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Last updated: November 27, 2024
Keywords #
acrochordon
skin tag
cutaneous papilloma
cutaneous tag
fibroepithelial polyp
fibroma molluscum
fibroma pendulum
Diagnosis #
Acrochordon, also known as “Skin Tag,” is a common, benign skin growth often found in areas of friction such as the neck, axilla, groin, and inframammary folds. Acrochordons are also commonly found on the eyelids. There is an increased incidence in obese patients and those with diabetes mellitus.[1] Clinically, acrochordons are soft, fleshy, pedunculated skin colored or hyperpigmented papules. Although the diagnosis is typically made clinically, histologically, an acrochordon is a polypoid lesion with an overlying mildly acanthotic epidermis, a loose, edematous fibrovascular core exhibiting mild chronic inflammation, and a nerveless dermis.[2] There are several possible underlying systemic or genetic diseases associated with increased amounts of acrochordons. These include diabetes mellitus, BHD syndrome, and tuberous sclerosis. Thus, if clinical suspicion is high, further evaluation for an underlying disease may be warranted.
Key Concepts #
- Acrochordons are benign connective tissue tumors of the dermis that appear as soft skin-colored growths and are often pedunculated but occasionally filiform.[3]
- They can present as early as teenage years but are more common in later life, with the highest prevalence occurring during/after the 4th decade of life.
- Considered to be excess growths of skin, associated with irritation, obesity, and hormonal imbalance.
- Histology will reveal the presence of mild hyperkeratotic epidermis, containing blood vessels of various sizes in the dermal stroma.[1]
- Acrochordons are benign and do not require treatment, but if they cause irritation or are aesthetically displeasing to the patient, they may be removed in the office with snip excision, cautery, or cryosurgery.
Epidemiology #
The reported incidence of acrochordons is 50-60% in the general population, with equal prevalence in males and females. The probability of their occurrence increases after the fourth decade of life, and by the 5th to 6th decade of life, roughly two-thirds of individuals may develop acrochordons. Skin tags tend to be more common in patients with underlying conditions, including obesity, diabetes, cardiovascular disease, abnormal lipid profile, metabolic syndrome, and certain genetic disorders including Birt-Hogg-Dube (BHD) syndrome and tuberous sclerosis. [1]
Clinical Features #
- Soft, fleshy, typically pedunculated papules located in the axilla, neck, inguinal area, inframammary folds, and eyelids. [3]
Differential Diagnoses #
- Molluscum contagiosum
- Verruca vulgaris
- Seborrheic keratosis
- Melanocytic nevi
- Fibroepithelioma of Pinkus
Diagnostic Workup #
Diagnosis is typically made clinically, but a snip excision or shave removal may be performed for confirmation. No further work-up is necessary unless there is a high suspicion of an underlying genetic condition.
Treatment #
The treatment of an acrochordon is the removal of the lesion. There are multiple ways to treat acrochordons including removal with snip excision or shave removal, cautery, and cryosurgery. Removal of an acrochordon is considered a low-risk procedure, but complications can occur and include bleeding, irritation, and scar formation.
Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/References #
- Pandey A, Sonthalia S. Skin Tags. [Updated 2021 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547724/
- El Safoury OS, Ibrahim M. A clinical evaluation of skin tags in relation to obesity, type 2 diabetis mellitus, age, and sex. Indian J Dermatol. 2011 Jul;56(4):393-7. doi: 10.4103/0019-5154.84765. PMID: 21965846; PMCID: PMC3179001.
- Banik R, Lubach D. Skin tags: localization and frequencies according to sex and age. Dermatologica. 1987;174(4):180-3. doi: 10.1159/000249169. PMID: 3582706.
