Tuesday, May 17, 2022

At-home and Surgical Options, Efficacy and Myths

  • Skin tags are small, harmless growths that hang from the skin by a thin piece of tissue 
  • These growths can be removed by over-the-counter products such as patches, pens and creams 
  • Surgical options include cryotherapy, excision and electrocautery
  • It is advised to see a dermatologist before attempting at-home removal to obtain an accurate diagnosis

Acrochordons, or simply skin tags, are noncancerous growths that typically develop in skin folds and are a result of the skin rubbing against itself. Skin tag removal can be achieved by purchasing over-the-counter (OTC) products or through professional treatments. 

Before attempting to remove it yourself, it is advised to have a professional examine your skin – especially if the skin tag is particularly large or situated in a sensitive area such as the eye or groin.

Skin tags are small, benign growths that contain fat, loose collagen fibers, and sometimes small blood vessels. They tend to be the same color as the skin but vary in size depending on the location; typically they develop in skin folds.

The neck and armpit areas usually range from 1–2 mm in width and height; 2 mm in width by 5 mm long for other areas of the body; and large-sized bag-like growths in the groin area. With age, they can increase in size and number.  

Skin tags are very common, with an incidence rate of 50%–60% among the general population; the prevalence is about equal between men and women.

Several studies have shown that skin tags are associated with obesity, diabetes and hypertension. Other studies have also linked the presence of skin tags to a higher risk of developing metabolic syndrome (a condition that describes risk factors for cardiovascular disease).

During pregnancy, hormonal changes have also been linked to greater presence of skin tags.

While it is possible for a skin tag to become twisted, cutting off the blood supply to the tissue,  this is usually not the case. Skin tags do not normally resolve on their own and therefore require treatment to be removed; do not attempt to cut a skin tag off yourself as this can lead to bleeding and infection. 

When Should a Skin Tag Be Removed?

Skin tags are usually harmless, painless and do not require removal. However, they may be unsightly, or cause irritation and pain if they become caught in clothing or jewelry. In some cases, they can grow unusually long – which does require removal. 

There are several OTC options available for you to choose from at your pharmacy; each uses a different mode of action to remove skin tags. While these products have been developed for this purpose, of note is that there is little scientific data to support their efficacy.

Creams

Skin tag removal creams typically contain tea tree oil or salicylic acid, and these agents work in different ways. 

As an antiseptic, tea tree oil works to break down and dry out skin tag tissue. Salicylic acid is a powerful desmolytic agent that breaks down the bonds that hold skin cells together and is therefore a very effective peeling agent.  

Patches

Homeopathic patches containing either essential oils or salicylic acid are marketed as skin tag removal solutions. 

These patches are formulated with essential oils such as tea tree oil, cedar leaf and caster oil; all of these are noted to be effective in drying out the skin. It is therefore believed that topical application will cause the skin tag to dry out, and with consistent use, to fall off.   

Other patches do not have any active ingredients but simply use pressure to cut off the blood supply, prompting the same result. 

Pens

At-home skin tag removal pens have been shown to be highly effective and have been studied in a clinical setting. This technology works by targeting the skin tag with extremely cold temperatures via liquid nitric oxide which halts cell growth, causes frostbite and effectively cuts off the oxygen supply. The skin tag then simply drops off after 1–3 treatments. 

One study examining the Pixie Skin Tag cryogenic pen applied at home found that after a maximum of three treatments, skin tags completely disappeared in 64% of the subjects. Researchers also determined this treatment to be safe and well tolerated by all participants. 

Removal bands 

Skin tag removal bands work by a process called ligation; bands are placed around the base of the skin tag to cut off the blood supply to the skin tag tissue which causes the skin tag cells to die and fall off. There are several types and sizes of bands available at the pharmacy. 

If your skin tag is small and easily accessible, you can also try tying a piece of dental floss or cotton thread around the base of the growth to achieve the same results as the removal bands. However, this should not be attempted without the direction of a doctor or if your skin tag is large. 

Safety of at-home solutions

Before using an OTC solution it is important to first determine if the growth is indeed a harmless skin tag otherwise you could be attempting to treat the wrong issue.

For those with dry or sensitive skin, skin can become irritated and overly dry due to the peeling effect of salicylic acid. At-home skin tag solutions such as patches, creams and oils may also cause skin irritation depending on how your skin reacts.

As there is little clinical evidence to support the safety or efficacy of these solutions, if you still want to try at-home treatments you should do so under the guidance of a dermatologist. The exception is the Pixie Skin Tag cryogenic pen (and similar pens) which has been established as an effective, safe treatment.

Lastly, these solutions are not intended for medium to large skin tags, nor skin tags in the eye or groin area.

Several professionally administered treatments are available that can effectively remove skin tags – in a safe and controlled environment. This is especially true if your skin tag is large or in a sensitive area.  

Cryotherapy and shave excision are common treatments in addition to electrocautery and medical-grade pressure devices; each targets removal via different modes of action.

Cryotherapy

Skin tags can be frozen off using liquid nitrogen. This causes irreversible damage to the skin tag tissue and the growth will fall off about 10–14 days after treatment. Multiple skin tags can be removed in one cryotherapy session depending on tolerance level. 

A liquid nitrogen spray or probe is commonly used to freeze the skin tag. If the skin tag is in a sensitive area, such as on the eyelids, forceps soaked in liquid nitrogen can be applied at one-week intervals over several sessions for successful removal. 

Shave or scissor excision

Another popular professional method is to remove small and large skin tags at their base, either with surgical scissors or a sharp blade. An anesthetic is usually injected at the base of the skin tag and a topical will be applied to stop any bleeding. 

Snip excision removes the skin tag immediately.

Pressure device

Working similarly to removal bands, several types of pressure devices have been demonstrated to be successful in cutting off blood supply to skin tags. A small device is placed over the skin tag and attaches to the skin with an adhesive-backed coating. 

One study showed a success rate of 90% in skin tags less than 1 mm in diameter and 76% for those under 2 mm.

Electrosurgery 

Electrocautery is a rapid treatment that uses a mild electric current to heat up the skin and destroy the targeted tissue. This is achieved by applying a needle or blade charged with an electric current or by using the same tools to excise the skin tag.

There are a range of skin tag removal treatments but these have no scientific backing; to safely and effectively remove these growths, you should seek advice and treatment from a medical professional. 

Apple cider vinegar 

Applying apple cider vinegar to a skin tag for up to 30 minutes two or three times a day is believed to remove a skin tag by breaking down skin tissue. In reality, the evidence for its efficacy is anecdotal; topical application of apple cider vinegar can lead to irritated skin. 

Toothpaste

Toothpaste contains hydrogen peroxide, a whitening agent that is also known to dry skin. It has not been proven to treat skin tags and can cause dry, irritated skin; it is not intended for use on the skin.

Overnight removal 

No at-home removal treatments exist that can work overnight; effective at-home treatments require several applications to achieve results. 

When Should You See a Doctor?

You should see a doctor before trying any OTC removal methods to receive an accurate diagnosis: Skin tags can resemble moles and moles can be cancerous. You should also undergo an examination if the skin tag changes size, shape or color; or if it is bothersome in any way. 

You should not attempt to remove a skin tag yourself if it is in a sensitive area or if it is large; whatever your situation, your doctor will recommend the correct course of action for your individual needs.

Takeaway

While skin tags are not harmful, they can be removed if they are unsightly or causing irritation.  If you wish to remove a skin tag, several OTC options are available for you to choose from. With the exception of at-home skin tag removal pens which have been proven effective, these remedies lack scientific evidence to support their efficacy.

Several in-office procedures that have been proven to be effective in removing these growths safely; these include cutting off the blood supply, excising or freeing the excess tissue, or simply cutting them off.

Sources

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  • Tripathy T, Singh BSTP, Kar BR. Association of Skin Tag with Metabolic Syndrome and its Components: A Case-control Study from Eastern India. Indian Dermatol Online J. 2019;10(3):284-287. doi:10.4103/idoj.IDOJ_238_18
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