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SKIN TAG EXCISION IN CROHN’S DISEASE: FIRST, DO NO HARM?
Ece Unal
*, Olga Lavryk, Arielle E. Kanters, Anna R. Spivak, Jeremy M. Lipman, Clifton G. Fulmer, Katherine Falloon, Taha Qazi, Benjamin L. Cohen, Stefan D. Holubar
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Background: Traditionally, perianal skin tag excision has been contraindicated in patients with Crohn’s disease (CD) owing to risk of non-healing wounds. However, little data exists on this topic. We aimed to review our institutional experience with outcomes after perianal skin tag excision in patients with CD. We hypothesized that perianal skin tag excision in CD would be associated with non-healing wounds.
Methods: We retrospectively reviewed adults with CD who underwent skin tag excision with or without limited excisional hemorrhoidectomy at our center between 2012 and 2024. Demographics, CD characteristics, medications, operative data, pathology, and postoperative outcomes were reviewed.
Results: Forty-five patients with CD underwent excision of skin tags (28, 62%) and/or limited excisional hemorrhoidectomy (20, 44%). Demographics, CD characteristics, and medications are detailed in Table 1. Short-term complications occurred in 2 (4.4%); 1 fistula and 1 wound dehiscence. Pathology results were available for 42 (93%) patients; the majority were benign (33, 78.5%) but a small subset (2, 5%) had anal intraepithelial neoplasms (
Table 2). Long-term complications occurred in 11 (24.4%) patients (Table 2), of which 9 (81.8%) were managed conservatively or with non-operative therapy. Complications included perianal fistula (4, 8.8%), anal stenosis (4, 8.8%), nonhealing wounds (2, 4.4%) and anal fissure (1, 2.2%). Of these patients, seven (63.6%) later had complete wound healing. Almost half of these patients had penetrating disease with perianal involvement (5, 45.5%).
At most recent follow-up, 41 (91.1%) patients had complete wound healing, and only one (2%) patient required proctectomy. Four patients (9%) had persistent non-healing wounds; 2 with history of perianal fistulae requiring surgery (one requiring diversion), 1 with fistula 4 years after skin tag excision, and 1 later diagnosed with perianal hidradenitis suppurativa. Three (75%) of these patients had prior surgery for perianal disease (one each: fissure, abscess, and stricture), and all were on biologic therapy (infliximab, 3; adalimumab, 1).
Conclusions: Perianal skin tag excision in carefully selected CD patients resulted in wound healing in the majority (91%) of patients and can be considered for lifestyle limiting symptoms. Pathology was typically benign but occasionally revealed actionable results, including neoplasia, and should encourage routine pathologic evaluation of specimens. The risk of long-term complications was low, but higher in the CD population compared to average, and the sequelae were mostly managed with non-operative therapy. Our data suggests that previous surgery for perianal Crohn’s may be a risk factor for non-healing wounds after perianal skin tag excision.
Table 1. Baseline demographic data, preoperative Crohn's characteristics and medication history
Table 2. Pathologic data, short- and long-term complications, and long term outcomes
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