II. Definitions
- Skin Tag (Acrochordon, Fibroepithelial Stromal Polyp)
- Benign epidermal hyperplastic lesion (Skin Tag)
III. Epidemiology
- Very common (occurs in 25% of adults)
- Increasing Prevalence with age (esp. age 20 to 50 years)
IV. Risk factors
- Obesity
- Advancing age
- Pregnancy
- Metabolic Syndrome or Diabetes Mellitus
V. Pathophysiology
- Develops in regions of increased skin friction and irritation
- Lesion of mesenchymal origin
- Hormone Sensitive
VI. Signs
- Characteristics
- Usually pedunculated (narrow stalk) but may be sessile
- Flesh-colored to brown
- Typically 2-5 mm in size (may be up to 1 cm, up to 20 cm in rare cases)
- May ulcerate or erode, bleed or have discharge with irritation
- Distribution (areas of friction)
- Axilla
- Neck
- Inguinal area
- Vulva
VII. Differential Diagnosis
- Pedunculated intradermal nevus
- Seborrheic Keratosis
- Neurofibroma
- Nevoid Basal Cell Carcinoma syndrome
- Skin Tags seen in childhood
- Only indication to send Skin Tags for histology
- Chiritescu (2001) J Am Acad Dermatol 44:789-94 [PubMed]
VIII. Labs
- Pathology is indicated in only atypical lesions
- Send one specimen per jar
IX. Management
- Indications for excision
- Local irritation (often caught on jewelry or clothing)
- Cosmesis
- Biopsy if present in childhood (see above)
- Techniques for destruction
- Refer those with Eyelid involvement
- Local Anesthesia only required for larger lesions
- Cut quickly in one stroke if not using Local Anesthesia
- Pedunculated Skin Tags
- Excise with iris scissors
- Pre-apply Topical Antiseptic (e.g. Alcohol, Chlorhexidine, Povidone Iodine)
- Apply topical Aluminum Chloride (e.g. Drysol) for coagulation
- Electrodesiccation
- Electrocautery at lesion base
- Preferred over cautery in darker skinned patients
- Cryotherapy with Liquid Nitrogen (for small Skin Tags)
- Exercise caution in patients with darker skin (risk of Hypopigmentation)
- Consider using an ear speculum to focus Cryotherapy on lesion
- Excise with iris scissors
- Sessile Skin Tags
- Shave excision
X. References
- Tavelli in Noble (2001) Primary Care, Mosby, p. 771
- Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
- Luba (2003) Am Fam Physician 67(4):729-738 [PubMed]
- Oluyadi (2023) Am Fam Physician 107(1): 87-8 [PubMed]
- Wagner (2024) Am Fam Physician 110(4): 353-61 [PubMed]