Medscape is available in 5 Language Editions – Choose your Edition here.


Seborrheic Keratosis Treatment & Management

  • Author: Arthur K Balin, MD, PhD, FACP; Chief Editor: William D James, MD  more...
Updated: Jun 28, 2016

Medical Care

Ammonium lactate and alpha hydroxy acids have been reported to reduce the height of seborrheic keratoses.[32, 33] Superficial lesions can be treated by carefully applying pure trichloroacetic acid and repeating if the full thickness is not removed on the first treatment.

Topical treatment with tazarotene cream 0.1% applied twice daily for 16 weeks caused clinical improvement in seborrheic keratoses in 7 of 15 patients.[34]

A drug that inhibits the activity of Akt kinase is currently under development and may cause seborrheic keratoses to self-destruct.[15]


Surgical Care

A variety of techniques may be used to treat seborrheic keratoses. They include cryotherapy with carbon dioxide (dry ice) or liquid nitrogen, electrodesiccation, electrodesiccation and curettage, curettage alone, shave biopsy or excision using a scalpel, or a laser or dermabrasion surgery. Some of these techniques destroy the lesion without providing a specimen for histopathologic diagnosis.

The shave biopsy provides histologic material for accurate diagnosis and removes the lesion in a cosmetically acceptable manner at the same time. After a shave biopsy is obtained, a curette can be employed to smooth and remove any remaining keratotic material. Generally, this is the author's preferred method of removal.

If a biopsy is not desired, light electrodesiccation facilitates a sharp curettage.

Freezing seborrheic keratoses with dry ice or liquid nitrogen avoids the need for surgical excision; however, complications of freezing include pigmentary changes and on occasion, scarring.

Curettage in conjunction with liquid nitrogen generally gives better results than liquid nitrogen alone.

Application of 70% glycolic acid for 3-5 minutes prior to curetting also is effective.



No consultations are needed, unless the sudden appearance of multiple pruritic seborrheic keratoses occurs (known as the Leser-Trélat sign).



No activity restrictions are recommended.


Long-Term Monitoring

Follow-up for patients with multiple seborrheic keratoses is important because malignant tumors can develop elsewhere on the body (or rarely within a seborrheic keratosis). New seborrheic keratoses develop as people age. Patients who see a doctor and who are assured that these lesions are benign may not pay attention to newly appearing lesions that continue to develop over time. One of the newly appearing lesions may not be a seborrheic keratosis but, in fact, a malignant tumor.

Contributor Information and Disclosures

Arthur K Balin, MD, PhD, FACP Medical Director, The Sally Balin Medical Center

Arthur K Balin, MD, PhD, FACP is a member of the following medical societies: American Academy of Dermatology, American Chemical Society, American College of Mohs Surgery, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Geriatrics Society, American Medical Association, American Society for Nutrition, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Dermatopathology, College of American Pathologists, Gerontological Society of America, International Academy of Pathology, International Society for Dermatologic Surgery, Pennsylvania Medical Society, Phi Beta Kappa, Royal Society of Medicine, Sigma Xi, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


With appreciation for the assistance of Michael Vilenchik, MD, PhD and Loretta Pratt, MD.

  1. Nakamura H, Hirota S, Adachi S, Ozaki K, Asada H, Kitamura Y. Clonal nature of seborrheic keratosis demonstrated by using the polymorphism of the human androgen receptor locus as a marker. J Invest Dermatol. 2001 Apr. 116 (4):506-10. [Medline].

  2. Ginarte M, Garcia-Caballero T, Fernandez-Redondo V, Beiras A, Toribio J. Expression of growth hormone receptor in benign and malignant cutaneous proliferative entities. J Cutan Pathol. 2000 Jul. 27(6):276-82. [Medline].

  3. Groves RW, Allen MH, MacDonald DM. Abnormal expression of epidermal growth factor receptor in cutaneous epithelial tumours. J Cutan Pathol. 1992 Feb. 19(1):66-72. [Medline].

  4. Nanney LB, Ellis DL, Levine J, King LE. Epidermal growth factor receptors in idiopathic and virally induced skin diseases. Am J Pathol. 1992 Apr. 140(4):915-25. [Medline].

  5. Nakagawa K, Yamamura K, Maeda S, Ichihashi M. bcl-2 expression in epidermal keratinocytic diseases. Cancer. 1994 Sep 15. 74(6):1720-4. [Medline].

  6. Tojo M, Mori T, Kiyosawa H, Honma Y, Tanno Y, Kanazawa KY, et al. Expression of sonic hedgehog signal transducers, patched and smoothened, in human basal cell carcinoma. Pathol Int. 1999 Aug. 49(8):687-94. [Medline].

  7. Hafner C, Hartmann A, Vogt T. FGFR3 mutations in epidermal nevi and seborrheic keratoses: lessons from urothelium and skin. J Invest Dermatol. 2007 Jul. 127(7):1572-3. [Medline].

  8. Hafner C, van Oers JM, Hartmann A, Landthaler M, Stoehr R, Blaszyk H, et al. High frequency of FGFR3 mutations in adenoid seborrheic keratoses. J Invest Dermatol. 2006 Nov. 126(11):2404-7. [Medline].

  9. Hafner C, Hartmann A, Real FX, Hofstaedter F, Landthaler M, Vogt T. Spectrum of FGFR3 mutations in multiple intraindividual seborrheic keratoses. J Invest Dermatol. 2007 Aug. 127(8):1883-5. [Medline].

  10. Hafner C, Toll A, Fernández-Casado A, Earl J, Marqués M, Acquadro F, et al. Multiple oncogenic mutations and clonal relationship in spatially distinct benign human epidermal tumors. Proc Natl Acad Sci U S A. 2010 Nov 30. 107 (48):20780-5. [Medline].

  11. Hafner C, Landthaler M, Mentzel T, Vogt T. FGFR3 and PIK3CA mutations in stucco keratosis and dermatosis papulosa nigra. Br J Dermatol. 2010 Mar. 162 (3):508-12. [Medline].

  12. Hafner C, Hartmann A, van Oers JM, Stoehr R, Zwarthoff EC, Hofstaedter F, et al. FGFR3 mutations in seborrheic keratoses are already present in flat lesions and associated with age and localization. Mod Pathol. 2007 Aug. 20 (8):895-903. [Medline].

  13. Simionescu O, Popescu BO, Costache M, Manole E, Spulber S, Gherghiceanu M, et al. Apoptosis in seborrheic keratoses: an open door to a new dermoscopic score. J Cell Mol Med. 2012 Jun. 16 (6):1223-31. [Medline].

  14. Manning BD, Cantley LC. AKT/PKB signaling: navigating downstream. Cell. 2007 Jun 29. 129 (7):1261-74. [Medline].

  15. Neel VA, Todorova K, Wang J, Kwon E, Kang M, Liu Q, et al. Sustained Akt Activity Is Required to Maintain Cell Viability in Seborrheic Keratosis, a Benign Epithelial Tumor. J Invest Dermatol. 2016 Mar. 136 (3):696-705. [Medline].

  16. Teraki E, Tajima S, Manaka I, Kawashima M, Miyagishi M, Imokawa G. Role of endothelin-1 in hyperpigmentation in seborrhoeic keratosis. Br J Dermatol. 1996 Dec. 135(6):918-23. [Medline].

  17. Tindall JP, Smith JG Jr. Skin lesions of the aged and their association with internal changes. JAMA. 1963 Dec 21. 186:1039-42. [Medline].

  18. Memon AA, Tomenson JA, Bothwell J, Friedmann PS. Prevalence of solar damage and actinic keratosis in a Merseyside population. Br J Dermatol. 2000 Jun. 142(6):1154-9. [Medline].

  19. Zhang RZ, Zhu WY. Seborrheic keratoses in five elderly patients: an appearance of raindrops and streams. Indian J Dermatol. 2011 Jul. 56(4):432-4. [Medline]. [Full Text].

  20. Rajesh G, Thappa DM, Jaisankar TJ, Chandrashekar L. Spectrum of seborrheic keratoses in south Indians: a clinical and dermoscopic study. Indian J Dermatol Venereol Leprol. 2011 Jul-Aug. 77(4):483-8. [Medline].

  21. Williams MG. Acanthomata appearing after eczema. Br J Dermatol. 1956 Jul-Aug. 68(7):268-71. [Medline].

  22. Yeatman JM, Kilkenny M, Marks R. The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency?. Br J Dermatol. 1997 Sep. 137(3):411-4. [Medline].

  23. Kwon OS, Hwang EJ, Bae JH, Park HE, Lee JC, Youn JI, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed. 2003 Apr. 19(2):73-80. [Medline].

  24. Gupta AK, Siegel MT, Noble SC, Kirkby S, Rasmussen JE. Keratoses in patients with psoriasis: a prospective study in fifty-two inpatients. J Am Acad Dermatol. 1990 Jul. 23(1):52-5. [Medline].

  25. Jacyk WK, Simson IW. Pemphigus erythematosus resembling multiple seborrheic keratoses. Arch Dermatol. 1990 Apr. 126(4):543-4. [Medline].

  26. Beckmann KR, Kirke BA, McCaul KA, Roder DM. Use of fake tanning lotions in the South Australian population. Med J Aust. 2001 Jan 15. 174(2):75-8. [Medline].

  27. Sperry K, Wall J. Adenocarcinoma of the stomach with eruptive seborrheic keratoses: the sign of Leserp-Trelat. Cancer. 1980 May 1. 45(9):2434-7. [Medline].

  28. Zhu WY, Leonardi C, Kinsey W, Penneys NS. Irritated seborrheic keratoses and benign verrucous acanthomas do not contain papillomavirus DNA. J Cutan Pathol. 1991 Dec. 18(6):449-52. [Medline].

  29. Li J, Ackerman AB. "Seborrheic keratoses" that contain human papillomavirus are condylomata acuminata. Am J Dermatopathol. 1994 Aug. 16(4):398-405; discussion 406-8. [Medline].

  30. Lee ES, Whang MR, Kang WH. Absence of human papillomavirus DNA in nongenital seborrheic keratosis. J Korean Med Sci. 2001 Oct. 16(5):619-22. [Medline].

  31. Liu HN, Chang YT, Chen CC. Differentiation of hidroacanthoma simplex from clonal seborrheic keratosis--an immunohistochemical study. Am J Dermatopathol. 2004 Jun. 26(3):188-93. [Medline].

  32. Klaus MV, Wehr RF, Rogers RS 3rd, Russell TJ, Krochmal L. Evaluation of ammonium lactate in the treatment of seborrheic keratoses. J Am Acad Dermatol. 1990 Feb. 22(2 Pt 1):199-203. [Medline].

  33. Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures for use in clinical practice. Cutis. 1989 Mar. 43(3):222-8. [Medline].

  34. Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol. 2004 Apr. 43(4):300-2. [Medline].

Sharply circumscribed elevated seborrheic keratoses.
Closer view of multiple seborrheic keratoses in an autosomally dominant mode of inheritance.
Seborrheic keratoses projecting above the level of the epidermis. Cysts represent sections of hyperkeratotic follicles.
Seborrheic keratosis showing lackluster surface and appearance of being stuck on the skin surface.
This is an autosomal dominant form of multiple seborrheic keratoses. This man's daughter is developing a similar distribution and quantity of seborrheic keratoses.
The back of this same patient as in the image above with multiple seborrheic keratoses. His face had a similar number of seborrheic keratoses.
Acanthotic type of seborrheic keratosis.
Higher-power view of the cells in an acanthotic seborrheic keratosis.
Hyperkeratotic type of seborrheic keratosis.
Reticulated (or adenoid) type of seborrheic keratosis.
This is a reticulated (or adenoid) seborrheic keratosis with abundant pigment.
Seborrheic keratosis with inflammation in the dermis.
This seborrheic keratosis was a pedunculated lesion in an axillary fold. Clinically, it had some resemblance to a skin tag.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.