What is the best course of action for treating multiple skin tags?

Treatment of Multiple Skin Tags

For patients with multiple skin tags, simple office-based removal using snip excision, cryotherapy, or electrodesiccation is the most appropriate treatment approach, with the choice depending on lesion size, location, and patient preference.

Standard Treatment Options

Primary Removal Methods

• Snip excision is effective for pedunculated skin tags and can be performed quickly in the office setting 1
• Cryotherapy provides a straightforward option for treating multiple lesions simultaneously 1
• Electrodesiccation offers another reliable method for removing multiple skin tags 1

Pain Management During Removal

• Ethyl chloride spray anesthesia applied immediately before excision with micro-scissors provides effective, painless removal and is preferred by patients over conventional local anesthetic infiltration 2
• This approach eliminates the need for multiple painful injections when treating numerous lesions 2

Alternative Mechanical Approach

• Adhesive pressure patches that occlude blood flow to the base of skin tags can achieve removal within 3-6 days with minimal discomfort 3
• Success rates are highest (90%) for lesions up to 1mm at the base, and 76% for lesions up to 2mm 3
• This method provides excellent cosmetic outcomes and represents a non-invasive option for patients who prefer to avoid immediate excision 3

Critical Clinical Pitfalls

Crohn's Disease Patients

• Never excise perianal skin tags in patients with Crohn's disease due to high rates of postoperative complications including poor wound healing, chronic non-healing ulcers, extensive scarring, and potential need for subsequent proctectomy 4
• Observation is strongly preferred over any intervention in this population 4

Atypical Presentations Requiring Biopsy

• Consider biopsy if skin tags appear atypical, as mycosis fungoides can rarely present with features mimicking skin tags, showing epidermotropism and atypical lymphoid infiltrates on histology 5
• Linear arrangements of skin tags may suggest friction as an etiopathogenic factor but do not require different treatment 1

Associated Metabolic Screening

While not affecting treatment decisions, patients with multiple skin tags warrant screening for:

• Hypercholesterolemia shows independent association with multiple skin tags 6
• Hypothyroidism demonstrates a possible trend toward association 6
• Acanthosis nigricans is independently associated with multiple skin tags 6
• Obesity and elevated triglycerides are commonly present 6