What are skin tags?
Skin tags are small benign lesions that commonly occur in the eyelids, face, neck, underarms and groins. They usually have a stalk (peduncle) containing connective tissue, blood vessels, nerves, fat cells and a covering of skin. While they are generally painless, you may experience discomfort when skin tags are caught within skin folds or snagged by clothing.
How do skin tags arise?
It is unclear what exactly causes skin tags, though some groups have a higher tendency of developing this condition. These include people with:
- Family history of skin tags
- Diabetes mellitus
- Obesity
- Pregnancy
- Infection with certain subtypes of human papilloma virus (HPV)
How do skin tags manifest?
Skin tags often arise in adulthood and affect both males and females. They start as small, pinhead-like lesions that may range from skin-coloured to dark brown, and their surfaces can be smooth or irregular. As they grow, skin tags become raised and pedunculated (i.e. hanging from a stalk). Their size ranges from 1 mm to 1 cm in size. You may experience discomfort when skin tags are caught in between skin folds, clothing or jewellery. They may bleed when traumatized; for example when shaving beards or under-arm hair. Skin tags tend to be aesthetically displeasing as well, particularly those occurring in the eyelids and neck.
How are skin tags treated?
1. Home remedies
A simple age-old remedy is to tie (ligate) the base of the skin tag with a fine thread and wait a few days for the skin tag to shrivel and fall off. This method may leave some parts of the stalk on the patient and some bleeding may occur as a result.
2. Over-the-counter remedies
Small skin tags can be treated using over-the-counter remedies available at many pharmacies. These involve the use of small hand-held apparatuses that deliver controlled freezing. Typically, skin tags treated in this manner will shrivel and drop off after about a week.
3. Cryotherapy
Cryotherapy treatment is usually administered by dermatologists and utilises a focused jet of liquid nitrogen to freeze the skin tag. Freezing causes cell death (apoptosis) and thrombosis (clotting) of the blood vessels in the skin tag. It must be carefully administered to ensure that there is minimal collateral injury to the surrounding normal skin. Cryotherapy can be used for medium-sized skin tags in the underarms and groins, but it is avoided at the eyelids and infrequently used in the face and neck since hypopigmentation may result in the surrounding skin.
4. Laser ablation or excision
Ablative lasers such as carbon dioxide laser can be used to vaporise small skin tags. The carbon dioxide laser produces a focused beam of light that is absorbed by intracellular water and converted to heat energy, resulting in vaporisation of the skin tag. This leaves a shallow wound that heals over in about one week. Laser vaporisation of skin tags is often bloodless as the heat energy from the laser seals up open blood vessels. Larger skin tags that are pedunculated (have a stalk) can be directly excised by cutting through the base of the stalk with the laser. Lasers are administered by trained medical practitioners including dermatologists and plastic surgeons, and selected general practitioners who meet licensing requirements.
5. Surgical excision
Surgical excision is a simple and effective method of treatment and is indicated for moderate to large size skin tags, or pedunculated ones. Skin tags of the eyelids are almost always removed surgically and the procedure is performed under local anaesthesia. The skin tag is excised at its base and one or two fine stitches may be used to close the wound for an optimal scar. Excision is appropriate for lesions that are too large for laser ablation, in cases where the specimen requires further testing to exclude other skin conditions or for insurance claims purposes.
Post Procedural Care
The post-procedural care following laser ablation or excision involves keeping the wound clean and dry. Topical creams and ointments are often prescribed to help maintain a moist wound environment, which promotes healing (epithelization). Patients are advised to avoid strong sunlight exposure and use sunblock diligently for two months post-procedure.
