Treatment of Acrochordons (Skin Tags)
Acrochordons are benign skin lesions that can be safely removed using simple office-based procedures including snip excision with scissors, cryotherapy, or electrocautery, with treatment primarily indicated for symptomatic lesions or cosmetic concerns rather than medical necessity.
Clinical Context and Treatment Indications
Acrochordons are exceedingly common benign pedunculated skin lesions that typically occur on the neck, axillae, and groin regions 1, 2. While these lesions have been associated with diabetes mellitus, hyperlipidemia, and metabolic abnormalities 3, 4, treatment is elective and based on patient preference, symptoms (irritation, bleeding), or cosmetic concerns rather than any malignancy risk, as these are entirely benign lesions.
The mere presence of skin tags does not justify aggressive screening for systemic disease unless other metabolic or clinical markers are present 5. However, clinicians should be aware that patients with multiple acrochordons have approximately 1.8 times greater risk of developing diabetes mellitus compared to those without skin tags 3.
Primary Treatment Options
Snip Excision (First-Line for Most Lesions)
Simple scissor excision is the most straightforward and effective method for removing skin tags, particularly for pedunculated lesions 1. This can be performed with:
- Ethyl chloride spray anesthesia: Provides fast, painless anesthesia for excision with micro-scissors and micro-forceps, with patients reporting significantly greater comfort compared to local infiltration anesthesia 1
- No anesthesia: For very small, thin-stalked lesions where a single snip is sufficient 1
- Local infiltration: Reserved for larger or multiple lesions requiring more extensive manipulation 1
Mechanical Occlusion Device
A novel adhesive patch device that applies pressure to the base of skin tags has demonstrated efficacy 2:
- 90% success rate for lesions up to 1mm at the base 2
- 76% success rate for lesions up to 2mm at the base 2
- Removal occurs within 3-6 days of application 2
- Minimal discomfort throughout the procedure 2
- Excellent cosmetic outcome after removal 2
This method is particularly useful for patients who prefer non-invasive treatment or have anxiety about surgical procedures 2.
Alternative Destructive Methods
While not specifically studied in the provided evidence for acrochordons, standard dermatologic destructive techniques can be applied:
- Cryotherapy: Can be used for smaller lesions
- Electrocautery: Effective for hemostasis if needed during excision
Treatment Algorithm
For isolated or few skin tags:
- Offer snip excision with ethyl chloride spray anesthesia as first-line treatment 1
- Consider mechanical occlusion device for lesions ≤2mm base diameter in patients preferring non-invasive approach 2
For multiple widespread skin tags:
- Ethyl chloride spray with serial snip excisions provides efficient, comfortable removal 1
- Mechanical occlusion devices can be applied to multiple lesions simultaneously 2
For symptomatic lesions (irritated, bleeding, or twisted):
- Immediate snip excision is appropriate 1
Important Clinical Considerations
Metabolic Screening
While acrochordons are associated with metabolic abnormalities, routine screening is not indicated based solely on the presence of skin tags 5. Consider metabolic evaluation (fasting glucose, lipid panel) if:
- Multiple skin tags are present (suggesting higher metabolic risk) 3, 4
- Patient has other risk factors for diabetes or metabolic syndrome 3, 4
- Family history or clinical suspicion warrants investigation 4
Common Pitfalls to Avoid
- Do not perform colonoscopy screening based solely on the presence of skin tags, as this does not significantly correlate with colonic polyps unless other GI symptoms or risk factors are present 5
- Avoid unnecessary local anesthetic infiltration for every small skin tag when ethyl chloride spray provides adequate anesthesia with less discomfort 1
- Do not treat acrochordons as precancerous lesions—they are entirely benign and have no malignant potential