Skin Tags

Skin tags (acrochordons) are soft, benign, pedunculated skin growths that arise at sites of friction, mainly the neck, axillae, groin, eyelids and under the breasts. They are very common in middle age.

• Associations: obesity, insulin resistance and type 2 diabetes, dyslipidaemia, polycystic ovary syndrome, pregnancy, acromegaly, metabolic syndrome, family history.
• Multiple tags may rarely accompany Birt Hogg Dube syndrome.

Skin coloured or brown, soft, 1 to 5 mm (rarely larger) polypoid growths on a narrow stalk, usually asymptomatic.

• Twisting causes pain, bleeding and thrombosis (rapid darkening).
• Differential diagnosis: seborrhoeic keratosis, viral wart, neurofibroma, naevus, molluscum contagiosum, basal cell carcinoma, fibroepithelial polyp, melanoma (pigmented).
• Complications: irritation, bleeding, infarction and pain, cosmetic concern, snagging on clothing, rare malignant transformation.

Clinical.

• Fasting glucose or HbA1c, lipid profile, blood pressure and body mass index for multiple tags.
• Consider PCOS evaluation or acromegaly assessment where suggested.
• Histology for atypical, pigmented, large or rapidly changing lesions.

Reassure; remove only for symptoms or cosmetic reasons.

• Supportive: weight loss and glycaemic control, avoid friction from clothing and jewellery, hygiene of folds.
• Pharmacological: lidocaine 1 percent local anaesthesia (1 to 2 mL) for excision of larger tags; topical anaesthetic cream (lidocaine 2.5 percent with prilocaine 2.5 percent) for small tags before removal; antiseptic and aluminium chloride 20 percent solution on the base for haemostasis.
• Procedures: snip excision with scissors, cryotherapy with liquid nitrogen for 5 to 10 seconds, electrocautery or radiofrequency ablation, ligation of the base with suture for larger stalked tags. Avoid cautery near the eyelid margin.
• Special groups: pregnancy, tags often regress after delivery so defer removal; children, rare, so assess for syndromic features; patients on anticoagulants, pressure haemostasis and avoid cautery near large vessels.
• Red flags: bleeding without trauma, rapid enlargement, irregular pigmentation, ulceration, firm base.
• Follow-up: none needed after removal unless histology is abnormal; address metabolic risk.