Reduced and Thinned Elastic Fibers in Skin Tag

Objective: Skin tag (fibroepithelial polyp) is a benign skin lesion that is composed of a core of connective tissue and overlying epidermis with unknown etiology and pathogenesis. We conducted this study to demonstrate its relationship with elastic fiber abnormality. Methods: We retrieved thirty histopathological cases of fibroepithelial polyps at king khalid University hospital, Riyadh, Saudi Arabia, during the period from 2010 to 2012. The cases were stained with elastic van Gieson stain. Results: All the cases showed thinned dermal elastic fibers and twenty one revealed decrease in their count. Conclusion: Fibroepithelial polyps show abnormal and/or decreased elastic fibers. There were 12 females and 18 males. The lesions were located most commonly on neck (n: 11) and thigh (n: 7) (Table 1). By Hematoxylin and eosin (H/E) stain, the lesion composed of a core of connective tissue covered by papillated epidermal surface (Figure 1). There were 17 furrowed, 7 bag-like and 6 filiform types. Elasticvan Gieson stain showed moderate to marked thinning of elastic fibers (EF) in all the cases as compared to normal control skin. Twenty one cases revealed reduced number of EF (Figure 2(A & B)). Introduction Fibroepithelial polyp (skin tag) is a small soft benign cutaneous neoplasm. It has received little attention in the dermatological literature, because they have been regarded as being of little consequence. Its etiology and pathogenesis are controversial. Previous theories have suggested that a localized paucity of elastic tissue may result in sessile or atrophic lesions [1]. However, a more recent study of elastic tissue in fibroepithelial polyps showed no significant abnormalities [2].


Introduction
Fibroepithelial polyp (skin tag) is a small soft benign cutaneous neoplasm.It has received little attention in the dermatological literature, because they have been regarded as being of little consequence.Its etiology and pathogenesis are controversial.Previous theories have suggested that a localized paucity of elastic tissue may result in sessile or atrophic lesions [1].However, a more recent study of elastic tissue in fibroepithelial polyps showed no significant abnormalities [2].

Methodology
This is a retrospective study in which thirty histopathological specimens of fibroepithelial polyp (skin tag) were examined.Their paraffin blocks were collected from the archives of the Pathology Department, king khalid University hospital, Riyadh, Saudi Arabia, during the period from 2010 to 2012.Age of the patient, sex, and site, of the lesions as well as type of skin tag were recorded.Sections from each paraffin block were cut by a microtome at 5-micron thickness, stained with hematoxylin and eosin for histopathologic revision and with elastic-van Gieson stain for dermal elastic fiber evaluation.The number and thickness of elastic fibers were evaluated for each case as normal, reduced, or thinned.Normal adjacent skin was used as normal control.

Results
The mean age of patients was 44 years (range 26 -66 years).

Discussion
Fibroepithelial polyp (FEP) also called soft fibroma, acrochordon, and skin tag is a common benign cutaneous neoplasm.Clinically, they are soft, skin-colored, variably sized, pedunculated papules.The most common locations involved included, in decreasing order of frequency, the axilla, neck, groin, eyelid, abdomen, and back.No significant difference between genders was found [3].In our cases, neck was the most common location and there was slight male predominance.
There are three types: furrowed papules, filiform lesions, and large bag-like protuberances.The histological features vary with the clinical type.The furrowed papules show epidermal hyperplasia and sometimes horn cyst formation.The filiform lesions are covered by an epidermis which shows only mild acanthosis.The larger, bag-like lesions usually have a stroma composed of loosely arranged collagen and a central core of adipose tissue [3].
There have been several reports suggesting an association between the presence of skin tags and underlying diabetes, abnormal lipid profile, colonic polyps, or acromegaly [4][5][6].Its relation to elastic fiber abnormalities was controversial.Clinically, FEPs bare some resemblance to cutis laxa and pseudoxanthoma elasticum (PXE).All three conditions are characterized by skin-colored, soft lesions [7].Furthermore, PXE characteristically affects some of the same sites as FEPs, including the neck and axilla.Because the etiology of PXE and cutis laxa is related to disorders of elastic tissue, one may theorize that FEPs are also caused by local abnormalities in elastic tissue.Old studies showed abnormal elastic tissue of in FEPs [1,8].One recent study demonstrated that there were no significant abnormalities in elastic tissue in the FEPs [2].Our study confirmed abnormality of elastic fibers of all cases of FEPs.All cases showed thinning of EFs as compared with adjacent normal dermis.Most of the cases revealed decreased number of dermal EFs.

Conclusion
Fibroepithelial polyp (skin tag) is a benign cutaneous neoplasm with unknown pathogenesis and controversial association with elastic fibers abnormality.Our study confirmed that thinned and reduced number of elastic fibers are strongly associated with FEPs.

Table 1 :
Clinical and pathological features of the cases.