1. 1

2.  Achrochordons or skin tags are common benign skin over growth usually begin in 2nd decade and peak by the 6th decade of life. There is familial disposition and more common seen in obese individuals.  The common site of skin tags are, axillae, neck, eyelids and under breasts.  Skin tags show no tendency to regress spontaneously and they are cosmetically undesirable.  New treatment modality for skin tags removal is laser therapy. 2

3.  To demonstrate the efficacy and safety of Carbon Dioxide Laser (10600nm) for the removal of skin tags (Achrochordons) in some Sudanese patients. 3

4.  This is a prospective descriptive, intervention study performed in the laser clinic, institute of laser, Sudan University of Science and Technology, Khartoum, Sudan.  It was conducted from June – October 2014.  The study included a total of 10 patients clinically diagnosed as having skin tags, they were selected from different dermatology clinics in Khartoum state. 4

5.  Inclusion Criteria: -Patients clinically diagnosed as skin tags -Over 18 years of age -Able to give informed consent. -Desires removal of lesions.  Exclusion Criteria: -Less than 18 years. -Pregnant. -Unable to give informed consent. 5

6.  The laser system used in this study was CO 2 laser system, its model IB-60IB, China.  CO 2 laser system emits wavelength of 10600 nm, maximum power 30 Watt, penetration depth is approximately 0.03 mm.  The tissue target for CO 2 laser is water. When light is absorbed by water inside the target tissues, rapid heating up to 100 o C occurs. Hence vaporization of the targeted tissue water as steam. 6

7.  All patients received single session, of the same laser parameters, power 3.5 watt, repetitive pulse, duty time 0.1sec, idle time 0.1sec.  The laser hand piece was applied horizontally by non contact method targeting the base of the lesion, removal of the lesions or blanching of the color of the base was the main feature noticed indicating the progress of treatment. 7

8.  Four elements were considered for evaluation of the results -Persistence of any of the lesions. -Discoloration after 3weeks. -Atrophic or hypertrophic scars -Patients satisfaction < 80%  For evaluation of the response, each of the above four elements was graded 25%. Excellent response mean that no element was noticed, very good response if the percentage scored is 25%, good response if the percentage scored is 50%, poor response if the score >50%. 8

9.  Ten patients with skin tags were included in this study their ages were range between 22- 48 years, 6 of them were females and 4 were males. 10987654321 Patient number MFF FF MMFFM Gender 44423927354834 383522 Age in years 9

10. Eight patients (80%) had skin tags on the neck; axillae were involved in 2 of them (20%), single lesion on the chin in one patient (10%), and single lesion on the thigh in one patient (10%), 10

11. 11

12. Six patients (60%) had DPN, four patients (40%) had skin tags only, 12

13. 13

14.  In our study we found that CO 2 laser therapy for skin tags is, easy to use, with excellent response and minimal complications to patients, which is highly encouraging and showed the possibility of laser therapy to gain the upper hand in treatment of skin tags. 14

15.  As lasers are becoming an important intervention in dermatology, I recommended that further studies with larger sample size should be done, to investigate the optimal laser parameters for skin tags removal and to be sure no side effect and complication. 15

16. 48years male with multiple skin tags on the neck. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, (C) three weeks after treatment the response was excellant A B C 16

17. 35years female with multiple skin tags on the neck. (A) Before treatment, (B) three weeks after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, the response was v.good A B 17

18. 22 years male with single skin tag on the chin. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, the response was excellant A B 18

19. 42years female with single skin tags on the thight. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, the response was excellent. 19

20. A B 44years male with multiple skin tags on the neck. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, idle time 0.1sec the response was excellent 20

21. 38years female with multiple skin tags on the neck. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, idle time 0.1sec the response was excellent A B 21

22. 38years female with multiple skin tags on the neck. (A) Before treatment, (B) one week after treatment with CO 2 laser, power: 3.5 watt, repetitive pulse, duty time: 0.1sec, idle time 0.1sec the response was excellent A B 22