Tretinoin is a powerful, prescription-strength retinoid, a derivative of Vitamin A, widely recognized for its effectiveness in treating acne and reducing the visible signs of photoaging. Skin tags, medically known as acrochordons, are common, benign skin growths that often appear in areas of friction. The impulse to apply an existing topical treatment like Tretinoin to a new skin concern is understandable. However, the fundamental difference between the biological structure of a skin tag and the conditions Tretinoin treats explains why this approach is not effective.
How Tretinoin Alters Skin Cell Behavior
Tretinoin exerts its effects primarily by interacting with retinoic acid receptors (RARs) within skin cells, regulating gene expression. This binding alters the behavior of keratinocytes, the main cells of the epidermis. A significant effect is the increase in the rate of cellular turnover, or desquamation, which is the shedding of dead skin cells from the outer layer of the skin.
This accelerated turnover prevents the buildup of keratin and dead cells within hair follicles, addressing the underlying cause of clogged pores in acne. Tretinoin also promotes the proliferation of new keratinocytes in the deeper basal layer of the epidermis, leading to epidermal thickening and improved skin texture. Furthermore, the retinoid stimulates the production of collagen and elastin fibers, which provides structural support and minimizes the appearance of fine lines.
The Biological Structure of Skin Tags
Skin tags are small, non-cancerous tumors known as acrochordons, which are structurally distinct from superficial skin blemishes. They are characterized by a fleshy stalk, called a peduncle, that connects the growth to the surrounding skin. This pedunculated structure indicates their deep-seated nature.
Microscopically, a skin tag is composed of a core of loose, fibrous connective tissue, blood vessels, and sometimes nerve cells, known as a fibrovascular core. This core is covered by an outer layer of epidermis. The growth’s composition—a dermis-like structure anchored by a stalk—means it is fundamentally different from the epidermal issues Tretinoin targets, such as acne or sun damage.
Why Tretinoin Does Not Resolve Skin Tags
Tretinoin is ineffective against skin tags because its mechanism of action is limited to the superficial layers of the skin, specifically the epidermis and the follicular lining. The drug accelerates the turnover of surface keratinocytes, causing the skin to shed more rapidly. While this process causes peeling and exfoliation, it is not capable of dissolving the deeper, dense structure of a skin tag.
The growth is anchored by a fibrovascular core composed of collagen fibers and blood vessels, which Tretinoin cannot penetrate or break down. Applying Tretinoin will primarily cause irritation, redness, and peeling on the epidermal surface of the growth. This irritation may make the tag appear smaller temporarily due to surface inflammation, but it will not eliminate the underlying stalk or sever the blood supply, meaning the growth remains in place.
Clinical Methods for Skin Tag Removal
Since Tretinoin cannot resolve skin tags, removal requires methods that physically eliminate the growth or cut off its blood supply. These procedures should always be performed by a healthcare professional. The choice of method depends on the size, location, and number of skin tags being treated, but all professional methods offer definitive results with minimal risk of scarring.
Cryotherapy
Cryotherapy involves the application of extremely cold liquid nitrogen directly to the skin tag. The intense cold destroys the tissue by freezing the cells. This causes the tag to blister, darken, and eventually fall off within seven to fourteen days. This method is quick, does not require anesthesia, and is effective for small to medium-sized tags.
Excision or Snip Removal
Excision is a surgical technique where the skin tag is physically cut off at its base using sterile scissors or a scalpel. For larger skin tags, local anesthetic may be injected to ensure patient comfort. This approach provides immediate removal and is preferred for larger or more fibrous lesions, though it may result in bleeding that must be controlled.
Electrocautery
Electrocautery, sometimes called diathermy, uses a high-frequency electrical current to generate heat. This heat effectively burns off the skin tag and seals the underlying blood vessels simultaneously. The precision of electrocautery makes it useful for treating smaller tags and immediately stops any bleeding.
Ligation and Home Removal Risks
Ligation involves tying a surgical suture or thread tightly around the base of the skin tag to restrict blood flow. This causes the tissue to die and fall off after several days. Attempting any of these removal methods at home using non-sterile tools or unproven topical solutions carries significant risks of infection, excessive bleeding, and permanent scarring. Professional intervention remains the safest choice.