Chapter 1: What Are Skin Tags?

Skin tags, while often regarded as unsightly, are generally harmless. These small, pedunculated pieces of flesh can become quite annoying. Many individuals resort to turtlenecks or high collars to conceal these tiny, dangling growths on their necks.

They frequently prompt visits to dermatologists. Beyond their appearance, these tags can easily snag on clothing or jewelry, leading to inflammation or irritation. Known medically as acrochordons, skin tags are benign growths that usually match the color of the surrounding skin, attached by a slender stalk.

If you were to investigate a skin tag (which is not advisable), you would discover blood vessels and collagen wrapped within the skin, resembling a peculiar spring roll.

According to the National Institutes of Health, up to 46% of the U.S. population has skin tags. They commonly appear in areas where skin rubs against skin or clothing, such as the neck, underarms, groin, beneath the breasts, and even on the eyelids.

Although skin tags are predominantly benign—more bothersome than dangerous—they can sometimes indicate underlying health issues. A sudden increase in their number, though rare, could signal conditions such as polycystic ovary syndrome, diabetes, metabolic syndrome, or acromegaly, a disorder linked to excessive growth hormone. Additionally, a genetic disorder known as Birt-Hogg-Dube can lead to the development of hundreds of skin tags, typically in less-frictional areas like the face and chest.

While most skin tags measure between 1–2mm (less than one-tenth of an inch), there have been extraordinary cases, including one instance of a 30 cm skin tag—nearly a foot long!—that developed over four years on a 56-year-old woman. Another case involved an 18 cm (7-inch) skin tag found in a man's armpit.

Occasionally, skin tags may turn black or purple if their blood supply is interrupted or clotted due to twisting of the stalk. However, the good news is that a thrombosed skin tag is likely to fall off naturally within three to ten days.

Causes of Skin Tag Development

The exact reasons behind skin tag formation remain unclear, but several factors might contribute:

• Friction: Skin tags often develop in areas where skin is subject to friction from clothing or other skin.
• Genetics: A family history of skin tags can increase the likelihood of developing them.
• Diabetes: Higher circulating insulin levels, common in diabetes and metabolic syndrome, can raise the risk.
• Weight: Increased body weight can lead to more skin folds, which create friction, as well as a heightened risk of metabolic syndrome. Notably, skin tags do not disappear with weight loss.
• Hormonal Changes: Fluctuations in hormones during pregnancy, puberty, or menopause may play a role.
• Age: Although skin tags can appear as early as the second decade of life, they are more prevalent in middle-aged and older adults.
• Pregnancy: During pregnancy, the body's growth phase, combined with weight gain and potential gestational diabetes, raises the chances of developing skin tags.

Chapter 2: Removing Skin Tags Safely

In this video, "Decoding Skin Bumps: Mole vs. Skin Tag - Know the Difference!", viewers will learn to differentiate between moles and skin tags, helping to identify what type of growth they may be dealing with.

Skin tags, unless thrombosed, do not fade away without intervention. The most common removal methods include liquid nitrogen application or surgical snipping. Once a skin tag is removed, it does not regrow.

For small skin tags, I typically utilize liquid nitrogen, an extremely cold substance at -320 degrees Fahrenheit (-195 degrees Celsius). This is applied to the base of the tag until the skin turns white from the freezing effect. After a brief pause, it is reapplied, effectively destroying the skin cells. The area may become red and slightly inflamed, but within a couple of days, the skin tag will detach.

For larger tags with thicker stalks, I generally administer a numbing agent (lidocaine) before carefully snipping them off with sterile instruments. Since the stalk contains blood vessels, I lightly cauterize the base to control any bleeding, covering it with antibiotic ointment and a band-aid. In a few days, the small scab formed will heal.

It's important to note that I do not recommend at-home removal of skin tags for several reasons. They can resemble other growths, such as moles or warts, which require specific treatments to prevent spreading. Additionally, skin tags may conceal cancerous growths.

For instance, a 27-year-old man from Dublin believed he had a small skin tag beneath his eye, only to discover through biopsy that it was malignant melanoma, necessitating more invasive surgery. A similar case involved a diabetic woman who developed squamous cell carcinoma at the tip of a seemingly normal skin tag.

While reports of cancer in skin tags are rare, a 1996 study indicated that malignancy was detected in only five out of 11,500 biopsies, or 0.04%. I have removed thousands of skin tags without encountering any cancerous growths.

Some patients have successfully removed skin tags at home using sterile scissors or over-the-counter cold sprays. However, I have also seen individuals return to my office with complications following botched removals. The dental floss method used to strangulate a tag can inadvertently lead to infection or prolonged pain.

If skin tags are causing discomfort, one simple solution is to wait. After the age of 70, individuals typically do not develop new skin tags. However, they may still experience an increase in age spots, wrinkles, and bruises from thinning skin.

In the video, "How to Remove Skin Tags and Warts Overnight - Dr. Berg Explains," viewers will discover effective techniques for skin tag and wart removal, helping them manage these common skin concerns.