Seborrheic Keratosis Treatment & Management

Updated: Sep 12, 2017
  • Author: Arthur K Balin, MD, PhD, FACP; Chief Editor: William D James, MD  more...
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Treatment

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]

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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.

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Consultations

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

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Activity

No activity restrictions are recommended.

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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.

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