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]
In 2017, the US Food and Drug Administration (FDA) approved a concentrated hydrogen peroxide 40% solution (Eskata) for adults with raised seborrheic keratosis. The solution is available within an applicator pen and is administered in a medical office setting by a healthcare professional. [35]
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.
Consultations
No consultations are needed, unless the sudden appearance of multiple pruritic seborrheic keratoses occurs (known as the Leser-Trélat sign).
Activity
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.
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Sharply circumscribed elevated seborrheic keratoses.
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Closer view of multiple seborrheic keratoses in an autosomally dominant mode of inheritance.
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Seborrheic keratoses projecting above the level of the epidermis. Cysts represent sections of hyperkeratotic follicles.
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Seborrheic keratosis showing lackluster surface and appearance of being stuck on the skin surface.
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This is an autosomal dominant form of multiple seborrheic keratoses. This man's daughter is developing a similar distribution and quantity of seborrheic keratoses.
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The back of this same patient as in the image above with multiple seborrheic keratoses. His face had a similar number of seborrheic keratoses.
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Acanthotic type of seborrheic keratosis.
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Higher-power view of the cells in an acanthotic seborrheic keratosis.
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Hyperkeratotic type of seborrheic keratosis.
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Reticulated (or adenoid) type of seborrheic keratosis.
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This is a reticulated (or adenoid) seborrheic keratosis with abundant pigment.
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Seborrheic keratosis with inflammation in the dermis.
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This seborrheic keratosis was a pedunculated lesion in an axillary fold. Clinically, it had some resemblance to a skin tag.
