Skin Tag; Causes, Symptoms, Diagnosis, Treatment

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Skin Tag (Acrochordons, fibroepithelial polyps, skin tags, papillomas) are common benign neoplasms of the skin, often associated with obesity. These small polyps are frequently a nuisance for patients, typically developing around the neck, axilla, and groin areas. They may bother patients because of associated symptoms such as itching, pain, and rubbing against clothes or simply because of their appearance. There may be a familial predisposition for developing these lesions, as well as the established association with obesity and insulin resistance.

skin tag or acrochordon is a small benign tumor that forms primarily in areas where the skin forms creases (or rubs together), such as the neck, armpit, and groin. They may also occur on the face, usually on the eyelids. Perianal skin tags can be associated with Crohn’s disease. Acrochorda is generally harmless and painless and usually, do not grow or change over time. Though tags up to a half-inch long have been seen,[rx] they are typically the size of a grain of rice. The surface of an acrochordon may be smooth or irregular in appearance and is often raised from the surface of the skin on a fleshy stalk called a peduncle. Microscopically, an acrochordon consists of a fibrovascular core, sometimes also with fat cells, covered by an unremarkable epidermis. However, tags may become irritated by shaving, clothing, jewelry or eczema.

Another Name

  • Also known as acrochordon, skin tag, soft fibroma, cutaneous papilloma, cutaneous tag, fibroma pendulum, fibroma molluscum

Types of Skin Tag

Three types of skin tags are described:[rx]

  • Small, furrowed papules of approximately 1 to 2 mm in width and height, located mostly on the neck and the axillae
  • Single or multiple filiform lesions of approximately 2 mm in width and 5 mm in length occurring elsewhere on the body.
  • Large, pedunculated tumor or nevoid, bag-like, soft fibromas that occur on the lower part of the trunk.

Causes of Skin Tag

  • Skin tags are thought to occur from skin rubbing up against the skin, since they are so often found in skin creases and folds.[rx] Studies have shown the existence of low-risk HPV 6 and 11 in skin tags, hinting at a possible role in its pathogenesis[rx] although one 2012 study found no association between skin tags and low risk or high-risk human papillomaviruses.[rx]
  • Acrochorda has been reported to have a prevalence of 46% in the general population.[]rx A causal genetic component is thought to exist.[rx] They also are more common in women than in men. Acrochorda were once thought to be associated with colorectal polyps, but studies have shown no such connection exists.[rx] Rarely, they can be associated with the Birt–Hogg–Dubé syndrome, acromegaly, and polycystic ovary syndrome.[rx]
  • Elevated blood sugar and insulin is linked to an increased incidence of skin tags through an unknown mechanism.[rx]
  • Skin tags are strongly associated with obesity and insulin resistance. Along with many other types of common benign skin lesions found on a skin exam of most adult patients (benign melanocytic nevi, seborrheic keratoses, cherry angiomas), they develop increasingly with age, and despite their benign nature, they can be of great concern and impact a patient’s quality of life. Other common benign lesions can mimic acrochordons, including benign melanocytic nevi and neurofibromas.
  • Etiology is unknown, but it is theorized that skin tags occur in localized areas with a paucity of elastic tissue resulting in sessile or atrophic lesions. In addition, hormone imbalances appear to facilitate their development (e.g., high levels of estrogen and progesterone are seen during pregnancy) and other factors including epidermal growth factor, tissue growth factor-α, and infection (e.g., human papillomavirus) have been implicated as cofactors.
  • Acrochordons also appear to be associated with impaired carbohydrate metabolism and diabetes mellitus
  • Pedunculated lesions may become twisted, infarcted, and fall off spontaneously.
  • Etiology is unknown, but it is theorized that skin tags occur in localized areas with a paucity of elastic tissue resulting in sessile or atrophic lesions. In addition, hormone imbalances appear to facilitate their development (e.g., high levels of estrogen and progesterone were seen during pregnancy) and other factors including epidermal growth factor, tissue growth factor-α, and infection (e.g., human papillomavirus) have been implicated as cofactors. Acrochordons also appear to be associated with impaired carbohydrate metabolism and diabetes mellitus
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Skin tags appear to be more common in:

  • people who are overweight and obese
  • those with diabetes
  • women during pregnancy, possibly due to hormonal changes and high levels of growth factors
  • those with some types of human papillomavirus (HPV)
  • people with a sex-steroid imbalance, especially if there are changes in levels of estrogen and progesterone
  • those whose close family members also have skin tags

Studies have found that skin tags are more likely to occur with:

  • obesity
  • dyslipidemia, for example, high cholesterol levels
  • hypertension, or high blood pressure
  • They have also been linked to insulin resistance and elevated high-sensitive C-reactive protein, a marker of inflammation.
  • This suggests that skin tags may offer an external sign of an increased risk of insulin resistance, metabolic syndrome, atherosclerosis, and cardiovascular disease.

Symptoms of Skin Tag

  • Soft papilloma, flesh-colored to dark brown, sessile to pedunculated
  • A few millimeters to multiple centimeters in size
  • Larger lesions often attach to skin by slender stalks.
Microscopic (histologic) description
  • Fibrovascular cores covered by squamous epithelium
  • Larger lesions may have a flattened epidermis
  • Smaller lesions can have epidermal hyperplasia or seborrheic keratosis-like changes
  • Central core composed of loose collagen with increased blood vessels
  • In larger lesion, may have a central core of adipose tissue
  • Pagetoid dyskeratosis is sometimes present as an incidental finding
  • May have ischemic necrosis due to torsion

Treatment of Skin Tag

Patients should be reassured that acrochordons are benign. If irritated or cosmetically undesired, they may be treated with any destructive modality, but they are most commonly treated by snip excision (with scissors) or liquid nitrogen cryotherapy. Other options may include shave excision, electrocautery, and ligation (tying a string or suture around the lesion). Multiple lesions may be treated at one visit, although some patients may prefer to have one individual lesion treated first as a test spot.

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Cryotherapy

  • Cryotherapy uses extreme cold to freeze off skin tags. Your doctor will apply liquid nitrogen to your skin on a cotton swab, or with a pair of tweezers. The liquid may sting or burn a bit when it goes on your skin. The frozen skin tag will fall off within 10 days. A blister will form in the area where the liquid nitrogen was applied. The blister should scab over and fall off within two to four weeks.

Surgical removal

  • Another way to remove skin tags is to cut them off. Your doctor will first numb the area, and then cut off the skin tag with a scalpel or special medical scissors.

Electrosurgery

  • Electrosurgery uses heat to burn off the skin tag at the base. Burning prevents excess bleeding when the tag is removed.

Ligation

  • During a ligation procedure, a doctor ties off the bottom of the skin tag to cut off its blood flow. After a couple of weeks, the skin tag will die and fall off.

Surgery

The following procedures may be used:

  • Cauterization: The skin tag is burned off using electrolysis
  • Cryosurgery: The skin tag is frozen off using a probe containing liquid nitrogen
  • Ligation: The blood supply to the skin tag is interrupted
  • Excision: The tag is cut out with a scalpel

These procedures should only be done by a dermatologist, or specialist skin doctor, or a similarly trained medical professional.

Home Remedies For Skin Tag Removal

A tag removal device

  • Skin tags do not require treatment and may fall away on their own, but medical removal is available. Skin tag removal kits are available for purchase online and in many stores. A person uses the device to cut off the supply of blood to the base of the tag with a tiny band.
  • The medical community refers to this process as ligation. Without a supply of blood, the cells will die, and the tag will drop away, usually within 10 days.

String

  • Some people try to achieve ligation with a piece of dental floss or string. It can be tricky to do this without the help of a device or another person.
  • When the flow of blood has been cut off for at least a few days, the tag should fall away. It may be necessary to tighten the string or floss every day.
  • Before using this method, clean the skin, string, and hands thoroughly to prevent infection.

Skin tag removal cream

  • Kits containing cream and an applicator are available. Usually, only one application of the cream is necessary. Instructions to some kits recommend cleaning the skin with an alcohol wipe and filing down the tag before applying the cream, to ensure that it is fully absorbed.
  • The cream may cause a mild stinging sensation. Tags should fall off within 2 to 3 weeks.

Freezing kit

  • A person can use a product containing liquid nitrogen to freeze off skin tags. These products are often available in drugstores and pharmacies. As always, follow instructions. Several applications may be necessary before a growth falls away, but this usually occurs within 10 days.
  • The spray should not come into contact with the surrounding skin. A person may want to apply petroleum jelly to the area around the tag for protection. Many factors can cause skin tags to form. In some cases, they require medical treatment. Learn more about skin tags here.
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Tea tree oil

  • Tea tree oil is an essential oil used to treat several skin conditions, including skin tags. However, only anecdotal evidence supports its use. People typically apply a few drops of the oil to a cotton ball, which they then affix to the skin tag with a bandage. The cotton ball is usually left on the skin tag for 10 minutes, three times daily. It may take several days or weeks for the tag to fall off. This remedy should be used with caution, as tea tree oil may irritate sensitive skin. Never use tea tree oil for tags located around the eyes.

Apple cider vinegar

  • Little research has been conducted on the effectiveness of apple cider vinegar for skin tag removal. People often soak a cotton ball in the vinegar and affix it to the tag with a bandage for 10 minutes two or three times a day, until the tag falls away. Watch for skin irritation and discontinue use if any adverse reactions are experienced. Do not use this method around the eyes.

Iodine

  • Anecdotal evidence suggests that a person can use liquid iodine to remove skin tags. First, protect the surrounding skin by applying petroleum jelly or coconut oil to the area. Soak a Q-tip in iodine and spread the liquid across the tag. Cover the area with a bandage until the iodine has dried. Repeat this treatment twice a day until the tag drops off.

Cutting

  • A doctor may recommend cutting away the growth with a sharp blade or scissors. Never attempt this with medium or large skin tags, as this can cause bleeding. Tags usually measure anywhere from a few millimeters to 2 inches in width. Only consider this method if the skin tag has a very narrow base. Scissors and blades should be sterilized before and after use

References

Skin Tag

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