Best Cosmetic Outcomes for Skin Tag Removal: A Systematic Review of Treatment Modalities and Patient-Reported Aesthetic Results

Skin tags (acrochordons) are common benign cutaneous lesions that may warrant removal for cosmetic, symptomatic, or functional reasons. While removal techniques are well established, data comparing their cosmetic outcomes, especially across diverse skin types, remain limited. This systematic review aimed to synthesize studies that evaluated cosmetic outcomes following skin tag removal using various treatment modalities, including cryotherapy, electrosurgery, laser therapy, pressure-based devices, surgical excision, and topical agents. A total of nine studies were included, encompassing randomized controlled trials, prospective comparative trials, pilot case studies, and single-patient case reports. Cosmetic outcomes were assessed using validated scales, physician and patient evaluations, and photographic documentation, with follow-up periods ranging from 21 days to 6 months. Electrosurgery and laser treatments were consistently associated with superior cosmetic scores compared to cryotherapy, which showed higher rates of pigmentary changes. Innovative approaches like tissue clamping and pressure patching offered excellent cosmetic results with minimal discomfort and no scarring or pigmentary changes. Topical Siddha therapies achieved favorable results in limited case reports. Across all modalities, post-treatment hyperpigmentation and erythema were the most frequently reported adverse events, particularly in skin of color, though Fitzpatrick type reporting was often omitted. These findings highlight the need for standardized cosmetic assessment tools, longer follow-up, and greater inclusion of diverse skin types in future studies to optimize aesthetic outcomes in skin tag management.