Synonyms: acrochordon, soft fibromas, fibroepithelial polyps, fibroma pendulans

Presentation

Skin tags are small, pedunculated skin-coloured or brown papules that occur around any site where skin folds occur (particularly around the neck, axilla, between the thighs and on the eyelids). They are more common in obese patients. They are usually 0.2 to 0.5 cms in diameter.

Epidemiology

They occur in almost half the population. They occur equally in men and women and increase with age. Two thirds of people will have some skin tags present by the age of 70 years.

Diagnosis

Usually obvious at sites where rubbing of clothing over skin occurs. Filiform warts have fine finger-like projections on the surface and tend to be firmer on palpation. Melanocytic naevi can also be pedunculated but have a broader base.

Differential diagnosis

Multiple (atypical) skin tags are seen in Birt-Hogg-Dubé (BHD) syndrome; a rare, autosomal dominant inherited dermatosis characterised by multiple skin coloured dome shaped papules developing in adulthood, mainly on face, neck and upper body.¹ These are folliculo-sebaceous differentiated hamartomas called fibrofolliculomas and trichodiscomas (tumours of the hair disc). Atypical skin tags (furrowed, 1-2 mm soft papules) looking like a wart with a thin neck (acrochordons) are often present.²

Primary care management

Lesions are easily removed by snipping off with a pair of sharp scissors or applying a ligature round the base. If the base is fine no anaesthetic is needed and no bleeding occurs. Larger ones will need local anaesthetic and can be removed by shave and cautery, or cutting cautery alone.