What are the treatment options for a skin tag under the arm?

Treatment Options for Skin Tags Under the Arm

Skin tags (acrochordons) under the arm are benign pedunculated lesions that can be safely removed using simple office-based procedures including snip excision, cryotherapy, or electrodesiccation, with snip excision being the most straightforward and cost-effective approach. 1, 2

Primary Treatment Options

Snip Excision (First-Line)

• Perform simple scissor excision at the base of the pedunculated lesion using micro-scissors and micro-forceps after topical anesthesia 1
• Use ethyl chloride spray for immediate topical anesthesia—this provides a painless, fast procedure that patients tolerate better than infiltrative local anesthesia 1
• For patients who have undergone conventional excision before, ethyl chloride spray technique is reported as more comfortable and painless 1
• The axilla is an ideal location for this technique given the intertriginous nature and common occurrence of skin tags in this area 2

Alternative Destructive Methods

• Cryotherapy can be used for smaller lesions, applying liquid nitrogen to freeze the base of the skin tag 2
• Electrodesiccation is another option for cauterizing the base of the lesion 2

Non-Invasive Device Option

• A mechanical pressure device (flat adhesive patch) can be applied to the base of skin tags, leading to removal within 3-6 days through vascular occlusion 3
• Success rates: 90% for lesions up to 1mm base diameter, 76% for lesions up to 2mm base diameter 3
• This option provides excellent cosmetic outcomes with minimal discomfort throughout the procedure 3
• The device works by decreasing blood flow to the lesion, though the degree of occlusion is not critical for success 3

Practical Approach Algorithm

For single or few skin tags:

1. Apply ethyl chloride spray to the lesion for immediate topical anesthesia 1
2. Grasp the skin tag with micro-forceps 1
3. Excise at the base with micro-scissors in a single motion 1
4. Apply pressure briefly for hemostasis
5. Cover with simple dry dressing 4

For multiple widespread skin tags:

• Consider the mechanical pressure device for patient convenience and minimal discomfort 3
• Alternatively, use ethyl chloride spray sequentially for multiple snip excisions in a single session 1

Important Caveats

• Friction is a known etiologic factor for skin tag development in intertriginous areas like the axilla, so counsel patients about this mechanism 2
• Skin tags are benign and treatment is primarily for cosmetic concerns or if they become irritated 2
• No histopathological examination is typically needed for classic appearing skin tags 2
• If a lesion appears atypical (not clearly pedunculated, irregular pigmentation, bleeding, or rapid growth), excise completely and send for histology to rule out other diagnoses 4

Post-Procedure Care

• Simple dry dressing coverage is sufficient 4
• Healing typically occurs within days to 2 weeks
• Excellent cosmetic outcomes are expected with proper technique 3
• Educate patients about signs of infection (increasing redness, warmth, purulent drainage) that would warrant immediate attention 4