Management of Skin Tags
Skin tags (acrochordons) are benign skin lesions that do not require treatment unless they are symptomatic or cosmetically bothersome to the patient.
What Are Skin Tags?
- Skin tags are common benign skin growths that appear as skin-colored or hyperpigmented, pedunculated (stalk-like) lesions 1
- They typically occur in intertriginous areas (skin folds) such as the neck, axillae (armpits), and groin regions 1, 2
- Friction appears to play a role in their development, as evidenced by cases where multiple skin tags develop in linear patterns along areas of repeated skin contact 1
When to Consider Treatment
- Treatment is primarily indicated for cosmetic concerns or when lesions become symptomatic (irritated, painful, or caught on clothing) 1
- No treatment is medically necessary for asymptomatic skin tags, as they are benign and pose no health risk 1
- The decision to treat should be based entirely on patient preference and symptoms 1
Treatment Options
Simple Office-Based Removal Methods
- Snip excision with scissors is the most straightforward approach for pedunculated lesions 1, 2
- Cryotherapy (freezing with liquid nitrogen) is effective for skin tag removal 1
- Electrodesiccation (cautery) can be used to remove skin tags 1
Anesthesia Considerations
- Ethyl chloride spray provides fast, painless topical anesthesia for skin tag excision and is preferred by patients over local infiltration 2
- Local anesthetic infiltration into each individual skin tag is more painful and less well-tolerated 2
- For multiple widespread lesions, ethyl chloride spray allows comfortable removal without the discomfort of multiple injections 2
Alternative Non-Invasive Method
- A mechanical pressure device (adhesive patch) can be applied to the base of skin tags, causing removal within 3-6 days through vascular occlusion 3
- This method shows 90% success for lesions up to 1mm at the base and 76% success for lesions up to 2mm 3
- The cosmetic outcome is excellent with minimal discomfort throughout the procedure 3
- This approach is suitable for patients who prefer non-invasive removal 3
Important Clinical Considerations
Associated Metabolic Conditions
- Multiple skin tags are associated with obesity, hypercholesterolemia, acanthosis nigricans, and possibly hypothyroidism 4
- Patients presenting with numerous skin tags should be screened for metabolic syndrome, diabetes, and lipid abnormalities 4
- The presence of acanthosis nigricans (dark, velvety skin in body folds) alongside multiple skin tags strengthens the association with insulin resistance 4
Red Flag: Atypical Presentations
- If lesions clinically appear as skin tags but show unusual features (rapid growth, bleeding, pain, ulceration, or widespread distribution with underlying erythema), biopsy is mandatory to exclude malignancy 5, 6
- Rare case reports document mycosis fungoides (cutaneous T-cell lymphoma) presenting with skin tag-like lesions 6
- Any skin tag that fails to respond to standard treatment or exhibits atypical behavior requires histological examination 5
Patient Counseling Points
- Skin tags are completely benign and do not transform into cancer 1
- Removal is purely elective and based on cosmetic preference or symptomatic relief 1
- Multiple treatment options exist with excellent cosmetic outcomes 1, 3
- Recurrence is possible, and new skin tags may develop over time, particularly in friction-prone areas 1
- Weight loss and management of metabolic conditions may reduce the development of new lesions 4