A skin tag is a common, benign growth of skin tissue that typically appears where skin rubs against skin, such as the neck, armpits, or groin. These small, soft lesions are generally harmless but can become irritated by clothing or jewelry. Ligation, or tying off the growth with a thread, is an at-home removal method aimed at causing the tag to fall off naturally. This technique involves deliberately cutting off the blood supply to the growth.
Proper Identification and When Not to Proceed
Before attempting any at-home removal, confirm the growth is a skin tag. A true skin tag is characteristically soft, flesh-colored, and attached to the body by a small, thin stalk of tissue called a peduncle. They are usually small, often the size of a grain of rice, and move easily when touched. Other growths, such as moles or warts, can mimic this appearance, making self-identification difficult.
Self-removal is not advised if the growth is larger than the width of a pencil eraser, or if it appears dark red, purple, or black. These colors may indicate a more complex structure or a different type of growth. Any growth that is painful, bleeds spontaneously, or is rapidly changing in size or color should be examined by a healthcare professional. Consulting a dermatologist is the safest course of action if there is any doubt about the identity of the growth, as misdiagnosis is the most significant risk of home removal.
Step-by-Step Guide to Tying Off the Tag
The ligation process requires careful preparation to minimize the risk of infection. Begin by thoroughly washing the area around the skin tag with soap and water. Then, gently swab the skin and the thread with rubbing alcohol to sterilize the materials. Use a thin, strong thread, such as clean cotton sewing thread or unwaxed dental floss, which is often easier to handle.
Ligation involves lifting the soft skin tag away from the surrounding skin to clearly expose the peduncle, or stalk, at its base. The thread must be tied tightly around this base, as close to the skin surface as possible, to effectively cut off the blood supply. This stops the flow of blood and oxygen, leading to the intentional death of the tissue, a process called necrosis.
A secure, non-slip knot is necessary to maintain the required pressure, often requiring multiple wraps or a double knot to prevent the thread from loosening or slipping. Once the knot is secure and tight, the excess thread should be trimmed, leaving the knot and a small tail in place.
What to Expect During Healing and Signs of Trouble
After the thread is securely tied, the skin tag will begin to change over the next several days. The lack of blood flow will cause the tag to first become darker, often turning a purplish color, and then black as the tissue becomes necrotic. This color change is expected and indicates that the ligation has been successful in cutting off the blood supply.
The desiccated skin tag typically dries up and falls off completely within three to seven days of successful ligation, though this timeframe can vary depending on the size of the growth. During this period, keep the area clean with gentle washing and monitor the site closely for any complications. Applying a thin layer of petroleum jelly and covering the area with a non-stick bandage can protect the site and promote optimal healing once the tag has fallen off.
If the thread comes off prematurely, the process may need to be repeated, provided the tag has not already begun the necrotic process. If the tag remains firmly attached after two weeks, the ligation was likely not tight enough, and a different approach or professional consultation is recommended. Immediate medical attention is necessary if signs of infection develop, including:
- Increasing redness spreading beyond the immediate site
- Warmth or worsening pain
- The presence of pus or cloudy discharge
- Red streaks extending from the wound
- The development of a fever