Treatment for Infected Genital Skin Tag
Immediate Management Priority
An infected genital skin tag requires treatment of the bacterial infection first with appropriate antibiotics and local wound care, followed by consideration of removal once the infection has resolved. This differs fundamentally from treating genital warts, which are viral HPV-related lesions that the provided guidelines address 1, 2.
Critical Distinction: Skin Tags vs. Genital Warts
- Skin tags are benign fibroepithelial polyps that can become secondarily infected, requiring bacterial infection management rather than the HPV-directed therapies described in the CDC guidelines 1
- The evidence provided focuses exclusively on HPV-related genital warts, not infected skin tags, which are entirely different pathologic entities 2, 3
- Infected skin tags present with signs of bacterial infection (erythema, warmth, purulent drainage, pain) rather than the asymptomatic or pruritic presentation typical of genital warts 1
Treatment Algorithm for Infected Genital Skin Tag
Step 1: Treat the Active Infection
- Initiate oral antibiotics covering skin flora (Staphylococcus and Streptococcus species) - typically first-generation cephalosporins or anti-staphylococcal penicillins
- Apply warm compresses to the affected area to promote drainage and reduce inflammation
- Maintain local hygiene with gentle cleansing using mild soap and water
- Consider topical antibiotic ointment if there is superficial skin breakdown
Step 2: Assess for Complications
- Examine for abscess formation, which may require incision and drainage
- Evaluate for cellulitis extending beyond the skin tag itself
- Check for systemic signs of infection (fever, malaise) that would warrant more aggressive management
- Consider diabetes screening and immunocompromised states as predisposing factors 4
Step 3: Definitive Management After Infection Resolution
- Once infection has cleared (typically 7-10 days), consider elective removal of the skin tag to prevent recurrence
- Removal options include:
- Surgical excision with scissors or scalpel under local anesthesia
- Electrocautery at the base
- Cryotherapy (though less ideal for pedunculated lesions)
- Send tissue for histopathologic examination if there is any diagnostic uncertainty 1
Important Caveats
- Do not attempt ablative procedures (cryotherapy, TCA/BCA, electrocautery) on actively infected tissue, as this can worsen infection and delay healing 1
- The CDC guidelines for genital wart treatment are not applicable to infected skin tags, as these address HPV-mediated lesions requiring different therapeutic approaches 1, 2
- Biopsy is indicated if the lesion appears atypical, pigmented, indurated, fixed, bleeding, or ulcerated to exclude malignancy 1, 5
- Recurrent infections of the same skin tag indicate the need for definitive removal rather than repeated antibiotic courses
When to Refer
- Extensive cellulitis or abscess formation requiring surgical drainage
- Diagnostic uncertainty between skin tag, genital wart, or premalignant/malignant lesion 5
- Immunocompromised patients with poor response to initial antibiotic therapy 4
- Large or multiple lesions requiring more extensive surgical intervention