Skin Tags

Julie A. Neville

Gil Yosipovitch

I. Definition and Pathophysiology

Skin tags (acrochordons) are small papillomas found commonly on the sides of the neck, axillae, upper trunk, and eyelids of middle-aged and elderly people. Obesity, pregnancy, menopause, and endocrine disorders such as acromegaly predispose to these benign epithelial hyperplastic lesions. Although controversial, it has been suggested that multiple skin tags may be a marker for diabetes mellitus or impaired carbohydrate metabolism and may indicate a significantly increased risk of colonic polyps if they occur rapidly over a short period of time. One study using polymerase chain reaction (PCR) found low but detectable levels of human papillomavirus (HPV) in 80% of the evaluated skin tags, with subtypes 6 and 11 being present 98% of the time.

II. Subjective Data

Skin tags are cosmetically bothersome but asymptomatic. Occasionally, a lesion will twist on its stalk and become painful, erythematous, and necrotic.

III. Objective Data

The lesions are single or multiple, 1 to 3 mm in diameter, soft, flesh-colored or hyperpigmented, oval or round papillomas. They are usually pedunculated.

IV. Assessment

Treatment of obesity or an underlying endocrinologic abnormality will decrease the likelihood of new lesion formation. Lesions may be confused with seborrheic keratoses, dermal nevi, neurofibromas, or warts. If multiple skin tags have occurred over a short period of time, referral for sigmoidoscopy or colonoscopy should be considered.

V. Therapy

Treatment is easily accomplished with any of the following methods:

Excision. Grasp the tag with forceps and sever the base with a sharp scissors (Gradle or iris scissors are excellent for this use) or a scalpel blade. Hemostasis may be secured by pressure, Monsel’s solution (ferric subsulfate solution), 20% aluminum chloride, mild acids (30% trichloroacetic acid), or an electrosurgical spark, although the use of these modalities can cause stinging if the area is not anesthetized. The lesion may be anesthetized with lidocaine or ethyl chloride spray before excision, but this is rarely necessary. Never use an electrosurgical apparatus around flammable ethyl chloride spray or aluminum chloride.
Destruction. Touch each lesion with a light electrosurgical spark or remove it with the cutting current. Administration of local anesthesia is usually unnecessary and causes as much pain as the treatment itself. Multiple lesions may be treated at one time.
Cryotherapy. Grasp the base of the skin tag with a forceps and direct liquid nitrogen spray at the lesion until frozen. The use of the forceps helps prevent transmission of the cryogen to the skin (minimizing the chance of hyper- or hypopigmentation) and allows a deeper freeze of the individual lesion. Alternatively, dip the tip of a hemostat, forceps, or needle holder into a Styrofoam cup with liquid nitrogen for 15 seconds without allowing the hinge to freeze. Use this instrument to grasp the lesion for 10 seconds. A cotton-tipped applicator dipped in liquid nitrogen can also be used to freeze the lesion, although this can lead to damage to the surrounding tissue.

	Manual of Dermatologic Therapeutics 7th Edition
	© 2007 Lippincott Williams & Wilkins

Manual of Dermatologic Therapeutics7th Edition

Manual of Dermatologic Therapeutics
7th Edition