Anal skin tag are soft shapeless outgrowths of skin up to 1.5 cm in size, located in the perianal zone. Skin growths look like a fringe. They are manifested by discomfort during defecation and walking, slight itching, difficulties with hygienic care, accompanied by pain, redness, wetness during inflammation. They are diagnosed by proctological examination, rectal finger examination, rectoromanoscopy, histological analysis of the biopsy. For removal, radio wave, cryodestructive and laser interventions are carried out.
ICD 10
64.4
General information
Anal (perianal, hemorrhoidal) skin tag in most cases do not have a bright clinical picture, are considered not a disease, but a cosmetic defect. They are equally often observed in men and women, usually appear after 25-30 years. In children, cutaneous perianal growths are diagnosed in sporadic cases. The risk group for the occurrence of anal skin tag includes women who have given birth many times, as well as patients who are overweight, lead a sedentary lifestyle, often eat spicy, smoked and spicy food, and abuse alcoholic beverages.
Causes
The occurrence of hemorrhoidal skin tag is associated with the presence of proctological diseases accompanied by stretching of the skin of the perianal zone. The probability of the appearance of skin outgrowths increases in the presence of a long-existing pathology. Specialists in the field of modern proctology distinguish the following etiofactors of the formation of anal skin tag:
- External hemorrhoids. Hemorrhoids are the most common cause of the development of perianal skin tag. Outgrowths are formed as a result of prolonged stretching of the skin by strained hemorrhoidal vessels, while a certain role is played by a violation of the trophic tissues.
- Prolonged labor. The appearance of anal postpartum skin tag can be observed with extreme tension and straining during labor attempts. The mechanism of pathology in this situation is similar to hemorrhoids with the difference that the increase in pressure in hemorrhoidal vessels is sharp, but short-term.
- Sphincteritis, anal skin tag. In the inflammatory and traumatic origin of anal skin tag, the formation of inflammatory infiltrates, vascular disorders and tissue edema plays a leading role. The probability of the formation of fringed outgrowths increases with a combination of anal canal cracks and inflammation.
- Proctological interventions. In case of non-compliance with the technique of performing surgery for hemorrhoids or other surgical pathology in the anus, inflammatory and traumatic swelling of tissues with stretching of the skin is possible. Postoperative thrombosis also becomes a contributing factor.
- Persistent constipation. In rare cases, fringed skin formations in the anus are the result of significant straining with difficult stool withdrawal. An additional role in the occurrence of skin tag in patients with chronic constipation is played by constant irritation of the skin with solid feces.
Pathogenesis
The mechanism of development of anal skin tag is represented by the formation of skin outgrowths over nodular formations around the anal opening. With long-existing hemorrhoids, chronic inflammatory processes, constant stretching of the skin contributes to a compensatory increase in the area of the integumentary epithelium and subcutaneous fibers. In patients with acute tension of the skin, a partial rupture of fibrous structures is an aggravating factor. In both cases, the contractility of the skin is violated, which takes the form of small freely hanging folds.
Symptoms of anal skin tag
The severity of the clinical picture of the disease depends on the size and number of growths. As a rule, skin folds do not cause pain to the patient. The main complaints are discomfort, slight itching in the perineum, difficulties during intimate hygiene procedures. With large growths along the entire circumference of the anus, pain and discomfort may appear during the act of defecation, sometimes patients note inconveniences when walking.
When infected, local signs of the inflammatory process develop: pain syndrome of varying intensity, redness and swelling of the skin tag, sometimes – wetness and bleeding. The general condition is disturbed only with a severe course of the disease or the formation of complications. Patients often have psychological problems associated with the presence of a cosmetic defect and a sense of shame during sexual intercourse.
Complications
Constant irritation of the anal skin tag with underwear leads to the appearance of micro-lesions of the skin, through which pathogenic microorganisms can droop. As a result of infection, local purulent inflammation of the anal skin folds occurs in patients, which is accompanied by an increase in unpleasant symptoms. In the future, the infectious process may spread to adjacent organs. The rectum is more often affected with the development of proctitis, in advanced cases, paraproctitis is formed.
Maceration of the fringe skin due to fecal contamination and insufficient hygiene often causes anal erosions and superficial ulcers. There is a constant separation of serous or hemorrhagic contents, sharp pain in the anus area, which increases with the act of defecation. In the case of deep ulcers, episodes of chronic bleeding are noted, which can lead to the development of posthemorrhagic iron deficiency anemia.
Diagnosis
Diagnosis is not difficult. Anal skin tag are easily detected during a routine examination by a proctologist and in typical cases do not require differentiation with other pathologies. The need for additional research is explained by the fact that skin folds are often combined with various diseases of the rectum. The most informative are:
- Proctological examination. During a routine examination of the anal area, the proctologist may notice the presence of small (1-1.5 cm) skin folds that are located around the anus. In case of inflammation, the skin tag may be hyperemic, edematous, covered with erosions or crusts.
- Finger examination. During the rectal examination, the doctor evaluates the elasticity and tone of the anal sphincter, examines the mucous wall of the rectum. After removing the finger, the nature of the detachable on the glove is determined. The method allows you to identify hemorrhoids and cracks.
- Rectoromanoscopy. If a combination of skin tag with another pathology is suspected, a visual examination of the inner surface of the rectum is performed using a rectoromanoscope. During the study, the condition of the mucosa, the presence of pathological formations or inflammation is assessed.
- Histological analysis. The study of the cytomorphological composition of biopsies of skin folds makes it possible to conduct a differential diagnosis of skin tag with benign skin formations around the anus, taking into account the cellular composition and structure of the tissue.
In the absence of complications of the disease, no changes are observed in clinical blood and urine tests. In the case of purulent inflammation, neutrophilic leukocytosis, increased ESR is detected. Frequent bleeding can lead to a decrease in the amount of hemoglobin and red blood cells. In the presence of purulent discharge, bacteriological sowing is carried out to clarify the type of pathogen.
Fringes most often have to be differentiated with benign neoplasms (anal polyps, papillomas). In doubtful cases, the main diagnostic criterion is the histological examination data. With simple anal skin folds, there are no anomalies in the structure of biopsies. Also, anamnesis and the presence of concomitant pathology of the rectum are important for differential diagnosis. According to the indications, a dermatologist or oncologist may be involved in the examination of the patient.
Treatment of anal skin tag
In the presence of small skin tag that do not become inflamed and do not disrupt the process of caring for the perianal area, it is recommended to monitor with periodic examinations to assess the growths and correct the diet with the exception of products that provoke constipation. If the formations cause the patient physical or pronounced psychological discomfort, surgical treatment is indicated. To exclude postoperative complications, instead of classical excision under local anesthesia, high-tech methods such as:
- Radio wave excision. Incision and coagulation of tissues by high-frequency waves is one of the most common methods of removing perianal fringe. The low traumatic nature of the intervention minimizes the risk of complications. To reduce pain after surgery, anesthetic ointments are used.
- Cryodestruction of hemorrhoidal skin tag. The advantage of the cryodestructive method, as well as the radio wave method, is low invasiveness, the ability to do without suturing. However, after almost painless cauterization of the anal fringe with liquid nitrogen, healing lasts longer, postoperative scars are formed more often.
- Laser removal of skin tag. Removal of anal skin outgrowths using a laser is characterized by high safety and low probability of infection. Laser cauterization of tissues and vessels in the anal zone reduces the risk of bleeding, and stimulation of regenerative processes by radiation accelerates healing.
Prognosis and prevention
The outcome of the disease in the presence of anal skin tag is favorable, relapses after surgical removal are extremely rare. Specific prevention measures have not been developed. To prevent the formation of cutaneous anal growths, it is necessary to carry out timely diagnosis and treatment of hemorrhoids, observe the technique of performing surgical manipulations in the anal area. In case of skin tag, you should consult a doctor to prevent complications.
