Treatment Options for Skin Tags
For routine skin tags, simple office-based excision with scissors (snip excision) is the treatment of choice, with optional ethyl chloride spray for anesthesia to minimize discomfort. 1
Primary Treatment Modalities
Snip Excision (First-Line)
- Direct scissor excision at the base of the pedunculated lesion is the most straightforward approach for skin tags on the neck, axilla, and groin regions 1
- Ethyl chloride spray anesthesia applied immediately before cutting provides effective pain control without the discomfort of needle infiltration 1
- Patients who previously underwent conventional excision with local anesthetic infiltration report that ethyl chloride spray is significantly more comfortable and painless 1
Alternative Office Procedures
- Cryotherapy can be used for skin tag removal, though it is less commonly employed than direct excision 2
- Electrodesiccation is another viable option for destruction of skin tags 2
- Both methods are effective but may require multiple treatments and have less predictable cosmetic outcomes compared to snip excision 2
Mechanical Ligation Device
- A flat adhesive patch device that applies pressure to the base of the skin tag achieves removal within 3-6 days 3
- Success rates are highest (90%) for lesions up to 1 mm at the base, dropping to 76% for lesions up to 2 mm 3
- The device works by occluding blood flow, causing ischemic necrosis 4
- Discomfort is minimal throughout the procedure, and cosmetic outcomes are excellent 3
- The ligature must be placed directly at the base to ensure complete vascular compromise 4
Critical Contraindications
Perianal Skin Tags in Crohn's Disease
- Do not excise or ligate perianal skin tags in patients with Crohn's disease 5, 4
- The American Gastroenterological Association and European Crohn's and Colitis Organisation strongly recommend observation over intervention due to high rates of postoperative complications 5
- Complications include chronic non-healing ulcers, extensive scarring, poor wound healing, and potential need for subsequent proctectomy 5, 4
Post-Procedure Management
Expected Normal Course
- Minimal clear to yellowish drainage without foul odor is expected after ligation 4
- Temperature below 38.5°C (101.3°F) and heart rate below 110 bpm indicate normal healing 4
- Less than 5 cm of erythema around the site is normal 4
- Minor bleeding may occur when necrotic tissue sloughs, typically 1-2 weeks after ligation 4
Wound Care
- Keep the area clean and dry when possible, but gentle cleansing with soap and water is acceptable 4
- Apply a simple absorbent dressing if drainage is bothersome 4
Warning Signs Requiring Medical Attention
- Surgical site infections rarely occur within the first 48 hours; fever or drainage during this period is usually non-infectious 4
- Early infections (within 48 hours) that do occur are typically caused by Streptococcus pyogenes or Clostridium species and present with severe pain, systemic toxicity, and rapid progression 4
- Do not start antibiotics empirically without clear signs of infection: fever, expanding erythema >5 cm, or purulent discharge 4
- Severe pain beyond expected mild discomfort requires evaluation 4
Special Population Considerations
High-Risk Patients
- Immunocompromised patients (uncontrolled HIV/AIDS, neutropenia, severe diabetes) have increased risk of severe complications including necrotizing infection and require closer monitoring 4
- Patients with Crohn's disease who have undergone perianal skin tag removal should contact their physician immediately due to high complication rates 4
Associated Metabolic Conditions
- Multiple skin tags (>5 in neck or axillae) are strongly associated with insulin resistance (odds ratio = 7.5 for HOMA-IR >3.8) 6
- Skin tags correlate with atherogenic lipid profiles (elevated triglycerides, decreased HDL cholesterol), type 2 diabetes, and cardiovascular disease risk 7
- Consider screening patients with multiple skin tags for metabolic syndrome, diabetes, and dyslipidemia 6, 7