What are the next steps for a skintag (skin tag) that is dark, soft, and squishy 4 days after ligation, without signs of dryness?

Skin Tag Ligation at 4 Days: Expected Appearance and Management

The dark, soft, and squishy appearance of your skin tag 4 days after ligation is concerning and suggests incomplete necrosis—the tissue should be progressing toward firm, dry, black eschar by this point, not remaining soft and squishy. 1

What Should Be Happening Now

Normal progression after ligation:

• The ligature creates tight encirclement at the base, occluding blood vessels and causing ischemic necrosis 1
• By day 4, the tissue should be darkening (which yours is) but also becoming progressively firmer and drier as necrosis advances 1
• Complete sloughing typically occurs 1-2 weeks after treatment 1

Your concerning finding:

• Soft and squishy texture at day 4 suggests the ligature may not have achieved complete vascular compromise 1
• Lack of dryness indicates ongoing blood flow or tissue edema rather than progressive necrosis 2

Immediate Assessment Required

Check for signs of infection (though unlikely at this stage):

• Temperature >38.5°C (101.3°F) or heart rate >110 beats per minute 1
• Expanding redness >5 cm around the site 1
• Purulent (pus-like) discharge with foul odor 1
• Severe pain beyond mild discomfort 1

Important context: Surgical site infections rarely occur in the first 48 hours, and you're now at day 4, so infection is still uncommon unless you see the specific signs above 1

Most Likely Explanation and Next Steps

The ligature has likely slipped or was not placed tightly enough at the base:

• Band slippage before complete necrosis is a recognized complication of skin tag ligation 1
• Studies show successful outcomes require immediate decrease in blood flow after application, which your soft/squishy texture suggests did not occur 2

Recommended action:

• Contact the provider who performed the ligation within 24-48 hours for re-evaluation 1
• The ligature likely needs to be replaced or the skin tag removed by an alternative method (snip excision, cryotherapy, or electrodessication) 3
• Do not attempt to tighten or manipulate the ligature yourself

Wound Care While Awaiting Re-evaluation

Keep the area clean:

• Gentle cleansing with soap and water is acceptable 1
• Keep the area dry when possible 1
• Apply a simple absorbent dressing if drainage is bothersome or staining clothing 1

What drainage is normal:

• Minimal clear to yellowish drainage without foul odor is expected 1
• This is serous fluid, not infection 1

Critical Pitfalls to Avoid

Do not assume this will resolve on its own:

• Incomplete vascular compromise means the tissue will not necrose properly and may remain attached indefinitely 2
• Partially necrotic tissue that remains soft can become a nidus for secondary infection over time 1

Do not start antibiotics empirically:

• Without clear signs of infection (fever, expanding erythema >5 cm, purulent discharge), antibiotics are not indicated 1
• Serous drainage alone does not warrant antibiotics 1

Special consideration if this is a perianal skin tag:

• If you have Crohn's disease and this is a perianal skin tag, contact your physician immediately—these have high rates of poor wound healing and complications 1