What Are Skin Tags? Understanding Causes and Treatments of Skin Tags with Dermatologist Dr Ne Win
August 05, 2020
I regularly see skin tags in clinic. They are usually as an incidental finding in my "2 Week Wait" skin cancer clinic, when I am doing a "top to toe” skin check on patients. Very occasionally, they are the primary lesion that the GP or the patient is worried about. This is more likely to be the case when they are very dark or have become irritated, perhaps covered in scabbing or stigmata of bleeding.
What are Skin Tags?
First and foremost, I often get the question: what exactly are skin tags?
Well, the main thing to emphasise is that skin tags are completely benign and harmless, and it is often a relief for me to give someone this diagnosis. Skin tags are incredibly common; chances are we all have some, or will develop them, or we know someone that has them. It’s likely we have at the very least seen them on other people at places such as the beach and swimming pool! (Or maybe that's just me who looks that closely at skin!) The older we get, and the larger we get, the more likely skin tags are to appear. About 25% of adults are reported to have skin tags, although the true scale may be greater.
Skin tags appear as small, superficial, fleshy, soft skin-coloured growths. They usually have a predilection for the neck, armpits, groin, inner thigh, or under the breasts. They like to appear in skin folds including under the buttock folds, abdominal apron, and even awkward areas such as the eyelids. They can range in size from a few millimetres to a few centimetres and can slowly enlarge over time.
Skin tags may be darker than the normal skin tone for the person, and can have either a smooth or wrinkled surface.
They can commonly be pedunculated. This means that they are on a stalk; in other words they consist of a larger soft fleshy mass of the skin tag connected to your skin by a much thinner stalk of skin. Less commonly, they may be filiform. This means that they are threadlike and can look like roots on a plant. Very small skin tags can simply appear as soft fleshy bumps.
They have various more scientific names that your Dermatologist may use. I usually don't, but they can be referred to as Acrochordon, Papilloma, Fibroepithelial polyp or soft fibroma. If you have had a skin tag removed then the histology report will use one of these terms.
Structurally, skin tags are made up of a core of loosely arranged and bundled collagen fibres and blood vessels enclosed by a thickened or thinned-out epidermis.
What Causes Skin Tags?
Another question I often receive concerns the causes of skin tags. Just what is it that makes skin tags appear? Ultimately, no one really knows - they are still a bit of a medical mystery!
As they tend to appear more in skin folds and creases and in obese or overweight people, it may be, at least in part, due to the mechanical friction and rubbing of the skin. This mechanical irritation may cause the growth of this "extra flesh". However, this is by no means a definite cause, and weight does not dictate whether or not skin tags appear, as I see them in patients of all weights, shapes, and sizes.
Additionally, there are a variety of other conditions that give rise to skin tags. For example, pregnancy can result in skin tags, as can endocrine disorders such as Acromegaly or Addison's disease. This may be due to the increase in growth factors.
While skin tags are not infective and therefore you cannot pass them around like viral warts, the Human Papilloma Virus (HPV) which is the cause of viral warts, may be implicated in causing them.
Another possible factor is insulin resistance which can be linked to something called the Metabolic Syndrome. This may just be due to causing obesity. Diabetics are also seen to develop skin tags more commonly, while other diseases such as Polycystic Ovarian Syndrome, which can also lead to obesity, may also be implicated in causing skin tags. In people with an inflammatory bowel disease called Crohn's disease, they tend to get skin tags around the anal opening, which can become quite irritating.
Skin tags seem to affect males and females equally, and there doesn't seem to be any racial preference. They do seem to run in families, however, so there may be a genetic preponderance. Skin tags are not present at birth but are more likely to develop with age, especially in middle age and later on in life - part of the joys of getting older!
What is the Treatment for Skin Tags?
Once we’ve established what skin tags are and some possible causes for them, patients’ thoughts often turn to the question of treatment. What can we do to get rid of skin tags?
As mentioned before, skin tags are completely harmless and are very unlikely to change into anything sinister. They also tend to be asymptomatic, in that is usually there is no pain or itching directly from the tag. However, they can get caught when shaving or on clothing such as bra straps, and under these circumstances they might become painful and bleed. When they appear on the eyelids, they can get in your field of vision and cause disruption in that way.
By far the most common issue is that people find skin tags rather unsightly; that is to say they are causing cosmetic issues. The NHS is not routinely able to offer treatment for skin tags that are causing cosmetic issues, so patients looking to remove them for this reason would have to see a private provider.
Skin tags that cause problems such as the ones I mentioned previously can be treated with various straightforward treatments that your Dermatologist can provide. Skin tags can mimic other skin lesions such as viral warts, Molluscum Contagiosum, or seborrhoeic keratoses, so for this reason it may be a good idea to have a Dermatologist review you. It’s important to note, though, that those differential diagnoses I have mentioned are also entirely benign.
Cryotherapy for Skin Tags
Cryotherapy is one option for removing skin tags. This is essentially where the skin tag is frozen, usually with two freeze-thaw cycles of liquid nitrogen via a handheld device by your Dermatologist or other appropriate healthcare provider, though GPs tend not to offer this service anymore. This is usually due to regulations regarding the safe storage and dispensing of liquid nitrogen. Cryotherapy can be too costly to provide in primary care.
Over the counter (OTC) freezing devices that are available for viral warts can be used at home but they are not as strong as the ones in hospitals or at a clinic. Liquid nitrogen cryotherapy is a generally safe and effective treatment for a variety of benign skin lesions including skin tags. It causes tissue damage to the offending lesion and will eventually cause it to necrose; that is to say it will die and "drop off". Sometimes the area can be quite sore and inflamed, or even blister. This can be due to damage to normal tissue. As your clinician is controlling the damage the normal tissues will heal with usually no scarring. You may however, end up with a hypopigmented or lighter patch of skin on the treated area. It is a very quick treatment with no down time as each freeze as part of the freeze-thaw cycle is 25-30 seconds. While it can sting or 'burn' a little, it is generally extremely well tolerated.
Surgery for Skin Tags
Skin tags can be removed with surgery under local anaesthetic. As they are usually pedunculated and attached only via a thin stalk they can be shaved off via shave excision with a scalpel or shave device. In a similar way they can also be "scraped off" via curettage and cautery. Both treatments are very straightforward and well tolerated. No stitches or sutures are required and the area will heal up like a graze, and with good aftercare will only leave a faint mark. Skin tags on the eyelid may require the expertise of an Ophthalmologist to treat them.
Electrosurgery for Skin Tags
You can have skin tags removed with an electrosurgical device such as a hyfrecator or bipolar diathermy device. The skin tag can be removed as well as cautery of the wound simultaneously, to help with speedy healing. Once again, this is a very simple and well tolerated procedure with good cosmetic outcomes.
Prevention of Skin Tags
When it comes to the prevention of skin tags, there is, annoyingly, not much evidence of any definitive way to prevent them. Avoiding obesity may be one of the only ways, and even this is not guaranteed as skin tags can appear on bodies of all weights, shapes and sizes.
So where does a collagen supplement like Absolute Collagen fit into this? There is no confirmed scientific evidence but it is possible that by replacing and rejuvenating your collagen, you can help to avoid the loose arrangement of collagen in the skin that causes skin tags. This is because keeping nice tight bundles of more youthful collagen, especially in areas of higher mechanical friction of the skin, may prevent the formation of skin tags. There is anecdotal evidence to support this from my own experiences; I don't tend to see skin tags in people with black skin tone. Black skin has naturally denser tighter bundles of collagen, which anecdotally supports this idea. However, future research on collagen supplementation may shed some light on this.
In conclusion, then, I think there are several take home messages when it comes to skin tags. Firstly, and most importantly, skin tags are benign and harmless. These fleshy growths often appear in skin folds, where there is a lot of skin rubbing against skin. They don’t usually cause problems, and are often just a cosmetic concern. They may run in families, but often appear with increased age and weight gain. If you do choose to pursue treatment, there are a range of simple, effective procedures with low risk of adverse outcomes.
If you have queries about skin tags or other dermatological concerns, please feel free to drop me an email on firstname.lastname@example.org.