What is the recommended management for a 2-year-old patient with skin tags on the neck?

Skin Tags on Neck of a 2-Year-Old

Immediate Evaluation Required

Skin tags in a 2-year-old are highly unusual and warrant prompt evaluation by a pediatric dermatologist to rule out underlying genetic syndromes, metabolic conditions, or other pathology, as true acrochordons are exceedingly rare in young children. 1

Why This is Concerning

• Skin tags (acrochordons) typically develop in adults, particularly in intertriginous areas and are associated with obesity, insulin resistance, and metabolic syndrome 2, 3
• In a toddler, what appears to be "skin tags" may actually represent:
  • Congenital melanocytic nevi with papillated or pedunculated features 1
  • Neurofibromas (suggesting neurofibromatosis type 1) 4
  • Other benign growths that require different management
  • Rarely, more serious pathology requiring biopsy 1

Recommended Action Plan

Referral to Pediatric Dermatology

• Establish care with a pediatric dermatologist for thorough evaluation including visual inspection, dermoscopic evaluation, and palpation of the lesions 1
• Regional lymph node examination should be performed to assess for any concerning features 1
• Serial photographs should be obtained to monitor for changes over time 1

What the Specialist Will Assess

• Rule out congenital melanocytic nevi, which can present with varied surface changes including papillated or mamillated appearance that may resemble skin tags 1
• Evaluate for syndromic associations, particularly if multiple lesions are present 1
• Consider biopsy if features are atypical or if diagnostic uncertainty exists 1

Interim Management While Awaiting Specialist Evaluation

• Keep the area clean with gentle, pH-neutral cleansers rather than soap 1, 5
• Avoid irritation from clothing, perfumes, or other skin irritants 1, 5
• Do not attempt removal at home - procedures appropriate for adult skin tags (cryotherapy, snip excision) 6, 7 are not appropriate without proper diagnosis in a young child

Critical Pitfalls to Avoid

• Do not assume these are benign adult-type skin tags without specialist evaluation - the differential diagnosis in a 2-year-old is broad and includes conditions requiring specific management 1
• Do not delay referral - early evaluation establishes baseline documentation and allows for appropriate monitoring 1
• Avoid cosmetic removal procedures until proper diagnosis is established, as some lesions may require histopathologic examination 1