Recorded: 1/23/2022 / Published: 8/07/2022
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- – In this week’s episode of The Krypt we are taking a deep dive into HPV and genital warts, and then comparing them to skin tags.
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- – “HPV/Genital Warts Vs Skin Tags-S04E20”
- STD Center New York
- This article should help people who aren’t doctors differentiate between skin tags and HPV (which is often called “genital warts”) and establish the right diagnosis.
- STD Center New York
It’s important to distinguish these two conditions because one of them—genital warts—is infectious, meaning it can be passed from one person to another. Skin tags are not infectious; their formation is induced by other factors, as discussed below.
Please keep in mind that neither condition is life threatening or even dangerous.
Both skin tags and genital warts are common conditions affecting the genitals of people of all ages and both genders. They can be easily confused because they’re similar in appearance.
When establishing the diagnosis and differentiating between those two conditions, a few things need to be considered in combination:
- Visual examination of the skin is 90% of the diagnosis.
- Context information is 10% of the diagnosis (mainly, it confirms the diagnosis made based on visual examination). The context includes the history of the bump (how it’s changing over time and how fast it is growing), the patient’s age, the location of the skin lesion, the prevalence of each condition in the geographic area, and the patient’s genetic predisposition.
Let’s talks about each of these things in more detail!
Visual exam of the skin
- A skin tag looks like a deflated balloon on a stalk.
- The base of the stalk is very thin, and it can be separated from the skin easily.
- Genital warts, unlike skin tags, are flat and have a broader base, and they’re usually firmly attached to the skin.
- If the growth is pedunculated (it consists of finger-like projections), the width of the skin lesion at its base and top is the same, unlike with skin tags, which are bigger on top and have a much thinner base.
- Skin tags can be different colors: the color of the patient’s skin (rarely), lighter, or (most commonly) darker. The color can change over time. Color differences are not cause for concern.
- Genital warts are usually the color of the patient’s skin. Occasionally they are darker.
- Skin tags are very soft to the touch.
- They can bend easily since they usually have a thinner base and bigger top.
- Genital warts are hard to the touch, with a rough and bumpy surface resembling cauliflower.
- They are usually flat (unless they are pedunculated) and not freely movable because of their broader base.
- A skin tag is usually a solitary growth.
- When there’s more than one skin tag, they’re separated by normal skin and they’re widespread, affecting different parts of the body at the same time.
- Genital warts can appear in clusters. This is because, unlike skin tags, genital warts are infectious and can spread (through scratching and shaving) to adjacent tissue more easily than to more distant areas.
Parts of the Body Affected
- Skin tags prefer certain parts of the body where daily friction is more common:
- Armpit, neck, under large breasts, groin creases
- Check to see if you have bumps in those areas in addition to your genitals.
- Genital warts, since they are infectious and transmitted through direct skin-to-skin contact, affect areas of skin not commonly protected during sexual contact and that are injured (by minor cuts) during sex:
- pubic area, shaft of the penis, area around the anus
Contextual information that helps make the diagnosis
- The context helps establish the right diagnosis by confirming the visual exam (about 10% of the diagnosis comes from the context). Contextual information includes the following:
- History of the condition, Patient age, Prevalence of the condition in the geographic area, Patient’s genetic predisposition, Other conditions that predispose the patient to the growth in question
Let’s talk about each of these in detail!
History of the condition
The history of the growth includes the following:
- 1. Why was the growth noticed? (Are there any symptoms, or was it accidentally noticed?)
- 2. How is it changing over time? (Is its appearance changing? Is it getting bigger?)
Let’s look at both questions with respect to skin tags and genital warts.
Why was the growth noticed?
- A skin tag is usually noticed after it is pulled on and it’s red, painful, and irritated
- Genital warts are usually noticed by a sexually active person after a sexual encounter with a person they don’t trust. However, the warts are most likely not related to a recent encounter.
How is it changing over time?
- Skin tags grow rapidly but at some point, they stop growing. They can change color over time. The growth will persist until it is torn or removed.
- Genital warts are very slow-growing lesions and take weeks to months to appear after they’re contracted infectiously.
- They might get bigger over time, and they might spread to adjacent skin through scratching and shaving.
- They might start shrinking and disappear completely eventually. Since this is an infectious condition, it might take up to two years for the immune system to clear it. On the other hand, the infection might remain dormant (without any visible skin growths) for life.
- Skin tags usually affect people after age 30. They’re rare before that age. The older the person, the greater their chance of getting a skin tag.
- Genital warts mostly affect sexually active people. People are most active with multiple partners at younger ages, so the chance of acquiring genital warts is higher for younger people.
- Both conditions are very common, but warts affect significantly more people.
- 25% of people get skin tags during their life
- 85% of people get genital warts (HPV) during their life
- Some people are genetically predisposed to skin tags—this means that people whose relatives have had skin tags are more likely to get them as well.
- Genital warts are infectious, and anyone can get them through direct skin contact with infected skin. No one is genetically predisposed to them.
Causes and predisposing conditions
- The exact cause of skin tags is unknown. Here are the risk factors:
- friction due to contact with fabric
- advanced age
- The cause of genital warts is well known. They are caused by HPV. Over 100 strains of the HPV virus exists, but genital warts are mainly caused by only two of them, type 6 and type 11. Luckily, these two strains are not cancerous.
Photos of skin tags and genital warts
Here we show you photos borrowed from other websites and explain the main differences between skin tags and genital warts, which will help with making a diagnosis.
Skin tag #1
- This image shows: A very thin base and a much bigger top. The appearance of a deflated balloon
Skin tag #2
- This image shows: A very thin base and bigger top. A skin tag is easily bendable. The skin tag is darker in color than the surrounding skin
Skin tag #3
- This image shows: Multiple skin tags in one of the areas where they most commonly appear, the neck (skin tags prefer dry areas with a lot of friction, and the neck tends to come in contact with jewelry and fabric.) Females are more likely to get skin tags. Variation in colors that are different from the color of the patient’s skin
Genital warts #1
- This image shows: Broad-based genital warts. A rough cauliflower surface. The location of the warts (the base of the penis) is an area that is not covered by a condom but that is exposed to infection.
Genital warts #2
- This image shows: Pedunculated warts—despite being pedunculated, the wart base is broad (usually as broad as the top of the warts.) Rubbery consistency (hard to the touch.) The location is the base of the penis (where a condom ends.) Multiple warts in clusters (extended to adjacent tissue by scratching and shaving.)
If a visual exam is not conclusive
- Most genital warts are diagnosed based on a visual examination at the doctor’s office. If the diagnosis is doubted, a skin biopsy is the next logical step. A whole bump or a portion of one is sent to a lab for further analysis under a microscope. A skin biopsy is considered a very minor in-office procedure; it is done under local anesthesia.
Do I need treatment?
- Skin tags and most visible genital warts are benign conditions, and treatment is optional.
- People sometimes get treatment for skin tags for these reasons:
- The tags are constantly irritated by being caught on cloth or jewelry
- For aesthetic reasons (they don’t like how they look)
- Unlike skin tags, genital warts are infectious and can spread to adjacent skin and to sexual partners. Therefore, people may choose to get treatment to stop local self-spread and to decrease the chance of spreading them to partners.
- Untreated warts usually get better over time, but it might take up to two years for the immune system to clear them.
- The treatment for genital warts and skin tags is the same, and it’s very effective. The skin tag or genital wart is destroyed. This can be achieved by different methods:
Cryotherapy: Cold liquid nitrogen(freezing) is applied ; it destroys the lesion
Surgery: The lesion is removed by cutting it with a scalpel or scissors. This is a very minor in-office procedure.
Laser: Direct rays of light burn away the tag or wart.
Acid: An application of acid destroys the tag or wart. The acid that is commonly used is trichloroacetic acid (TCA).
Can these bumps be prevented?
- It is not completely clear why and how skin tags develop. Multiple factors might be involved and for that reason they are not considered preventable.
- Unlike skin tags, genital warts can be prevented or (to be more precise) the chance of getting them can be minimized in these ways:
- Getting the vaccine
- Using protection during sex
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