Color Change in Skin Tags During First 3 Days After Ligation
Yes, significant color change of a skin tag is expected during the first 3 days after ligation, progressing from the normal skin color to darker shades (purple, black) as ischemia develops, which is the intended therapeutic effect leading to tissue necrosis and eventual removal.
Expected Timeline and Color Changes
The color change you observe represents the normal progression of ischemic necrosis following successful ligation:
- Days 1-3: The skin tag should darken progressively as blood flow is occluded, transitioning through shades of purple to dark brown or black 1
- Days 3-6: Complete necrosis typically occurs, with the tissue becoming fully gangrenous and ready for removal 1, 2
- Complete removal: Most skin tags treated with ligation devices fall off within 3-6 days of application 1
Mechanism of Color Change
The darkening represents successful vascular occlusion:
- Blood flow reduction occurs immediately after proper ligation application 1
- Continued decrease in blood flow at 2-3 days correlates with successful outcome 1
- The degree of occlusion influences success, though complete occlusion is not always critical for eventual removal 1
Warning Signs vs. Expected Changes
Expected (normal) findings:
- Progressive darkening of the skin tag itself
- The tag becoming firm and desiccated
- Minimal discomfort during the process 1
Concerning findings requiring evaluation:
- Erythema, warmth, or swelling extending beyond the skin tag into surrounding normal skin 3
- Purulent drainage 3
- Systemic signs: fever >38.5°C, significant pain, or signs of spreading infection 3
- Retained gangrenous tissue beyond 6-7 days that fails to separate 4
Common Pitfalls
Incomplete ligation: If the color change is not progressing or the tag remains pink/normal colored after 2-3 days, the ligation may be inadequate and blood flow may still be present 1, 4. One case report documented bilateral retained gangrene and cellulitis following unsuccessful suture ligation 4.
Confusing normal necrosis with infection: The black, necrotic appearance is the desired endpoint, not a complication, as long as it remains confined to the ligated tissue without surrounding cellulitis 4.