Monday, 8 February 2016

Fibroepithelial polyps of the anus (anal tags)

Fibroepithelial polyps of the anus are relatively common lesions, some of which are thought to arise from enlargement of anal papillae. Others are thought to arise from  fibrosed haemorrhoids

They are oedematous, flesh-coloured, sessile protrusions usually measuring 1–2 cm in length.  Underlying constipation might be present. Fibroepithelial polyps of the anus may be associated with local inflammation such as fissure, fistula and irritant or allergic contact dermatitis.  A variant associated with lichen sclerosus may also occur.

A fibroepithelial polyp of the anus has a myxoid and/or collagenous stroma covered by stratified squamous epithelium which may show some swollen cells with vacuolation near the surface. The stroma sometimes contains atypical cells showing fibroblastic and myofibroblastic differentiation. Hyalinized vascular changes may be present near the base of the polyps. There is an increase in CD34+ stromal cells.

Fibroepithelial polyps of the anus should not be mistaken for condylomas. They should also be distinguished from the much smaller transient infantile perianal pyramidal protrusion which occurs predominantly in young girls in the midline. Larger, fleshier, more oedematous skin tags should arouse the suspicion of Crohn’s disease. They can predate gastrointestinal disease by several years. Disturbance of the normal embryological development of the anus may rarely result in the appearance of one or more polypoid projections at the anus (anomalous anal papillae). These may be asymptomatic, but often become complicated by ulceration, faecal retention and constipation.

Fibroepithelial polyps of the anus  might be treated successfully by topical steroid applications however, removal is the standard treatment when required.

Before treatment

After treatment 

This page was last updated in March 2016

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology