Skin Tags: Definition, Characteristics, and Management
Skin tags (acrochordons) are benign, pedunculated skin growths that commonly occur in intertriginous areas such as the neck, axilla, and groin regions. They typically appear as skin-colored or hyperpigmented soft tissue protrusions that may cause cosmetic concerns or discomfort due to friction.
Clinical Characteristics
Appearance: Soft, flesh-colored or slightly darker, pedunculated (attached by a stalk) skin growths
Size: Usually small (1-5 mm), but can grow larger
Location: Predominantly found in skin fold areas:
- Neck
- Axillae (armpits)
- Groin
- Under breasts
- Eyelids
- Perianal region
Etiology: Often associated with:
- Friction between skin surfaces 1
- Obesity
- Pregnancy
- Aging
- Diabetes
- Hormonal changes
Diagnosis
Skin tags are typically diagnosed through visual examination. They should be distinguished from other skin lesions such as:
- Warts
- Molluscum contagiosum
- Small melanomas
- Neurofibromas
Management Options
Skin tags are benign and treatment is generally for cosmetic reasons or if they cause discomfort. Several removal methods exist:
1. Cryotherapy
- Application of liquid nitrogen or specialized home cryotherapy devices 2
- Freezes the tissue, causing it to fall off within days
- Success rates vary (64.3% complete removal with Pixie® Skin Tag device versus 7.1% with Wortie® skin tag remover) 2
2. Snip Excision
- Quick removal using scissors or scalpel
- Can be performed with or without local anesthesia
- Ethyl chloride spray can provide painless anesthesia for quick excision 3
3. Electrodessication
- Uses electric current to destroy the tissue
- Provides simultaneous hemostasis
4. Ligation Devices
- Pressure-applying adhesive patches that cut off blood supply
- Can lead to removal within 3-6 days
- Most effective for smaller tags (90% success for tags up to 1mm in base, 76% for tags up to 2mm) 4
5. Surgical Excision
- For larger skin tags or those with atypical features
- May require local anesthesia
Special Considerations
Perianal Skin Tags
- May be associated with other anorectal conditions like hemorrhoids or Crohn's disease
- Excision of perianal skin tags in patients with Crohn's disease is generally not recommended due to high rates of poor wound healing and complications 5
- Simple removal techniques can be used during other anorectal procedures like stapled anopexy 6
Multiple or Recurrent Skin Tags
- May indicate underlying metabolic disorders (diabetes, obesity)
- Linear arrangement may suggest friction as a causative factor 1
Complications of Removal
- Bleeding
- Infection
- Scarring
- Pain
- Recurrence
When to Seek Medical Evaluation
Skin tags requiring medical evaluation include those that:
- Change in appearance (color, size, shape)
- Bleed or become painful
- Are located in sensitive areas
- Are numerous and rapidly developing
Conclusion
Skin tags are common benign growths that can be easily treated with various methods. The choice of removal technique should consider the size, location, and number of skin tags, as well as patient preference and comfort. For most cases, simple in-office procedures provide excellent cosmetic results with minimal discomfort.