What is the management of anal skin tags: conservative versus surgical?

From the Guidelines

Conservative management is the preferred approach for anal skin tags, as it is generally safe and effective, with surgical removal reserved for larger, symptomatic skin tags that cause significant discomfort or hygiene issues. The management of anal skin tags can be approached either conservatively or surgically, with the choice depending on symptom severity and patient preference. Conservative management includes maintaining good anal hygiene with gentle cleansing using mild, fragrance-free soap and water after bowel movements, followed by patting the area dry. Sitz baths for 10-15 minutes, 2-3 times daily with warm water can help reduce irritation. Topical preparations containing witch hazel or hydrocortisone 1% cream can be applied sparingly to reduce inflammation and itching. Dietary modifications to increase fiber intake (25-30g daily) and adequate hydration (8-10 glasses of water daily) help prevent constipation, which can exacerbate symptoms.

Some key points to consider in the management of anal skin tags include:

• Maintaining good anal hygiene to reduce irritation and prevent infection
• Using topical preparations to reduce inflammation and itching
• Making dietary modifications to prevent constipation and reduce symptom severity
• Reserving surgical removal for larger, symptomatic skin tags that cause significant discomfort or hygiene issues. Although the provided evidence 1 discusses the management of anorectal emergencies, including acute anal fissure, it does not directly address the management of anal skin tags. However, the principles of conservative management and surgical intervention can be applied to the treatment of anal skin tags. Surgical options, such as simple excision under local anesthesia, electrocautery, or cryotherapy, are generally performed as outpatient treatments with minimal recovery time, though patients may experience mild pain, bleeding, or discharge for a few days afterward.

In terms of specific treatment options, some considerations include:

• Topical preparations, such as hydrocortisone 1% cream, to reduce inflammation and itching
• Sitz baths to reduce irritation and promote healing
• Dietary modifications to prevent constipation and reduce symptom severity
• Surgical removal for larger, symptomatic skin tags that cause significant discomfort or hygiene issues. It is essential to weigh the benefits and risks of each approach, considering that while surgery provides definitive treatment, it carries small risks of bleeding, infection, and recurrence, whereas conservative measures are safer but may not completely resolve the skin tags 1.

From the Research

Management of Anal Skin Tags

• The management of anal skin tags can be either conservative or surgical, depending on the type and severity of the condition 2.
• Conservative management may be suitable for small, asymptomatic skin tags, while surgical removal may be necessary for larger, symptomatic, or problematic skin tags.
• There is no specific information available in the provided study regarding the management of anal skin tags, as the study focuses on the characterization and prevalence of anal skin tags in patients with inflammatory bowel disease 2.

Classification of Anal Skin Tags

• Anal skin tags can be classified into two types:
  • Type 1: raised, broad, or narrow, single or multiple, soft or firm, and painless, often referred to as "elephant ears" 2.
  • Type 2: edematous, hard, often cyanotic, tender or not, and typically arising from a healed anal fissure, ulcer, or hemorrhoid 2.

Prevalence of Anal Skin Tags

• Anal skin tags are more commonly found in patients with Crohn's disease (75.4%) compared to patients with ulcerative colitis (24.6%) 2.
• The presence of anal skin tags may be diagnostic of Crohn's disease, especially in young people with diarrhea, abdominal pain, and/or growth retardation 2.