Cryotherapy for Skin Tag Removal
Cryotherapy with liquid nitrogen is an effective and well-established treatment for skin tags, with success rates of approximately 64% complete clearance, though electrosurgery may offer superior patient satisfaction for this specific lesion type. 1, 2
Efficacy and Clinical Performance
Liquid nitrogen cryotherapy successfully treats benign skin lesions including skin tags, with the technique being well-established in dermatologic practice 3
In a randomized controlled trial, cryotherapy achieved 64.3% complete clearance of skin tags, with half of these lesions clearing after just one treatment session 1
However, when directly compared to electrosurgery in a blinded randomized trial, electrosurgery demonstrated significantly higher physician and patient satisfaction for skin tag removal specifically 2
The mechanism involves thermal damage to the lesional tissue through freezing, causing tissue destruction 4
Treatment Protocol
Apply liquid nitrogen directly to the skin tag for 15-20 seconds until 1-2 mm of surrounding normal skin appears frozen 5
Allow the area to thaw for 20-60 seconds, then freeze again using a freeze-thaw-freeze cycle 6
For incomplete responses, repeat treatments at 3-week intervals until complete resolution occurs 5
Most skin tags require up to three treatment sessions maximum, with 15-day intervals between treatments 1
Local anesthesia is usually unnecessary for this procedure 3
Anatomical Considerations and Safety
Avoid cryotherapy on eyelids, tip of nose, lips, mucous membranes, cartilaginous structures, and superficial nerves 6, 7
Skin tags on the neck, breast, and underarm areas are appropriate treatment sites 1
The procedure is safe, painless, and well-tolerated by approximately 64% of patients 1
Expected Side Effects and Healing
Immediate post-treatment effects include vesicle formation, erythema, swelling, and burning pain at the treatment site 5, 8
A crusted eschar typically forms within days after treatment as part of normal healing 5
Both hypopigmentation and hyperpigmentation can occur, particularly in patients with darkly pigmented skin, though these changes typically improve by 6-12 months 5, 2
Complications are infrequent when correct technique is used 3
Secondary bacterial infection can occur, warranting use of topical antibiotics and dressing for several days after treatment 5
Patient Satisfaction and Practical Considerations
In clinical trials, 72% of patients using cryotherapy were satisfied with results for skin tag removal 1
Two-thirds of treated patients would purchase and use the device again for other skin tags 1
The success of cryotherapy is highly dependent on operator skill and completeness of application 5
Common Pitfalls to Avoid
Do not use cryoprobes in anatomically sensitive areas where perforation risk exists 6
Avoid treating skin tags on high-risk facial areas (nose, eyelids, lips) where cosmetic outcomes and complications are more problematic 7
Do not expect immediate results—healing takes weeks, and repeat treatments are often necessary 5
Consider electrosurgery as an alternative if patient satisfaction is a primary concern, as it demonstrates superior outcomes specifically for skin tags 2