Snavely, N.R., Lee, K.K., Swanson, N.A.,

2012. Dermal hypertrophies and benign

fibroblastic/myofibroblastic tumors. In: Goldsmith

LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ,

Wolff K, editors. Fitzpatrick’s Dermatology in

General Medicine. 8

ed. New York: The McGraw-

Hill Companies, Inc;. p.707-17.

Tosson, Z., Ibrahim, S.A., Kandil, A.H., Husam, M., 2013.

Relationship between skin tags , leptin hormone and

The Serum Lipid Proﬁle of Patients with Skin Tag in Dr. Mohammad Hoesin General Hospital Palembang

243

metabolic disturbances. Egyptian Dermatology Online

Journal 9, pp. 1–12.

Wali, Vinod V., Wali, Vishal V., 2016. Assessment of

various biochemical parameters and BMI in patients

with skin tags. Journal of Clinical and Diagnostic

Research 10, BC09-BC11.

doi:10.7860/JCDR/2016/15994.7062

World Health Organization Western Pacific Region. 2000.

The Asia-Pacific perspective: redefining obesity and

its treatment.

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

244