Medically reviewed by Chandre Tina May, Registered Nurse & Menopause Society Certified Practitioner (MSCP). See our editorial policy.
You noticed a small soft bump under your arm, or a patch of skin on the back of your neck that looks darker and almost velvety – like it won’t wash off. Maybe you’ve been embarrassed by it, or brushed it off, or quietly worried. What almost certainly did not happen is a doctor looking you in the eye and saying: this is a PCOS skin symptom, and here’s why your body is doing it. That silence is not your fault, and it ends here.
PCOS skin tags and the other visible skin changes that come with polycystic ovary syndrome are among the most overlooked – and most distressing – signs of the condition. They are not random, not a hygiene issue, and not cosmetic vanity. They are your skin reflecting what is happening with your hormones and insulin. Understanding that changes everything.
What’s actually happening – the House metaphor
Think of your body as a house with a central heating system. In PCOS, that system – driven largely by insulin – runs too hot. The thermostat (your insulin signalling) keeps cranking up the heat even when the rooms don’t need it. All that excess warmth has to go somewhere, and one place it shows up is the walls: your skin.
Here’s the specific mechanism. Many women with PCOS have insulin resistance – the body’s cells don’t respond efficiently to insulin, so the pancreas pumps out more and more of it. High circulating insulin stimulates skin cells called keratinocytes and fibroblasts to overgrow in certain areas. The result? Small soft growths (skin tags) and thick, darkened patches – a condition called acanthosis nigricans. Elevated androgens (testosterone and related hormones, which are also characteristically high in PCOS) add to the picture, contributing to skin texture changes and sometimes excess hair on the same patches.
None of this means your skin is dirty or broken. It means your house’s heating system needs attention.
The three skin changes most linked to PCOS
1. Skin tags (acrochordons)
Skin tags are tiny, soft, flesh-coloured or slightly darker growths that hang from the skin on a thin stalk. They most commonly appear in skin folds – the neck, armpits, groin, under the breasts, or inside the thighs. On their own they are harmless, but their presence – especially in multiples – is a well-recognised marker of insulin resistance. According to the NHS, skin tags are benign and very common, but clusters of them appearing in your 20s or 30s alongside other symptoms absolutely deserve a conversation with your doctor.
2. Acanthosis nigricans – the velvety dark patches
This is the dark, velvety or rough-feeling discolouration that typically appears on the back of the neck, in the armpits, around the groin, or in elbow creases. It can look like a shadow that won’t scrub away, because it isn’t a stain – it’s a thickening of the skin driven by high insulin levels. Acanthosis nigricans is considered a clinical sign of insulin resistance and appears across all skin tones, though it is most visible on medium to deeper complexions. If a doctor has ever dismissed it as “just hyperpigmentation,” it’s worth going back and asking specifically about insulin levels.
3. General skin texture changes
Beyond tags and dark patches, some women with PCOS notice skin that feels rougher, thicker, or more prone to congestion in certain areas. Elevated androgens affect sebaceous glands (oil production) and can alter the skin’s surface texture even independently of acne. If you also experience PCOS-related acne or oily skin, the same androgen excess is likely driving both.
What these skin changes are often mistaken for
These symptoms get misread constantly – and that misreading delays diagnosis. Acanthosis nigricans is frequently dismissed as a tan line, dirt, or a fungal skin condition. Skin tags are waved away as “just ageing” even in women in their twenties. Rough skin patches get attributed to eczema or keratosis pilaris without anyone asking why they appeared or worsened.
The crucial difference: these PCOS-linked changes tend to cluster in the same areas (neck, underarms, groin), often appear together, and typically coincide with other PCOS signs like irregular periods or unwanted hair growth. If you also notice hair thinning or unusual hair growth patterns, that’s another piece of the same hormonal picture worth raising with your GP.
What actually helps
Lifestyle approaches
- Reducing insulin resistance through food and movement is the most direct route. A diet that steadies blood sugar – lower in refined carbohydrates, higher in fibre, protein, and healthy fats – can reduce circulating insulin over time. According to Verity (the UK’s PCOS charity), even modest weight-neutral improvements in insulin sensitivity can reduce acanthosis nigricans visibly.
- Regular movement – particularly resistance training and brisk walking – improves how cells respond to insulin, addressing the root cause rather than just the surface symptom.
Skincare and topical options
- Gentle exfoliation (a soft flannel, low-concentration lactic acid, or urea-based creams) can soften acanthosis nigricans patches and improve texture. These won’t remove the darkening entirely while insulin remains elevated, but they do help the skin feel more comfortable.
- Retinoids (prescription or over-the-counter) are sometimes used to improve skin texture in PCOS-related changes – a dermatologist can advise on what’s appropriate for your skin tone, as some ingredients can worsen pigmentation on darker complexions if used incorrectly.
Medical options
- Treating insulin resistance medically – your doctor may discuss medications such as metformin, which reduces insulin levels and has been shown to improve acanthosis nigricans in some women with PCOS. A clinician decides whether this is appropriate for you.
- Skin tag removal – once the hormonal picture is being managed, skin tags can be removed by a GP or dermatologist via cryotherapy, ligation, or minor excision if they are causing discomfort or distress. Removal without addressing the underlying insulin resistance often means new ones appear.
- Hormonal treatments – the combined oral contraceptive pill and other hormonal therapies that lower androgen levels may improve skin texture over time. This is something to discuss with a doctor who understands the full range of PCOS symptoms and treatments.
When to see a doctor
Please do book an appointment if:
- You have multiple skin tags appearing, especially in skin folds, before the age of 40
- You have dark, velvety patches on your neck or underarms that haven’t been investigated
- These skin changes have appeared alongside irregular periods, unwanted facial or body hair, or difficulty managing weight
- A skin tag changes colour, bleeds, or becomes painful (this is uncommon but warrants a check)
- You have a family history of type 2 diabetes – insulin resistance in PCOS sits on a spectrum with that condition, and early action matters
You are entitled to ask your GP to check your fasting insulin and glucose levels, and to request a PCOS workup if you haven’t had one. You do not have to accept “it’s just your skin” as an answer.
Frequently asked questions
Do PCOS skin tags go away on their own?
Skin tags don’t usually disappear without treatment, but addressing the underlying insulin resistance – through lifestyle changes or medication – can slow new ones forming. Existing tags can be removed by a clinician once the hormonal picture is being managed, otherwise new ones tend to reappear in the same areas.
Is acanthosis nigricans permanent?
Not necessarily. It can fade significantly when insulin resistance improves, whether through dietary changes, exercise, medication, or a combination. Topical treatments can help texture and comfort in the meantime, but the most meaningful improvement usually comes from treating the underlying cause.
Can you have PCOS skin changes without being overweight?
Yes, absolutely. Insulin resistance and the skin changes it causes can occur in women of any size. Lean women with PCOS are frequently missed precisely because doctors associate these signs only with higher body weight. If you have skin tags or acanthosis nigricans, your insulin levels are worth checking regardless of your weight.
Should I see a GP or a dermatologist?
Start with your GP, who can assess whether these skin changes fit a pattern of PCOS and arrange blood tests. A dermatologist is useful for managing the skin symptoms directly – texture, pigmentation, removal – but they’ll work best alongside a doctor who is also treating the hormonal root cause.
Are these skin changes dangerous?
The skin changes themselves are benign. However, they are meaningful signals of insulin resistance, which over time increases the risk of type 2 diabetes and cardiovascular changes. Think of them as your body flagging something worth addressing – not a crisis, but a clear reason to seek proper assessment and support.
This article is for general information and is not medical advice. It was reviewed by a certified healthcare professional in line with our editorial policy, and we update our content as the science evolves – but every woman’s body is different, so please speak to a qualified healthcare professional about your own symptoms.