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Our specialist surgeons discourage the removal of skin tags for purely cosmetic reasons. Below are some common questions asked by patients considering anal skin tag removal.
What causes skin tags?
Skin tags are very common. They develop due to:
⦁ Natural stretching and folding of the skin with opening and closing of the anus (“wear and tear”)
⦁ Normal wrinkling of perianal skin, which is present in most people
⦁ Previous haemorrhoids – when a swollen haemorrhoid resolves, stretched skin may remain permanently as a skin tag
Types of skin tags
⦁ Small, flat, wide-based skin tags
These may simply represent prominent skin wrinkles. They are a normal variant and do not require removal.
⦁ Large skin tags with a long, narrow stalk
These are the easiest and safest to remove, as the wound is small and usually heals quickly.
⦁ Large, wide-based skin tags
These are the most difficult and painful to remove. Removal results in a larger open wound that may take 6–12 weeks or longer to heal.
When is skin tag excision necessary?
Skin tag excision may be appropriate when skin tags:
⦁ Interfere with perianal cleaning and hygiene
⦁ Cause discomfort, irritation, or itch
Low-risk skin tags
⦁ Large skin tags on a thin stalk
⦁ Lowest risk of complications
⦁ Small wound with faster healing
High-risk skin tags
⦁ Large wide-based skin tags
⦁ Larger wound after removal
⦁ More pain and longer recovery
When is skin tag excision unnecessary?
Small skin tags that:
⦁ Do not cause pain, bleeding, or itch
⦁ Do not interfere with hygiene
are usually best left alone. Removal in these cases is often cosmetic rather than medically necessary.
Is it safe to remove skin tags for purely cosmetic reasons?
Removal of small, asymptomatic skin tags for cosmetic reasons is generally not recommended.
Possible complications include:
⦁ Regrowth of a skin tag during healing
⦁ Delayed wound healing
⦁ Development of a painful anal fissure, especially if constipation occurs during the first 6–12 weeks after excision
If a painful anal fissure develops, symptoms can be prolonged and difficult to treat, and some patients regret having undergone surgery for cosmetic reasons alone.
Healing and scar formation vary between individuals. Patients prone to excessive scarring or keloid formation may find that the scar is more uncomfortable or unsightly than the original skin tag.
How quickly does the wound heal after skin tag excision?
The anal area is exposed to bacteria and regular wiping. Closing the skin after excision can result in:
⦁ Infection
⦁ Wound breakdown (up to 50% of cases)
For this reason, most colorectal surgeons recommend leaving the wound open to heal by secondary intention. New skin gradually grows in from the edges until closure occurs (re-epithelialisation).
What factors can prevent wound healing?
Constipation during healing can cause the wound to tear
Repeated tearing can lead to a painful anal fissure
Treatment of anal fissure may include:
⦁ Stool softeners
⦁ Topical creams (e.g. Rectogesic or 2% Diltiazem, applied three times daily)
⦁ Botox injections (often 1–2 injections; approx. $500 per injection)
In 10–20% of cases, fissures persist and may require lateral sphincterotomy, which is:
⦁ Over 90% successful
⦁ Associated with a ~3% risk of permanent faecal incontinence
For this reason, surgery is not a first-line treatment.
Do skin tags turn into cancer?
Simple anal skin tags do not turn into cancer.
Skin lesions with cancer risk
⦁ Wart-like lesions caused by HPV may have a small risk of malignant change
⦁ Patients with previous HPV infection may be prone to anal neoplasia
Any new or suspicious lesion should be examined by a colorectal surgeon and may require biopsy or removal.
What is involved in having a skin tag removed?
⦁ Most skin tags can be removed under local anaesthetic in the rooms
⦁ Hospital surgery is rarely required
⦁ Local anaesthetic injections may cause brief discomfort
⦁ The excision itself is usually painless
⦁ If diathermy is used, you may feel warmth or heat
Can I drive or use public transport afterwards?
It is preferable to have someone accompany you home.
Although sedation is usually not required, anxiety or pain can occasionally cause dizziness.
If no escort is available, a short period of observation (up to one hour) may be required.
When should I follow up?
Routine follow-up is not always required. You should contact your colorectal surgeon if you experience:
⦁ Significant pain or bleeding several weeks after surgery
⦁ Bleeding greater than one tablespoon
⦁ Signs of infection (bleeding 1–2 weeks after surgery, redness, warmth)
Infections usually respond to a 5-day course of antibiotics (e.g. cephalexin and metronidazole).
How painful is recovery?
Pain varies depending on:
⦁ Individual pain tolerance
⦁ Size of the wound
How is post-operative pain managed?
Most pain can be managed with:
⦁ Paracetamol
⦁ Ibuprofen
These do not cause constipation or dependence.
Stronger pain medications are rarely required and should be used cautiously due to the risk of constipation and dependence. If needed, Palexia IR is preferred over older opioids.
How do I clean the wound?
⦁ Use water whenever possible
⦁ A handheld shower after bowel motions is ideal
⦁ Avoid dry toilet paper
⦁ Alternatives include: water-soluble lubricating jelly on toilet paper or wet wipes
Is salt water better than plain water?
There is little evidence that salt water is better than plain water.
The warmth of the water is the most important factor for comfort and spasm relief.
Is discharge from the wound normal?
⦁ Yellow fluid from an open wound is common and usually normal healing fluid
⦁ Antibiotics are rarely needed for open wounds
If a white discharge, redness, or warmth occurs after wound closure, this may indicate infection and should be reviewed.
What should I do if there is severe pain or bleeding?
⦁ Apply firm pressure with a pad
⦁ Call our rooms on 1300 265 666 and ask to speak with your colorectal surgeon
If bleeding is:
⦁ Less than a teaspoon per day – it usually settles
⦁ More than a tablespoon and after hours – contact your surgeon, call an ambulance, or attend the nearest emergency department