Treatment for Skin Tags
For typical benign skin tags, simple office-based removal techniques including snip excision, cryotherapy, or electrodesiccation are the standard treatments of choice. 1, 2
Important Context-Specific Considerations
Crohn's Disease-Associated Perianal Skin Tags
Do NOT excise perianal skin tags in patients with Crohn's disease due to high rates of postoperative complications including poor wound healing and potential need for subsequent proctectomy. 3 This represents a critical exception where observation is strongly preferred over intervention. 3
Post-Excision of Perianal Skin Tags (Anal Cancer Context)
If perianal skin tags have already been excised and completeness of excision cannot be guaranteed (piecemeal excision), or if margins are narrow and re-excision is not feasible, postoperative chemoradiation should be considered. 3 This applies specifically when there is concern about underlying malignancy or incomplete excision of concerning lesions.
Standard Treatment Options for Benign Skin Tags
Office-Based Removal Techniques
Snip excision with scissors: Fast, effective method using micro-scissors and micro-forceps, particularly when combined with ethyl chloride spray anesthesia for patient comfort. 1 This approach is reported as more comfortable and painless compared to conventional local anesthetic infiltration. 1
Cryotherapy: Standard destructive method using liquid nitrogen, effective for routine skin tag removal. 2
Electrodesiccation: Alternative destructive technique for skin tag removal. 2
Novel Device-Based Approach
- Adhesive pressure device: A flat adhesive patch that applies pressure to the base of the skin tag, leading to removal within 3-6 days. 4 Success rates are highest (90%) for lesions up to 1 mm at the base, and 76% for lesions up to 2 mm. 4 The cosmetic outcome is excellent with minimal discomfort. 4
Special Populations
- Newborns with preauricular skin tags: After careful clinical examination to exclude accessory tragus or hair follicle nevi, Ligaclip application is a rapid, safe, economical option. 5 The skin tag falls off between days 7-10 with excellent scarring results at 3-month follow-up. 5
Clinical Pitfalls to Avoid
Never excise perianal skin tags in Crohn's disease patients - this can lead to chronic non-healing ulcers, extensive scarring, and potentially necessitate proctectomy. 3
Ensure proper differential diagnosis in preauricular lesions to distinguish true skin tags from accessory tragus or hair follicle nevi, as misdiagnosis can lead to complications like chondritis. 5
Consider underlying etiology: Friction is a recognized causative factor, particularly in intertriginous areas. 2