Treatment Options for Skin Tags
For typical skin tags, simple snip excision with scissors is the most practical first-line treatment, and can be performed painlessly using ethyl chloride spray anesthesia rather than infiltrative local anesthesia. 1
Standard Treatment Approaches
Primary Treatment Methods
The most commonly employed techniques for skin tag removal include:
- Snip excision using micro-scissors and micro-forceps, which allows for immediate removal with minimal discomfort 1
- Cryotherapy with liquid nitrogen, which causes tissue destruction through freezing 2
- Electrodesiccation, which uses electrical current to destroy the lesion 2
Optimal Anesthesia Strategy
Ethyl chloride spray anesthesia is superior to infiltrative local anesthesia for skin tag excision, as it provides adequate pain control without the discomfort of multiple needle injections, particularly important when treating multiple lesions. 1 Patients who previously underwent conventional excision with infiltrative anesthesia report that the ethyl chloride technique is significantly more comfortable and painless. 1
Alternative and Specialized Approaches
Mechanical Occlusion Device
For patients preferring non-invasive options, a flat adhesive patch device that applies pressure to the base of the skin tag can achieve removal within 3-6 days. 3
Efficacy varies by lesion size:
- Lesions up to 1 mm base diameter: 90% success rate 3
- Lesions up to 2 mm base diameter: 76% success rate 3
- Overall success rate: 65% for all treated lesions 3
The device works by decreasing blood flow to the lesion, with outcome dependent on achieving blood flow reduction immediately after application and at 2-3 days, though the degree of occlusion is not critical. 3 Discomfort is minimal and cosmetic outcomes are excellent. 3
Ligaclip for Newborns
In newborns with preauricular skin tags, Ligaclip application is a safe, rapid, and economical treatment option. 4 The lesion falls off between days 7-10 with no reported complications including edema, cellulitis, clip loss, or bleeding, and scarring results are extremely satisfactory at 3-month follow-up. 4
Critical caveat: Careful clinical examination is essential to differentiate true skin tags from hair follicle nevi or accessory tragus, as misdiagnosis can lead to serious consequences such as chondritis. 4 Only lesions without a pilosebaceous unit and with a thin, soft pedicle should be treated with this method. 4
Special Considerations and Contraindications
Perianal Skin Tags in Crohn's Disease
Perianal skin tags in patients with Crohn's disease should NOT be excised. 5 Both the American Gastroenterological Association and European Crohn's and Colitis Organisation strongly recommend against excision due to:
- High rates of postoperative complications 5
- Poor wound healing 5
- Risk of chronic non-healing ulcers 5
- Extensive scarring 5
- Potential need for subsequent proctectomy 5
Observation is strongly preferred over intervention in this population. 5
When Malignancy is Suspected
If perianal skin tags have already been excised and completeness of excision cannot be guaranteed, or if margins are narrow and re-excision is not feasible, consider postoperative chemoradiation, particularly when there is concern about underlying malignancy or incomplete excision of concerning lesions. 5
Common Clinical Pitfalls
- Avoid infiltrating local anesthesia to every single skin tag when treating multiple lesions, as this causes unnecessary pain; use ethyl chloride spray instead 1
- Do not excise perianal skin tags in Crohn's disease patients under any circumstances due to severe complications 5
- Ensure proper differential diagnosis in preauricular lesions before treatment to avoid complications like chondritis 4
- Skin tags subjected to trauma can occasionally bleed with possible infection and pain, though they are generally benign lesions of cosmetic concern 4