The pathology of skin tags
BETTER UNDERSTANDING, BETTER HEALING!
What are skin tags?
Skin tags are growths or folds of skin in the anal area that vary greatly in size and shape.
Smaller skin tags are generally only a few millimetres long while the largest can be over 2.5 centimetres.
They are usually painless and only cause hygiene and aesthetic problems. If they are painful, one should suspect the presence of an underlying condition, most often an anal fissure.
What causes the appearance of skin tags:
- An external hemorrhoid (e.g.: following pregnancy) that has only partially diminished;
- Previous hemorrhoidal thrombosis;
- Anal fissure (in this case, the skin tag stems from a tear in the epithelium of the anal canal).
In the presence of skin tags, it is important to have the patient complete a thorough questionnaire and clinical exam:
- of the perineal region to check for the presence of skin issues (dermatitis, eczema and lesions due to scratching)
- of the anal region to check for the presence of genital warts (condylomas)
- of the anal canal to check for the presence of a fissure (with hypertonia of the sphincters), an anal ulcer (which may indicate Crohn’s disease) or even anal cancer
- of the rectum to eliminate other conditions (internal hemorrhoids, ulcerative proctitis, Crohn’s disease or rectal cancer)
Small skin tags generally do not produce any symptoms. However, the larger or more numerous they are, the more they can become problematic.
More often than not, they result in hygiene-related issues that can cause skin problems: itching, dermatitis with infection, lesions caused by scratching.
For many, they are a source of embarrassment due to the unaesthetic appearance of lesions. People often report that it affects their sex life.
Skin tags can also be uncomfortable or painful. In this case, it is important to check for the presence of an underlying lesion—generally an anal fissure or internal hemorrhoids.
How to treat skin tags
Treatment of skin tags
Proper treatment of skin tags rests mainly upon good local hygiene: washing with warm water (no soap) after a bowel movement (compressed towels can be very handy) and applying protective cream to dry skin as needed.
It is also important to treat skin infections (bacterial infections or mushrooms) when they occur as well as genital warts.
When skin tags are bulky and get in the way, there are two treatment options for reducing or eliminating them: cryotherapy and local surgery.
Jet cryotherapy (using liquid nitrogen) is not effective in this case since it does not allow for deep penetration into the skin tissue.
Prolonged cryotherapy using nitrous oxide and a specially designed instrument (a cryoprobe) is the preferred method in this case.
The average duration of treatment is 60 seconds for each lesion. In general, only one lesion is treated at a time. Once the anesthesia wears off, the pain usually lasts about 30 minutes (which is why patients are advised to take an analgesic [acetaminophen or ibuprofen] one hour before treatment).
It is rare for the pain to last several hours or days. However, if this does occur, an anti-inflammatory will be prescribed (Naproxen).
Cryotherapy is effective for smaller lesions. Following treatment, the skin tag swells with plasma (like frostbite). A clear discharge follows and persists for two to three weeks while the lesion gradually shrinks. After this treatment, it is important to ensure good local hygiene and apply an antibiotic ointment (Polysporin).
For larger lesions, cryotherapy is less effective. Following the treatment, the reduction in size is often only partial and a fibrous transformation (like a scar) can be seen.
If the reduction is not sufficient, surgery is then performed. Surgery is, however, facilitated by the reduction in size and the presence of scar tissue following cryotherapy.
Local surgery consists of infiltrating the skin with a local anesthetic (Xylocaine) and excising the lesions. The procedure rarely lasts longer than fifteen minutes. In general, the wounds are left open and heal within three weeks.
Practical tips
In order to help you, we have put at your disposal several useful tips.
