Skin Tags: A Comprehensive Overview
Author: Dr. Gary Jayne Rothfeld
Last Update: September 24, 2024
Continuing Education Activity
Skin tags, clinically referred to as acrochordons, are benign epithelial growths commonly encountered in dermatological practice. These soft, elevated lesions are primarily composed of excess skin and appear as small, fleshy protrusions. Research indicates that approximately 50% to 60% of adults will develop at least one skin tag during their lifetime, with the likelihood of occurrence markedly increasing after the age of 40. It is noteworthy that acrochordons are more prevalent among individuals with obesity, diabetes, metabolic syndrome, and those with a family history of such lesions. Both sexes are equally affected. This article aims to elucidate the characteristics, classification, and underlying mechanisms of skin tags, while also emphasizing the importance of an interprofessional approach in their management.
Objectives
- Define and categorize skin tags, including their etiological factors.
- Discuss the evaluation process for patients presenting with skin tags.
- Differentiate skin tags from conditions that may mimic them and outline the diagnostic approach.
- Describe the roles of various healthcare professionals in the effective management of skin tags.
Introduction
Skin tags, or acrochordons, manifest as soft, pedunculated growths often found in regions where skin folds exist, such as the axilla, neck, eyelids, and groin. They can be skin-colored, brown, or even red, typically ranging from 1 to 5 mm in diameter but can occasionally reach sizes of 1 to 2 centimeters. While these lesions are generally asymptomatic, they can be a source of discomfort when they become caught on clothing or jewelry, leading to irritation, bleeding, or itching.
Acrochordons may develop in adolescence but are most frequently observed in older adults. Interestingly, recent studies have shown a rising incidence of skin tags among children and adolescents, correlating with the global increase in childhood obesity. It is rare for these lesions to appear after the age of 70. Genetic predispositions, such as those seen in conditions like Birt-Hogg-Dubé syndrome and tuberous sclerosis, can lead to a proliferation of skin tags, often forming a distinctive appearance around the neck.
Etiology
The development of skin tags is associated with several factors, including:
- Abnormal lipid profiles
- Type 2 diabetes
- Cardiovascular disease
- Obesity
- Genetic predispositions
Frequent skin irritation, particularly in obese individuals, is believed to contribute to their formation. Aging is a significant factor, often accompanied by loss of skin elasticity. Hormonal fluctuations, such as elevated levels of progesterone, estrogen, and human growth hormone, can also play a role. While infectious causes have not been definitively linked to skin tags, some studies suggest a possible association with human papillomavirus (HPV) infections, as well as a notable correlation with type 2 diabetes.
Epidemiology
The reported incidence of acrochordons in the general population is around 50% to 60%. Both males and females show equal prevalence. As individuals age, the likelihood of developing these lesions increases, with around two-thirds of people experiencing them by their fifth or sixth decade of life.
Pathophysiology
Histological examination of skin tags reveals an attenuated epidermis with a flattened basal layer and increased pigmentation. The mass consists primarily of loose fibrous tissue attached to the skin via a narrow pedicle. While melanocytic proliferation is typically absent, some skin tags may represent remnants of pre-existing nevi, emphasizing the overlap with other dermatological conditions.
Evaluation
Patients presenting with skin tags should undergo a thorough evaluation for underlying conditions such as diabetes. This includes testing for HbA1c, fasting blood glucose levels, and a lipid profile. Monitoring the patient's body mass index (BMI) is also essential for comprehensive care.
Treatment and Management
The primary treatment for skin tags involves their removal. Currently, radiocautery is the most commonly utilized method due to its precision and efficiency. Alternative removal techniques include:
- Snip excision
- Cryosurgery
- Laser therapy (e.g., Q-switched Ndor CO2 lasers)
Local anesthesia may be administered to minimize discomfort during procedures. Following excision, the wound typically heals well without complications.
While skin tag removal is generally a low-risk procedure, it is important to manage potential bleeding during the process. Adequate patient history regarding medication use is crucial, as certain medications can affect bleeding tendencies. Patients should receive proper postoperative care instructions to mitigate the risk of infection.
Differential Diagnosis
Conditions that may resemble skin tags include:
- Neurofibromatosis type 1
- Genital warts
- Melanocytic nevi
- Nongenital warts
- Seborrheic keratosis
Surgical Oncology
Most skin tags are benign, and histopathological examination after excision usually confirms this.
Prognosis
Skin tags, if left untreated, may increase in size due to persistent friction. However, they possess a very low risk of malignancy.
Complications
Complications may include inflammation, particularly in obese individuals, as well as scarring or changes in cosmesis resulting from improper removal techniques. Rarely, complications such as neuromas may develop if nerves within the skin tag are inadvertently cut.
Postoperative and Rehabilitation Care
Post-removal, the application of moisturizing agents can facilitate healing and minimize irritation.
Deterrence and Patient Education
Patients should be informed that while skin tags are benign, they may correlate with conditions like type 2 diabetes and obesity. Maintaining a healthy weight and stable blood glucose levels is important. Individuals with skin tags around the neck should avoid wearing restrictive jewelry, and those with lesions in other areas should be cautious with tight clothing.
Lifestyle Recommendations
Encouraging weight loss, a nutritious diet, and regular physical activity can reduce the likelihood of developing skin tags and lower the risk of obesity and diabetes. Proper skin care, including the use of syndet bars and moisturizers, may also contribute to prevention.
Enhancing Healthcare Team Outcomes
Skin tags should not be viewed in isolation; they often indicate a potential underlying metabolic disorder, especially in patients with diabetes or metabolic syndrome. A thorough evaluation is essential, and collaboration among healthcare providers can optimize patient outcomes. Dermatologists should remain vigilant about the possibility of comorbidities in patients with skin tags, and removal should be performed by trained professionals to ensure safety and efficacy.
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| DR GARY JAYNE ROTHFELD |