Hyperplasia

Skin Tag

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Skin Tag, Acrochordon, Fibroepithelial Stromal Polyp, Fibroepithelial Polyp

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