What are the treatment options for skin tags?

Treatment Options for Skin Tags

The most effective treatment options for skin tags include surgical excision, cryotherapy, electrodesiccation, and ligation, with the choice depending on the size, location, and number of skin tags present. 1, 2, 3

What Are Skin Tags?

Skin tags (acrochordons) are benign skin lesions that are typically:

• Skin-colored or hyperpigmented 2
• Usually pedunculated (attached by a stalk) 2
• Commonly found on the neck, axilla, groin regions, and intertriginous areas 2, 4
• May develop due to friction in certain areas 4

Treatment Options

Surgical Methods

• Snip excision: Using scissors or scalpel to remove the skin tag at its base

  • Can be performed with local anesthesia for larger tags 1
  • Ethyl chloride spray can provide painless anesthesia for quick excision 2
  • Provides immediate results 1, 2

• Ligation techniques:

  • Tying off the base of the skin tag with suture material or specialized devices 3
  • Ligaclip application - particularly useful for preauricular skin tags in newborns 5
  • Adhesive patch devices that apply pressure to the base, causing the tag to fall off within 3-6 days (90% success rate for tags up to 1mm in base) 3

Destructive Methods

• Cryotherapy:

  • Application of liquid nitrogen to freeze the skin tag 1
  • May require multiple treatments for complete removal 1
  • Can cause temporary discomfort and hypopigmentation 1

• Electrodesiccation:

  • Using electric current to destroy the tissue 1
  • Effective for multiple small tags 1
  • May cause minimal scarring 1

Chemical Methods

• Trichloroacetic acid (TCA):
  • 50-80% solution applied weekly for up to 8 weeks 1
  • Less commonly used than physical methods 1

Treatment Selection Based on Skin Tag Characteristics

Size-Based Approach

• Small tags (≤1mm base):

  • Adhesive patch devices (90% success rate) 3
  • Snip excision with ethyl chloride spray anesthesia 2
  • Cryotherapy 1

• Medium tags (1-2mm base):

  • Adhesive patch devices (76% success rate) 3
  • Snip excision with local anesthesia 1, 2
  • Electrodesiccation 1

• Large tags (>2mm base):

  • Surgical excision with local anesthesia 1
  • Electrodesiccation 1

Location-Based Considerations

• Neck/face: Consider cosmetic outcome - snip excision or electrodesiccation may provide better cosmetic results 1, 2
• Intertriginous areas: Cryotherapy or ligation methods may be preferred 1, 3
• Anal region: Special techniques using circular anal dilators during procedures 6
• Preauricular region in newborns: Ligaclip application shows excellent results with minimal complications 5

Special Considerations

Multiple Skin Tags

• For patients with numerous skin tags, consider:
  • Cryotherapy for treating multiple lesions in a single session 1
  • Ethyl chloride spray with micro-scissors for quick, sequential removal 2
  • Electrodesiccation for efficient treatment of multiple small tags 1

Contraindications and Cautions

• Crohn's disease: Excision of skin tags in patients with Crohn's disease is not recommended due to high risk of poor wound healing and complications 1
• Bleeding disorders: Use caution with surgical methods; consider cryotherapy or ligation 1
• Infection: Treat any active infection before removal 1

Post-Treatment Care

• Keep the area clean and dry 1
• Apply topical antibiotic ointment if recommended by provider 1
• Monitor for signs of infection (increased redness, swelling, drainage) 1
• Expect complete healing within 1-2 weeks for most methods 2, 3

Treatment Efficacy

• Most methods have high success rates (>90%) for complete removal 1, 2, 3
• Recurrence is possible but uncommon 1
• Cosmetic outcomes are generally excellent with proper technique 2, 3, 5