Skin tags, also known as acrochordons, are benign skin lesions ranging in color from dark brown to the natural tone of the skin. They typically appear as small, fleshy papules that may present in the following forms: • Small filiform tags (1–2 mm, elongated and thin) • Medium pedunculated tags (3–5 mm, oval, fleshy, with a stalk) • Large fibrous tags (over 1 cm, pedunculated)
Despite their frequent occurrence, skin tags are benign and not associated with malignancy. They commonly develop in areas of friction, such as the neck, armpits, chest, eyelids, genital region, and groin folds. Approximately 60% of the population will develop skin tags by the age of 69. They are more frequent in obese individuals and in women during pregnancy due to hormonal changes.
Symptoms
Skin tags are usually asymptomatic but can cause: • Cosmetic concern, especially when located on visible areas such as the face and neck • Inflammation, tenderness, or even gangrene in cases of trauma or torsion of the stalk • Genital skin tags may appear as flesh-colored lesions, solitary or in clusters, that can grow into cauliflower-like masses
Causes
• Mechanical irritation (friction) • Obesity and metabolic syndrome (e.g., type 2 diabetes) • Hormonal disorders (e.g., polycystic ovary syndrome) • Age (more common after age 40) • Hereditary predisposition • Human papillomavirus (HPV) infection: In the genital area, HPV infection promotes the development of papillomas, which may be linked to more serious conditions such as cervical cancer, especially when co-infected with herpes simplex virus (HSV)
Diagnosis
Diagnosis is clinical (via dermoscopy). Biopsy is rarely required and is only indicated in cases of: • Atypical appearance in size or color • Rapid growth • Bleeding • Suspicion of another underlying pathology
Potential Complications
• Bleeding, due to trauma or unsuccessful removal • Secondary infection, in lesions that have been mechanically irritated and subsequently bleed • Association with precancerous changes and spread (mainly in the genital region, especially in women, when linked to HPV infection)
Treatment
Skin tags may be removed using different techniques depending on the location: • Neck and body: Electrocautery, cryotherapy, laser, or surgical excision • Face: Cryotherapy is generally avoided due to the risk of hypopigmented scarring • Genital area: Special care is needed to avoid confusion with genital warts. Treatment may involve topical medications (creams or chemical agents) or surgical removal All sexual partners of patients with genital skin tags must be examined and treated if necessary.
Prevention • Vaccination: The Gardasil vaccine protects against four HPV types responsible for most genital papillomas and cervical cancer. It is recommended for girls and women aged 9–26. • Regular screening: Routine Pap tests for sexually active women • Protective measures: Use of condoms and avoidance of multiple sexual partners
Conclusion Early diagnosis and appropriate treatment ensure effective management. Vaccination and preventive measures significantly reduce the risk of development and complications.
