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Fast and Painless Skin Tag Excision with Ethyl Chloride

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Tahsin Görgülü at Bülent Ecevit University
Tahsin Görgülü
Merve Torun Karadere at Bülent Ecevit University
Merve Torun Karadere
Ramazan Güler
Ramazan Güler
Ramazan Güler
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Abdulkerim Olgun at Atatürk University
Abdulkerim Olgun
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Abstract

Skin tags (acrochordon) are skin colored or hyperpigmented, usually pedunculated benign skin lesions and often occur on the neck, axilla, and groin regions. It is difficult choice to excise these multiple, widespread, and pedinculated lesions with or without local anesthesia. One option is to infiltrate local anesthesia to every single skin tag, while cutting pedicle with single move is another option. However, both of these options are painful to some degree. We routinely use ethyl chloride spray anesthesia for skin tag excision with micro-scissor and micro-forceps. We received positive feedback from patients, who underwent skin tag excision before with conventional techniques. They declare that ethyl chloride procedure is more comfortable and painless. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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L E T T E R T O T H E E D I T O R NON-SURGICAL AESTHETIC
Fast and Painless Skin Tag Excision with Ethyl Chloride
Tahsin Go
¨rgu
¨lu
¨
1
•Merve Torun
1
•Ramazan Gu
¨ler
1
•Abdulkerim Olgun
1
•
Eksal Kargi
1
Received: 6 April 2015 / Accepted: 18 May 2015
ÓSpringer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2015
Abstract Skin tags (acrochordon) are skin colored or
hyperpigmented, usually pedunculated benign skin lesions
and often occur on the neck, axilla, and groin regions. It is
difficult choice to excise these multiple, widespread, and
pedinculated lesions with or without local anesthesia. One
option is to infiltrate local anesthesia to every single skin
tag, while cutting pedicle with single move is another
option. However, both of these options are painful to some
degree. We routinely use ethyl chloride spray anesthesia
for skin tag excision with micro-scissor and micro-forceps.
We received positive feedback from patients, who under-
went skin tag excision before with conventional tech-
niques. They declare that ethyl chloride procedure is more
comfortable and painless.
Level of Evidence V Level of Evidence V This journal
requires that authors assign a level of evidence to each
article. For a full description of these Evidence-Based
Medicine ratings, please refer to the Table of Contents or
the online Instructions to Authors www.springer.com/
00266.
Keywords Skin tag Acrochordon Ethyl chloride
Anesthetic spray Painless Fast
To the Editor,
Skin tags (acrochordon) are skin colored or hyperpig-
mented, usually pedunculated benign skin lesions and often
occur on the neck, axilla, and groin regions. These lesions
are very common, especially in older women, and some
studies have shown their association with impaired carbo-
hydrate metabolism [1–3]. Due to the unspecific etiology of
skin tags, no specific prevention strategies have been
identified. Many treatment modalities are present for skin
tags, such as cryosurgery, excision, electrosurgery, and
ligation.
Patients presented to our outpatient clinic for excision of
skin tags due to difficulties in putting on clothes and
necklaces as well as esthetic concerns. It is a difficult
choice to excise these multiple, widespread, and pedincu-
lated lesions with or without local anesthesia. One option is
to infiltrate local anesthesia to every single skin tag, while
the cutting pedicle with single move is another option.
However, both of these options are painful to some degree.
Ethyl chloride is an anesthetic spray that vaporizes
immediately on contact, it cools the skin and the sur-
rounding tissue to temperatures of -4°, and its effective-
ness was shown in minimally invasive procedures
especially injections [4]. Furthermore it improves the
antiseptic effect of betadine skin preparation [5]. One
should remember that this spray should be carefully used
around the eyes due to the possibility of its serious com-
plication occurrence [6]. Some use EMLA cream for local
anesthesia purposes, in order to provide anesthesia one
should wait approximately half an hour. This is a time-
consuming procedure when compared to ethyl chloride or
without anesthesia procedure.
We routinely use ethyl chloride spray anesthesia for skin
tag excision with micro-scissor and micro-forceps (Video-1).
Electronic supplementary material The online version of this
article (doi:10.1007/s00266-015-0508-6) contains supplementary
material, which is available to authorized users.
&Tahsin Go
¨rgu
¨lu
¨
tahsinmd@gmail.com
1
Department of Plastic, Reconstructive and Aesthetic Surgery,
Bulent Ecevit University, A blok Kat:3, Kozlu, Zonduldak,
Turkey
123
Aesth Plast Surg
DOI 10.1007/s00266-015-0508-6
This combination provides quick and painless excision. After
excision, there is no need for sutures and usually no bleeding
occurs; if bleeding occurs it is the oozing type. For a dressing
we use steri-strips, they are comfortable and cosmetically
tolerable for patients. We received positive feedback from
patients, who underwent skin tag excision before with con-
ventional techniques. They declare that the ethyl chloride
procedure is more comfortable and painless.
Conflict of interest The authors declare that they have no conflicts
of interest to disclose.
References
1. Bhargava P, Mathur SK, Mathur DK et al (1996) Acrochordon,
diabetes and associations. Indian J Dermatol Venereol Leprol
62(4):226–228
2. Margolis J, Margolis LS (1976) Skin tags—a frequent sign of
diabetes mellitus. N Engl J Med 294:1184
3. Kahana M, Grossmal E et al (1987) Skin tags—a cutaneous marker
for diabetes mellitus. Acta Derm Venereol 67:175–177
4. Irkoren S, Ozkan HS, Karaca H (2014) A clinical comparison of
EMLA cream and ethyl chloride spray application for pain relief of
forehead botulinum toxin injection. Ann Plast Surg. doi:10.1097/
SAP.0000000000000121
5. Azar FM, Lake JE, Grace SP, Perkinson B (2012) Ethyl chloride
improves antiseptic effect of betadine skin preparation for office
procedures. J Surg Orthop Adv 21(2):84–87
6. Rodriguez NA, Ascaso FJ (2012) Ocular surface frostbite
secondary to ethyl chloride spray. Cutan Ocul Toxicol 31(1):77–80
Aesth Plast Surg
123
... They are hypertrophied redundant skin folds, frequently occurring on the neck, axilla, and groin region. 1 Skin tags are typically found on flexural body surfaces more commonly in individuals who are older, female, or who have obesity. 2 They can become irritated when they rub against clothing or jewelry. ...
... Indications for removal include ongoing irritation and patient preference for aesthetic reasons. 1 Skin tags can be treated with snip excision and hemostasis, electrosurgery, chemical cautery, and cryosurgery. 3 Treating skin tags with excision and hemostasis is an efficient and inexpensive means of removal and carries minimal risk of infection compared to electrosurgery or cryosurgery. ...
A Comparison of Ferric Subsulfate Solution, Silver Nitrate, and Aluminum Chloride for Pain Assessment, Time to Hemostasis, and Cosmesis in Acrochordon Snip Excision
Article
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BACKGROUND: Acrochordon (skin tag) removal by snip excision is a routine dermatologic procedure. Bleeding is a common sequelae of snip excision that requires hemostatic control. Chemical cautery is a common means of achieving hemostasis in this procedure. OBJECTIVE: The aim of this study was to evaluate three different chemical cautery solutions for their time to hemostasis, pain upon application, and associated pigmentary changes. METHODS: Twelve patients with six or more skin tags on the bilateral neck and/or axilla were enrolled. Two skin tags were cauterized with ferric subsulfate solution, two with silver nitrate, and two with aluminum chloride hexahydrate solution. Time to hemostasis and pain with application of each cautery solution to the skin tag was recorded. At a two-week follow-up appointment, patient satisfaction was assessed with a survey, and pigmentary changes were documented with digital photography. RESULTS: There was no significant variability in the time to hemostasis among the three chemical cautery solutions (p=0.57). Pain response was significantly different among the three solutions (p=0.003). Compared to silver nitrate (median=6.00, interquartile range [IQR]: 4.50-6.50), aluminum chloride hexahydrate (median=1.00, IQR: 0.50 to 6.00; Sidak p=0.02) and ferric subsulfate (median=1.50, IQR: 0.00-3.50; Sidak p=0.01) had a significantly lower pain response. Among participants, three (25%) experienced a pigmentary change with ferric subsulfate, two (17%) with aluminum chloride, and six (50%) with silver nitrate (overall p= 0.14). CONCLUSION: These results indicate that the three standard chemical cautery solutions for skin tag snip excision have significant differences in pain upon application and pigmentary changes. This might be a relevant consideration when selecting a chemical cautery solution.
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... A lot of treatment options exist for skin tag in older children and in adult patients, such as cryosurgery, surgical excision, and electrosurgery, while ligature or excision are preferred for the newborns (21). ...
Preauricular tags and pits – a minor anomaly in newborns, and when further investigation is needed
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Preauricular skin tags represent a commonly seen minor congenital anomaly of the auricle that may occur either in isolation or together with other dysmorphic features or malformations as part of a syndrome. Even minor dysmorphic features can lead to a genetic diagnosis with far-reaching, systemic implications. Neonatologists must be familiar with this common presentation and have good communication with the medical geneticist to identify a possible underlying genetic condition early and manage each case appropriately. Ear abnormalities such as preauricular tags and pits may be associated with additional specific abnormalities such as hearing loss or renal malformations that need to be considered and further investigated. This article aims to provide data and guidance for the management of neonates with preauricular tags or preauricular pits, a minor congenital anomaly of the ear, where early recognition of syndromes based on minor anomalies is ideal.
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Anal Warts and Skin Tags
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  • Apr 2025
Perianal skin tags are defined as soft growths that develop in the perianal region. Perianal skin tags commonly develop in patients with chronic anal fissures or following the healing of anal fissures and thrombosed external hemorrhoids. Perianal skin tags are not contagious and cannot be transmitted through sexual contact. Perianal warts can develop secondary to infection or virus such as human papillomavirus (HPV). Genital warts are considered the most common sexually transmitted disease (STD). This chapter discusses the difference between anal warts and skin tags, their etiology, clinical features and treatment.
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Ligaclip for Preauricular Skin Tags in the Newborn
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  • Jun 2020
Introduction Skin tags are benign lesions, that often represent only an aesthetic problem; if subjected to trauma, they can occasionally bleed with possible infection and pain. When they occur in the preauricular region, attention should be paid to the diagnosis and approach; in fact, controversy exists in the differential diagnosis between hair follicle nevi, accessory tragus, and skin tag. Misdiagnosis and failure of treatment can lead to serious consequences, such as chondritis. Materials and Methods In our retrospective study, we evaluated 19 newborns affected by single, unilateral skin tag in the preauricular region. Each patient underwent a careful clinical examination; lesions without a pilosebaceous unit and with a thin, soft pedicle were treated in the nursery with Ligaclip (Johnson & Johnson). Results Skin tag falls between day 7 and 10. We had no cases of edema, cellulitis, clip loss, or bleeding. Scarring results were extremely satisfactory at 3-month follow-up. Conclusion We believe that after a careful clinical examination, cases of skin tags in the preauricular area can be selected and treated with Ligaclip. This procedure can be considered rapid, safe, economical, and simple in the newborn patients.
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Sterility of Ethyl Chloride Spray After Use in the Clinic
Article
  • May 2019
Background: Ethyl chloride spray is used frequently in the outpatient setting as a local anesthetic for injections and aspirations with varying consensus about the sterility of the spray. We hypothesize that ethyl chloride spray remains sterile and would show no bacterial growth during routine clinical use. Methods: Thirteen ethyl chloride bottles were collected for testing. Two unopened bottles were used as controls. Eleven unopened bottles were placed in orthopedic clinics and recollected after varying duration of use. The final volume and duration of use were recorded. Each bottle was sprayed in a separate test tube and allowed to evaporate. Trypticase soy broth was added to each tube and incubated for 48 hours. Control test tubes with broth alone were prepared and incubated under the same conditions. Cultures were evaluated at 24 and 48 hours. Results: The mean duration of ethyl chloride bottle use prior to culturing was 26 days. The average volume used per day was 1.9 mL. Each ethyl chloride bottle had an initial volume of 103.5 mL. Using the average daily volume usage, an extrapolated lifespan of each bottle was estimated at 7.7 weeks. None of the samples showed bacterial or fungal growth at 24 or 48 hours. Conclusion: Ethyl chloride bottles used in the clinical settings showed no bacterial or fungal contamination through their shelf life and routine use. The duration and amount of use did not affect sterility. Although the antimicrobial activity of ethyl chloride spray on skin is debated, ethyl chloride itself remains sterile through clinical use.
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Ethyl chloride spray for musculoskeletal ultrasound‐guided injections: An alternative to subcutaneous injection of local anesthetic solution
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  • Dec 2017
  • J CLIN ULTRASOUND
Ultrasound-guided injections such as steroid injections are common procedures involving the musculoskeletal system. They are usually performed after a subcutaneous injection of local anesthetic (LA), which can be painful. In 126 consecutive patients, local anesthesia was performed using ethyl chloride spray prior to a therapeutic ultrasound-guided injection in joints, tendons, or bursae. Ninety-nine (78.5%) patients found the use of ethyl chloride spray helpful. The use of ethyl chloride spray is an effective, patient-friendly alternative to the standard injection of local aesthetic for ultrasound-guided therapeutic musculoskeletal injections with the advantage of a lower cost of $0.18 per procedure.
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Skin Tags and Atherogenic Lipid Profile in Diabetes Mellitus Type 2 in Jabir Abu Eliz Diabetes Center
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Full-text available
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Introduction: Skin tags are common skin lesions, and they been reported that they might reflect insulin resistance states, and also state that the atherogenic profile is associated with diabetes mellitus, particularly the type 2 form, but not exclusively. The studies suggested that skin tags may be an important physical sign that should alert the clinician to look for possible impaired glucose tolerance or diabetes mellitus in patients who manifest them. Also, the presence of the atherogenic lipid profile should also be looked for in these individuals. Clinical signs can aid those patients for health care screening, and skin tags may be an indicator of higher cardiovascular risk that could be useful in general practices. Objectives: To correlate the relationship between Skin Tags, DM2 and atherogenic lipid profile. Patients and Methods: This is a cross sectional, observational, descriptive prospective hospital based study conducted in Jabir Abu Eliz Diabetes center outpatient clinic in the period from August to November 2015. Included 60 Diabetics type 2 patients presented with skin tags with known or unknown atherogenic history, with 20 patients as a control population. All patients underwent data collection using previously designed questionnaire, clinical examination, tested for lipid profile including Triglyceride, Cholesterol and analyzed by computer using SPSS program. Results: This study showed that skin tags study sample were 60 patients represented 9.4% of DM patients (640 patients). (Figure 1) Showed that higher prevalence was found in age group more 61 years represented 53.3%, while figure 2 showed that males were the more dominant with skin tags in DM (60%). It was found that 8.3% of study sample were suffering of hyperlipidaemia (5patients), in addition to 31 patients (51.7%) known to be hyperlipidaemics and taking antilipidemic medications with total percentage of (60%) positive results, while 34 patients (56.7%) had a history of hypertension (HT), history of cardiovascular diseases (CVD) was positive in 10 patients represented (16.7%). In the vast majority, 39 patients represented (65%), ST were small in size, in 49 patients (81.7%) they were pedunculated, while 38 patients (63.3%) have hyperpigmented ST. Conclusion: Skin tags with DM2 were found to be hyperlipidaemia in 60% of cases while in control it was found to be 50% associated with hyperlipideamia.
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Skin Tags and Atherogenic Lipid Profile in Diabetes Mellitus Type 2 in Jabir Abu Eliz Diabetes Center Nisreen A. O. Mustafa1, Abdel Rahaman M. A. Ramadan2, Khalid O. Alfarouk3, Ahmed Aljarbou3, Gamal O. Elhassan4, Abdel Khalig Muddathir5, Intisar A. Bashir5, Anas E. Halloul6, Adil H. H. Bashir7,*
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Full-text available
  • Jan 2017
Introduction: Skin tags are common skin lesions, and they been reported that they might reflect insulin resistance states, and also state that the atherogenic profile is associated with diabetes mellitus, particularly the type 2 form, but not exclusively. The studies suggested that skin tags may be an important physical sign that should alert the clinician to look for possible impaired glucose tolerance or diabetes mellitus in patients who manifest them. Also, the presence of the atherogenic lipid profile should also be looked for in these individuals. Clinical signs can aid those patients for health care screening, and skin tags may be an indicator of higher cardiovascular risk that could be useful in general practices. Objectives: To correlate the relationship between Skin Tags, DM2 and atherogenic lipid profile. Patients and Methods: This is a cross sectional, observational, descriptive prospective hospital based study conducted in Jabir Abu Eliz Diabetes center outpatient clinic in the period from August to November 2015. Included 60 Diabetics type 2 patients presented with skin tags with known or unknown atherogenic history, with 20 patients as a control population. All patients underwent data collection using previously designed questionnaire, clinical examination, tested for lipid profile including Triglyceride, Cholesterol and analyzed by computer using SPSS program. Results: This study showed that skin tags study sample were 60 patients represented 9.4% of DM patients (640 patients). (Figure 1) Showed that higher prevalence was found in age group more 61 years represented 53.3%, while figure 2 showed that males were the more dominant with skin tags in DM (60%). It was found that 8.3% of study sample were suffering of hyperlipidaemia (5patients), in addition to 31 patients (51.7%) known to be hyperlipidaemics and taking antilipidemic medications with total percentage of (60%) positive results, while 34 patients (56.7%) had a history of hypertension (HT), history of cardiovascular diseases (CVD) was positive in 10 patients represented (16.7%). In the vast majority, 39 patients represented (65%), ST were small in size, in 49 patients (81.7%) they were pedunculated, while 38 patients (63.3%) have hyperpigmented ST. Conclusion: Skin tags with DM2 were found to be hyperlipidaemia in 60% of cases while in control it was found to be 50% associated with hyperlipideamia. Keywords Skin Tags, Diabetes mellitus, Sudan
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A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection
Article
  • Dec 2014
This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection. Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity. In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05). Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.
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Ethyl Chloride Improves Antiseptic Effect of Betadine Skin Preparation for Office Procedures
Article
  • Sep 2012
  • J Surg Orthop Adv
To determine if ethyl chloride is an effective disinfectant alone or combined with povidone iodine in a clinical setting, 35 volunteers had different portions of their knees swabbed with sterile cotton-tip applicators after an area of skin was prepared with either ethyl chloride alone, povidone iodine alone, or povidone iodine followed by ethyl chloride. An area with no preparation at all served as the control. Specimens were then cultured on agar plates and bacterial growth assessed. When the data was categorized as colony forming units (CFUs) or no CFUs, both ethyl chloride and povidone iodine used alone had significantly fewer specimens with CFUs (p=0.001) than controls, but were not significantly different from each other (p=0.18). Additionally, the combination of povidone iodine followed by ethyl chloride spray had significantly fewer samples with CFUs than either product used alone (p=0.001). In addition to its local anesthetic properties, ethyl chloride may be an effective disinfectant alone and may improve skin disinfection when used with povidone iodine compared to povidone iodine alone.
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Ocular surface frostbite secondary to ethyl chloride spray
Article
  • Sep 2011
  • CUTAN OCUL TOXICOL
Ethyl chloride (EC) is a fast-acting vapo-coolant spray that provides rapid, transient, local analgesia for minor invasive procedures. Although the application of EC has decreased, it can be used as a cryoanalgesic agent in minor surgical procedures. Despite the widespread use of EC as a local anesthetic, there are few reported cases of serious adverse side effects. We report a 67-year old otherwise healthy man who underwent excision of a papilloma on his superior right eyelid by a general practitioner at a primary care center. The lesion was removed by curettage after slight freezing with EC spray. This chemical agent was applied without the adequate eye protection, and eight hours later the patient presented an acute frost injury of ocular surface. Urgent treatment included copious irrigation of the affected eye, especially the conjunctival fornices, corticosteroid (prednisone) and antibiotic (neomycin) ointment. A week later, the eyelid lesion and keratoconjunctivitis had resolved but evidence of early cicatrization involving the inferior conjucntival fornix and symblepharon formation were present. To the best of our knowledge, this is the first reported case of an acute burn of the ocular surface following EC spray exposure. EC should be avoided for short-term local anesthesia in the periocular region to prevent this serious complication.
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Acrochordon, diabetes and associations
Article
  • Jul 1996
  • INDIAN J DERMATOL VE
A study of clinical profile of acrochordons was carried out in 100 patients. Their association with diabetes mellitus and other disorders was studied. Acrochordons were found to be closely associated with pseudo-acanthosis nigricans, seborrhoeic keratosis, obesity and non-insulin dependent diabetes mellitus.
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Letter: A frequent sign of diabetes mellitus
Article
  • Jun 1976
Of the 500 patients examined, 47 had single or multiple skin tags. Of the 47 patients with skin tags, 34 had diabetes mellitus. Seven patients with skin tags did not have diabetes mellitus, nor did they have an abnormal glucose tolerance test. Of the 34 patients with skin tags and diabetes, 7 did not know that they had diabetes before examination. All persons with diabetes do not have these skin lesions. The authors found 62 patients with diabetes among the 500 examined. Only one of the 20 female patients in their group had skin tags, and none of them had diabetes. During the past several years of observing patients with skin tags, the authors found 4 patients with skin tags without evidence of diabetes in whom, several years later, diabetes mellitus did develop. One can almost predict that a male patient will have diabetes if the lesions are multiple, large, hyperpigmented and bilateral.
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Skin tags: A cutaneous marker for diabetes mellitus
Article
  • Feb 1987
Two hundred and sixteen non hospitalized patients with skin tags (ST) were studied for the presence of diabetes mellitus (DM) and obesity. Overt DM was found in 57 (26.3%) patients and impaired glucose tolerance test was found in 17 (7.9%) patients. Sixteen new cases of DM were found among this group. All the diabetic patients in the study population had non-insulin dependent DM. Sixty-two (28.7%) of the patients were obese. No correlation was found between the localization, size, colour and number of the ST and the presence of DM. Our study indicates that ST are not associated with increased incidence of obesity compared to the general population. On the other hand, ST are associated with impaired carbohydrate metabolism, and may serve as means for identifying patients at increasing risk of having DM.
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