Seborrheic Keratosis Treatment & Management

  • Author: Arthur K Balin, MD, PhD, FACP; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 12, 2012
 

Medical Care

Ammonium lactate and alpha hydroxy acids have been reported to reduce the height of seborrheic keratoses.[25, 26] 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.[27]

Next

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.
Previous
Next

Consultations

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

Previous
Next

Activity

No activity restrictions are recommended.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Arthur K Balin, MD, PhD, FACP  Clinical Professor, Lankanau Medical Research Center, Jefferson Health System

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 Micrographic Surgery and Cutaneous Oncology, 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 Clinical 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, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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

References

  1. 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. Jul 2000;27(6):276-82. [Medline].

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

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

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

  5. 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. Aug 1999;49(8):687-94. [Medline].

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

  7. 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. Nov 2006;126(11):2404-7. [Medline].

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

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

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

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

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

  13. 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. Jul-Aug 2011;77(4):483-8. [Medline].

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

  15. 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. Sep 1997;137(3):411-4. [Medline].

  16. 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. Jul 1990;23(1):52-5. [Medline].

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

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

  19. 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. Apr 2003;19(2):73-80. [Medline].

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

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

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

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

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

  25. 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. Feb 1990;22(2 Pt 1):199-203. [Medline].

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

  27. 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. Apr 2004;43(4):300-2. [Medline].

  28. Braun-Falco O, Weissmann I. [Stuccokeratoses. Review and own observations]. Hautarzt. Nov 1978;29(11):573-7. [Medline].

  29. Cascajo CD, Reichel M, Sanchez JL. Malignant neoplasms associated with seborrheic keratoses. An analysis of 54 cases. Am J Dermatopathol. Jun 1996;18(3):278-82. [Medline].

  30. Di Benedetto G, Pierangeli M, Bertani A. A peculiar case of multiple gigantic seborrheic keratoses. Plast Reconstr Surg. Apr 1997;99(5):1466-7. [Medline].

  31. Eads TJ, Hood AF, Chuang TY, Faust HB, Farmer ER. The diagnostic yield of histologic examination of seborrheic keratoses. Arch Dermatol. Nov 1997;133(11):1417-20. [Medline].

  32. Gill D, Dorevitch A, Marks R. The prevalence of seborrheic keratoses in people aged 15 to 30 years: is the term senile keratosis redundant?. Arch Dermatol. Jun 2000;136(6):759-62. [Medline].

  33. Graham-Brown RA, Berth-Jones J, Dure-Smith B, Naafs B, Pembroke AC, Harth W, et al. Dermatologic problems for immigrant communities in a Western environment. Int J Dermatol. Mar 1990;29(2):94-101. [Medline].

  34. Hairston MA Jr, Reed RJ, Derbes VJ. Dermatosis papulosa nigra. Arch Dermatol. May 1964;89:655-8. [Medline].

  35. Holdiness MR. The sign of Leser-Trelat. Int J Dermatol. Nov 1986;25(9):564-72. [Medline].

  36. Izikson L, Sober AJ, Mihm MC Jr, Zembowicz A. Prevalence of melanoma clinically resembling seborrheic keratosis: analysis of 9204 cases. Arch Dermatol. Dec 2002;138(12):1562-6. [Medline].

  37. Maize JC, Snider RL. Nonmelanoma skin cancers in association with seborrheic keratoses. Clinicopathologic correlations. Dermatol Surg. Nov 1995;21(11):960-2. [Medline].

  38. Mehregan AH. Lentigo senilis and its evolutions. J Invest Dermatol. Nov 1975;65(5):429-33. [Medline].

  39. Mishima Y, Pinkus H. Benign mixed tumor of melanocytes and malpighian cells. Melanoacanthoma: Its relationship to Bloch's benign non-nevoid melanoepithelioma. Arch Dermatol. Apr 1960;81:539-50. [Medline].

  40. 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. Apr 2001;116(4):506-10. [Medline].

  41. Nindl M, Nakagawa H, Furue M, Ishibashi Y. Simple epithelial cytokeratin-expression in seborrheic keratosis. J Cutan Pathol. Oct 1992;19(5):415-22. [Medline].

  42. Pesce C, Scalora S. Apoptosis in the areas of squamous differentiation of irritated seborrheic keratosis. J Cutan Pathol. Mar 2000;27(3):121-3. [Medline].

  43. Provost N, Kopf AW, Rabinovitz HS, Oliviero MC, Toussaint S, Kamino HH. Globulelike dermoscopic structures in pigmented seborrheic keratosis. Arch Dermatol. Apr 1997;133(4):540-1. [Medline].

  44. Reiches AJ. Seborrheic keratoses; are they delayed hereditary nevi?. AMA Arch Derm Syphilol. May 1952;65(5):596-600. [Medline].

  45. Roncalli de Oliveira W, Neto CF, Rady PL, Tyring SK. Seborrheic Keratosis-like lesions in patients with epidermodysplasia verruciformis. J Dermatol. Jan 2003;30(1):48-53. [Medline].

  46. Shimizu N, Ito M, Tazawa T, Sato Y. Immunohistochemical study on keratin expression in certain cutaneous epithelial neoplasms. Basal cell carcinoma, pilomatricoma, and seborrheic keratosis. Am J Dermatopathol. Dec 1989;11(6):534-40. [Medline].

  47. Soini Y, Kamel D, Pääkkö P, Lehto VP, Oikarinen A, Vähäkangas KV. Aberrant accumulation of p53 associates with Ki67 and mitotic count in benign skin lesions. Br J Dermatol. Oct 1994;131(4):514-20. [Medline].

  48. Tsuji T, Kitajima S, Koashi Y. Expression of proliferating cell nuclear antigen (PCNA) and apoptosis related antigen (LeY) in epithelial skin tumors. Am J Dermatopathol. Apr 1998;20(2):164-9. [Medline].

  49. Unal G. Giant seborrheic keratoses. JEADV VII. Sup 2:s177.

  50. Verhagen AR, Koten JW, Chaddah VK, Patel RI. Skin diseases in Kenya. A clinical and histopathological study of 3,168 patients. Arch Dermatol. Dec 1968;98(6):577-86. [Medline].

  51. Wrone DA, Yoo S, Chipps LK, Moy RL. The expression of p63 in actinic keratoses, seborrheic keratosis, and cutaneous squamous cell carcinomas. Dermatol Surg. Oct 2004;30(10):1299-302. [Medline].

  52. Yamamoto T, Yokoyama A. Hereditary onset of multiple seborrheic keratoses: a variant of Leser Trelat sign?. J Dermatol. Mar 1996;23(3):191-5. [Medline].

  53. Young AW Jr. Dermatogeriatric problems in the chronic disease hospital. N Y State J Med. Jul 1 1965;65:1748-52. [Medline].

 
Previous
Next
 
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 © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.