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Seborrheic Keratosis

• A 66-year-old man comes to his primary care physician concerned about melanoma. He notes that over the past several years, several greasy moles have cropped up on his back. His cousin had died of melanoma and he is scared that these moles are melanomas. On exam, the moles appeared flat, greasy, and dark with a “stuck on” appearance. He is reassured that these are not melanomas and do not have malignancy potential.
• Common, benign persistent epidermal proliferations with variable appearances
• Can mimic malignancies, especially melanoma
• can be inherited
• Leser-Trélat sign : sudden appearance of multiple seborrheic keratoses may indicate underlying malignancy
• NOT related to actinic keratosis or seborrheic dermatitis (despite the similarity in name)
• Rare before 30-years-old
• One of the most common benign growths
• asymptomatic
• patients can often scratch off a lesion
• usually multiple lesions
• common on trunk, face, extremities
• flat or raised
• smooth, velvety, or verrucous
• color ranges from white, pink, brown, or black
• even within a single lesion, color may vary
• “stuck on” waxy, greasy appearance
• inflammed seborrheic keratoses may have edema, erythema, hemorrhage
• skin biopsy
• can be mistaken for melanoma
• Leser–Trélat sign (sudden onset of multiple seborrheic keratosis) could suggesting underlying malignancy
• for flat lesions, liquid nitrogen ( cryotherapy )
• for raised lesions, curettage
• persistent, grows slowly
• no risk for progression to malignancies
• Dermatology
• - Seborrheic Keratosis

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Seborrheic keratosis

On this page, when to see a doctor, risk factors.

A seborrheic keratosis (seb-o-REE-ik ker-uh-TOE-sis) is a common noncancerous (benign) skin growth. People tend to get more of them as they get older.

Seborrheic keratoses are usually brown, black or light tan. The growths (lesions) look waxy or scaly and slightly raised. They appear gradually, usually on the face, neck, chest or back.

• Seborrheic keratoses on the back

Seborrheic keratoses are very common on the back. They appear as waxy light tan, brown or black growths that look as if they were dripped onto the skin by a candle. Some can grow large, more than 1 inch (2.5 centimeters) across.

Seborrheic keratoses are harmless and not contagious. They don't need treatment, but you may decide to have them removed if they become irritated by clothing or you don't like how they look.

• Close-up of seborrheic keratoses

Seborrheic keratoses are usually round or oval and range in color from light tan to black. They can develop as a single growth or in clusters.

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A seborrheic keratosis grows gradually. Signs and symptoms might include:

• A round or oval-shaped waxy or rough bump, typically on the face, chest, a shoulder or the back
• A flat growth or a slightly raised bump with a scaly surface, with a characteristic "pasted on" look
• Varied size, from very small to more than 1 inch (2.5 centimeters) across
• Varied number, ranging from a single growth to multiple growths
• Very small growths clustered around the eyes or elsewhere on the face, sometimes called flesh moles or dermatosis papulosa nigra, common on Black or brown skin
• Varied in color, ranging from light tan to brown or black

See your doctor if the appearance of the growth bothers you or if it gets irritated or bleeds when your clothing rubs against it. Also see your doctor if you notice suspicious changes in your skin, such as sores or growths that grow rapidly, bleed and don't heal. These could be signs of skin cancer.

Experts don't completely understand what causes a seborrheic keratosis. This type of skin growth does tend to run in families, so there is likely an inherited tendency. If you've had one seborrheic keratosis, you're at risk of developing others.

A seborrheic keratosis isn't contagious or cancerous.

The peak time for developing seborrheic keratoses is after your 50s. You're also more likely to have them if you have a family history of the condition.

Jan 18, 2022

• Seborrheic keratoses. American Academy of Dermatology. https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-overview. Accessed July 9, 2021.
• AskMayoExpert. Seborrheic keratosis. Mayo Clinic; 2021.
• Kelly AP, et al., eds. Geriatrics. In: Taylor and Kelly's Dermatology for Skin of Color. 2nd ed. McGraw-Hill; 2016. https://accessmedicine.mhmedical.com. Accessed July 9, 2021.
• High WA, et al., eds. Special considerations in skin of color. In: Dermatology Secrets. 6th ed. Elsevier; 2021. https://clinicalkey.com. Accessed June 1, 2021.
• Goldstein BG, et al. Overview of benign lesions of the skin. https://www.uptodate.com/contents/search. Accessed July 13, 2021.
• Diseases & Conditions
• Seborrheic keratosis symptoms & causes

More Information

Associated procedures.

• Skin biopsy

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Chapter 47:  Seborrheic Keratosis

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Introduction, epidemiology, pathogenesis, physical lesions, differential diagnosis, laboratory examination, key consultative questions.

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Seborrheic keratosis (SK) are the most common benign cutaneous tumors, and in adults SK are warty, keratotic skin growth that first present after the fourth decade. The measure from a few millimeters to centimeters The color ranges from pink to tan to dark brown. Lesions can be solitary or multiple ( Fig. 47.1 ). Over time, patients develop anywhere from a few to hundreds of SKs. Many patients request removal of SKs, particularly when multiple or large, because of their unsightly appearance.

Figure 47.1

Multiple seborrheic keratoses on back of elderly male

Incidence: very common

Age: usually in fourth decade and become more numerous in middle age and beyond

Race: more common in Caucasians

Precipitating factors: family history with likely autosomal dominant inheritance

Classically, SKs are well-circumscribed epidermal growths that rise above the surface of the surrounding skin. All feature hyperkeratosis, papillomatosis, and acanthosis. The epidermis contains basaloid cells that show squamous differentiation. Squamous eddies may be present.

There are many clinical variants of SKs. They range in size from a few millimeters to a few centimeters and most commonly occur on the face, neck, and trunk. They typically first present as well-demarcated tan or light brown macules. With time, they rise to become plaques and develop a warty and stuck-on appearance. Horn cysts become apparent within the lesions. They can occur anywhere on hair-bearing skin and are not seen on the palms and soles.

Lentigines, verruca, acrochordons, condyloma acuminatum, acrokeratosis verruciformis, dermatosis papulosa nigra, Bowen’s disease, nevus, epidermal nevus, lentigo maligna, melanoma, and squamous cell carcinoma. The clinical appearance and presence of horn cysts in SKs makes the diagnosis straightforward.

None; skin biopsy if suspect malignancy.

They present in the fourth decade and persist for years. Over time, they become larger, more pigmented and feature a more verrucous appearance. They typically become more numerous with age. Infrequently, they can regress spontaneously.

Family history of skin cancer

History of bleeding

Time of onset

Was there a rapid onset of numerous SKs?

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Types of Seborrheic Keratosis Treatment

Surgical treatment for multiple lesions may be better than topicals alone

• Treatment Goals
• Topical Treatment
• Surgical Treatment
• Does It Come Back?

Seborrheic keratosis treatment is often not needed. These wartlike growths, also called skin barnacles or barnacles of aging, are harmless. Many people choose to have them removed to relieve symptoms or improve the way they look.

While these bumps are benign (noncancerous), they can itch, bleed, and may cause you to have concerns about the way you look. Treating them can make them go away, though they can recur elsewhere.

Choosing the right treatment can be a challenge. Treatments like cryotherapy and shave excision produce the best results, though they have risks of side effects. Topical treatments can help but may take time and produce fewer results.

This article describes seborrheic keratosis treatments and their success in ridding your skin of these growths.

Ian_Redding / Getty Images

Goal of Seborrheic Keratosis Treatment

The goal of seborrheic keratosis treatment is usually not related to medical treatment. The primary purpose of removing skin barnacles typically involves the following:

• Remove visible signs of the disease for cosmetic reasons.
• Reduce bothersome symptoms, especially pruritus (itching) and erythema (skin redness).
• Remove growths that are easily irritated by clothing and jewelry.
• Extract a sample for skin cancer testing.

Some growths that occur with seborrheic keratosis can look like a precancerous lesion called actinic keratosis or cancerous conditions like basal cell carcinoma and melanoma . In these cases, your dermatologist will perform a skin biopsy by shaving or scraping off skin cells from the growth. The skin cells will be analyzed under a microscope for the presence of cancer.

Since it's not known what causes seborrheic keratosis, there is no way to completely prevent the development of these growths. Research indicates they are not related to hygiene. Instead, they may be linked to factors including genetics, exposure, and changes in estrogen levels.

Seborrheic Keratosis Topical Treatment

Seborrheic keratosis topical treatments provide noninvasive options for the removal of growths caused by this condition.

These treatments yield different responses, though they typically do not achieve the results reported with cryosurgery. While studies on topical treatments are limited, research shows they may trigger minor local skin reactions like redness or swelling.

A review of the most commonly used topical therapies for seborrheic keratosis reported the following results:

A good to excellent response from the following topical treatments:

• Maxacalcitol ( vitamin D3 analogue ointment)
• Hydrogen peroxide 40%
• Tazorac ( tazarotene 0.1% cream) twice daily
• Doxium (5% potassium dobesilate)
• Voltaren (1% diclofenac sodium gel)
• URE-K 50% (urea 50% cream)
• Nitric-zinc 30%-50% solution
• Trichloroacetic acid
• Alpha hydroxy acid (AHA) products, including glycolic acid and salicylic acid peels

Poor response was reported from the application of the following topical treatments:

• Tacalcitol (vitamin D3 analog ointment)
• Tazorac ( tazarotene 0.1% cream) once daily
• Retin-A (tretinoin 0.05% cream)
• Efudex ( fluorouracil 5% cream)
• Lac-Hydrin (12% ammonium lactate cream)
• Aldara ( imiquimod )
• Picato ( ingenol mebutate 0.05% cream)

For the best results, consult your dermatologist for a diagnosis of any skin growth and advice on how to get rid of seborrheic keratosis using topical treatments.

Eskata (40% hydrogen peroxide) Discontinued

Eskata (40% hydrogen peroxide) was the first Food and Drug Administration (FDA)–approved topical treatment for seborrheic keratosis. Despite offering a promising balance between efficacy and side effects, Eskata was discontinued for distribution in the United States due to insufficient market acceptance by physicians and patients.

Seborrheic Keratosis Surgical Treatment

Seborrheic keratosis surgical treatments are safe and effective options for removing skin barnacles. Surgical treatments typically work faster than topical therapies, but they have a higher risk of side effects.

Cryotherapy

Cryotherapy is the most frequent and effective treatment for freezing seborrheic keratosis. It involves a treatment in which an extremely cold substance like liquid nitrogen or carbon dioxide is applied to the growth to freeze it off the body. The growth falls off within a few days of treatment.

While effective in removing seborrheic keratosis with little risk of scarring or recurrence, cryotherapy can include the following side effects:

• Bulla (large fluid-filled blisters) formation
• Post-procedure hyperpigmentation (dark areas of the skin) where the growth was removed

Electrodesiccation/Curettage

Electrodesiccation is a treatment in which an electrical current is applied to the growth to remove it. It may be used with or without curettage (a procedure that uses a surgical tool called a curette to scrape the remains of the growth). These procedures may also be used alone.

Electrodesiccation with or without curettage has low complication rates, though there is a low risk of side effects like erythema, scaling, and hyperpigmentation.

Shave Excision

Shave excision uses a special exfoliating blade or double-edged razor blade to remove a growth and save a sample for examination under a microscope. The process leaves the deep layers of the skin intact. Local anesthesia is used.

Shave excision can involve complications like wound infection and bleeding. Damage to other structures like nerves and vessels is rare but possible. Scarring with or without hypopigmentation (lighter skin at the treatment site) or hyperpigmentation is also possible.

Laser Therapy

Laser therapy uses light from a laser to destroy the growth and seal the wound. The two types of laser therapy can be used to treat seborrheic keratosis are:

• Ablative laser therapy: Er:YAG (erbium-doped yttrium aluminum garnet) and CO2 lasers
• Non-ablative therapy: 755-nanometer (nm) alexandrite laser

Treatment with the Er: YAG laser causes less hyperpigmentation than cryotherapy and a lower recurrence rate than shaving. It has very good cosmetic results. However, laser therapy is more expensive than other treatments.

Does Seborrheic Keratosis Come Back After Treatment?

Seborrheic keratosis is a chronic, relapsing skin condition. The prognosis for someone treated for seborrheic keratosis is very good. While most removed seborrheic keratoses do not return, new ones can develop elsewhere.

A seborrheic keratosis that recurs in the same location after treatment usually requires a skin biopsy (removing a sample of skin for analysis in a lab). This is to ensure that the original diagnosis was correct and rule out the presence of cancer.

Seborrheic Keratosis vs. Cancerous Spots

The discolored growths that occur with seborrheic keratosis can appear similar to cancerous spots from conditions like melanoma or basal cell carcinoma. A skin biopsy can help your dermatologist make a definitive diagnosis. These conditions vary in the following ways:

Seborrheic keratosis:

• Often appear as multiple growths
• Bumpy texture
• Well-defined border
• Uniform in color
• Changes slowly

Cancerous spots:

• Usually appears as one growth
• Often smooth
• Ragged or blurry border
• Asymmetrical and/or multiple colors
• Changes quickly in shape and size

Daily Skin Care With Seborrheic Keratosis

Skin affected by seborrheic keratosis is easily irritated. Irritations can cause the condition to flare. You can help reduce flares with the following daily skin-care strategies.

Cover your seborrheic keratosis growth with a bandage to prevent rubbing and bleeding if clothing irritates it.

After seborrheic keratosis removal, follow the instructions from your healthcare provider. This usually involves the following:

• Avoid hydrogen peroxide or alcohol since they can interfere with healing.
• Cover the wound with a thin layer of petroleum jelly and a nonstick bandage until it heals.

Contact your healthcare provider if you notice the following:

• A mole that bleeds
• A crusted or scaly growth on your skin
• A fast-growing mole
• A sore that does not heal
• A change in the appearance of a skin growth
• A new growth that has ragged borders and irregular color
• New itchiness in an existing mole

Home Remedies/Drug-Free Treatments

There are no proven home remedies for seborrheic keratosis removal. Products marketed for mole removal or home remedies like apple cider vinegar or tea tree oil tend to cause more irritation and can increase the risk of scarring.

Do not try to remove seborrheic keratosis at home. Doing so can be dangerous because the growth may be something more serious. It also presents a risk of infection.

Seborrheic keratosis can usually be left alone without treatment. While these benign skin growths can look like cancer, they are viewed as harmless and rarely present a health concern.

However, having them can pose problems. These growths can become itchy and bleed. They can also affect the way you look and the way you feel about yourself.

Safe and effective treatments exist, though most have a risk of side effects. Scarring, discoloration, and redness at the treated site can occur. Even when a cure succeeds, there is always a risk that another growth will occur elsewhere from this chronic problem.

If removing these growths is right for you, consult your dermatologist for advice on choosing the treatment that is best.

American Academy of Dermatology Association. Seborrheic keratoses: overview .

Practical Dermatology. New options for the treatment of extensive seborrheic keratosis .

American Association of Dermatology Association. Seborrheic keratoses: diagnosis and treatment .

Yale Medicine. Seborrheic keratosis .

Natarelli N, Krenitsky A, Hennessy K, Moore S, Grichnik J. Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review .  Journal of Dermatological Treatment . 2023;34(1):2133532. doi:10.1080/09546634.2022.2133532

Sun MD, Halpern AC. Advances in the etiology, detection, and clinical management of seborrheic keratoses .  Dermatology . 2021;238(2):205-217. doi:10.1159/000517070

GlobelNewswire. Aclaris therapeutics reports second quarter 2019 financial results, provides business strategy update and provides update on clinical and commercial developments .

American Academy of Ophthalmology. Seborrheic keratosis .

Gorai S, Ahmad S, Raza SSM, et al. Update of pathophysiology and treatment options of seborrheic keratosis .  Dermatologic Therapy . 2022;35(12). doi:10.1111/dth.15934

Abhishek K, Khunger N. Complications of skin biopsy .  J Cutan Aesthet Surg . 2015;8(4):239-241. doi:10.4103/0974-2077.172206

Bringham and Women's Hospital. Seborrheic keratosis .

Diep D, Calame A, Cohen PR. Morphologic mimickers of seborrheic keratoses: cutaneous lesions masquerading as seborrheic keratoses .  Cureus . 13(10):e18559. doi:10.7759/cureus.18559

City of Hope. Skin cancer symptoms .

Kaiser Permanente. Seborrheic keratosis: care instructions .

American Association of Dermatology Association. Seborrheic keratoses: tips for managing .

By Anna Giorgi Giorgi is a freelance writer with more than 25 years of experience writing health and wellness-related content.

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• Published: 04 March 2024

Comparative study on the age-related incidence of seborrheic keratosis and verruca plana in patients with verruca plana-like lesions

• Han-Seul Kim 1 ,
• So Yeon Myeong 2 ,
• Hee Young Kang 1 &
• Jin Cheol Kim 1  

Scientific Reports volume  14 , Article number:  5223 ( 2024 ) Cite this article

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• Epidemiology
• Skin diseases
• Skin manifestations

Seborrheic keratosis (SK) is a common skin disease in the elderly. However, in cases where SK presenting as multiple skin-colored or clustered lesions can be easily misdiagnosed as verruca plana (VP), especially in the young population. This retrospective study investigated the prevalence of SK and VP in the lesions that appear clinically similar to VP according to age. We examined the pathology slides of the skin tissue and photographs of patients who were clinically suspected to have VP. A total of 503 patients were included in the study, out of which 174 patients were finally diagnosed with SK (34.6%) and 132 with VP (26.2%). The mean ages of the SK- and VP-diagnosed group were 39.3 and 35.4 years, respectively. SK had a higher prevalence among individuals older than 30 years, and relative frequency of SK should not be ignored in patients with a grouped distribution in their 20 s and 30 s. Therefore, our study suggests that multiple verrucous skin-colored to brownish plaques are also commonly diagnosed as SK in young people as well as VP, and the prevalence of SK and VP may not always depend solely on chronological aging, and the prevalence of SK among young people may be higher than commonly believed stereotypes suggest.

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Introduction.

Seborrheic keratosis (SK) is one of the most common benign skin lesions with a higher prevalence in the elderly 1 . In contrast, verruca plana (VP) is an infectious skin disease caused by human papillomavirus and more commonly observed in children and early adulthood 2 . VP presents as multiple small papules on the face and dorsum of the hands and causes major cosmetic concerns in patients 2 . In addition, VP is highly contagious and is usually transmitted through direct contact 2 , 3 ; thus, it can cause substantial psychological distress in patients, especially among those around immunosuppressed patients, pregnant women, or children in their families. Unlike typical SK that presents as slightly raised brownish plaques, some SKs share similar morphological characteristics with VP such as multiple small-sized skin-colored papules 4 , 5 , 6 . Because of such similarities between SK and VP, dermatologists often experience difficulties in clinically differentiating between the two diseases 5 , 7 , 8 , 9 . Therefore, a skin biopsy is necessary to diagnose VP and SK distinctly, and empirical treatments should be considered for SK in old age and VP in young age 7 , 9 , 10 , 11 . However, recent evidence suggests that SKs occur in young people as well 12 , 13 , 14 . Up to 24% of the general population in Australia, aged between 15 and 30 years, were reported to have SK 12 . In the UK population, 17% of women under the age of 40 years had at least one form of SK 13 . Thus, in this study, we analyzed the histology of clinically diagnosed VP-like lesions according to age in a real-world setting, assessed the prevalence of SK that clinically mimics VP in young adults between SK- and VP-diagnosed patients.

Demographics and clinicopathological characteristics of study population

Most VP-like lesions were diagnosed with SK or VP (Figs.  1 , 2 ); 174 cases were diagnosed with SK (34.6%) and 132 with VP (26.2%) (Table 1 ). Other common diagnoses were syringoma (6.2%), milium (3.4%), folliculitis (3.2%), chronic dermatitis (2.6%), and sebaceous hyperplasia (2.2%). The pathological diagnoses for all cases are shown in Supplementary Table 1 . There were 330 females (75.2%), and the mean age at the time of biopsy was 37.7 years (range 1–88 years). Most lesions were located on the face (48.5%), followed by the extremities (25.4%). The number of total lesions was generally more 5 but less than 30 (53.3%). In most cases, the lesion size was < 3 mm (61.6%). A majority of VP-like lesions (283 cases) represented skin-colored lesions (56.3%), while the remaining appeared brown (43.7%). A total of 293 patients (58.3%) showed a grouped distribution. Most patients diagnosed with SK were females (80.5%), had lesions on the face (52.9%); the lesions were > 5 (89.6%), were small than 3 mm (70.1%), brown-colored (65.5%), and were round in shape (83.9%). In contrast, 53.0% of the patients diagnosed with VP were female; among them, the lesions were usually located on the face (43.2%), followed by the extremities (39.4%). The lesions in patients diagnosed with VP were commonly larger than 3 mm, (52.3%), heterogeneous in size (57.6%), skin-colored (65.2%), round (75.8%), and grouped (68.2%). Patient sex (P < 0.001), lesion location (P < 0.001), size (P < 0.001), color (P < 0.001), and distribution (P < 0.001) were significant independent predictors for the histological diagnosis of SK. However, there were no statistically significant differences between the SK and VP groups with respect to the number of lesions and heterogeneity of lesion size, shape, or height.

Discrepancy between dermoscopic findings and histopathological results of verruca plana (VP)-like seborrheic keratosis (SK) and verruca plana. ( a , b ) Dermoscopic finding shows brain-like appearance suggesting a higher likelihood of SK. ( c ) Histopathological examination of the lesions with features highly indicative of SK ( a , b ) revealed numerous koilocytes, ultimately confirming a diagnosis of VP. ( d , e ) Dermoscopic finding shows also brain-like appearance suggesting a higher likelihood of SK. ( f ) Histopathological examination of the lesions with features highly indicative of SK ( d , e ) revealed epidermal acanthosis and horn pearls, finally confirmed with SK.

Representative clinical photographs of verruca plana (VP)-like seborrheic keratosis (SK) and verruca plana in different age groups. ( a ) Multiple skin-colored papules on the face that diagnosed as SK. ( b , c ) Skin-colored to brownish papules on face that diagnosed as SK. ( d ) Skin-colored round papules on arm that diagnosed as SK. ( e ) Multiple skin-colored papules on the face that diagnosed as VP. ( f , g ) Skin-colored to brownish papules on face that diagnosed as VP. ( h ) Brownish papules on trunk that diagnosed as VP.

Prevalence of SK and VP in VP-like lesions according to chronological age

The age distribution of cases pathologically diagnosed with SK or VP in VP-like lesions are presented in Table 1 and Fig.  3 . The mean age of patients pathologically diagnosed with SK was 39.3 years, and that of those with VP was 35.4 years. The age group with the highest prevalence of VP-like lesions was in the range of 30–39 years, and the frequency of SK in this age range was higher than that of VP (57.2% and 30.4%, respectively). Patients aged < 30 years had a higher prevalence of VP (29.4% for 0–9 years; 40.0% for 10–19 years, and 35.1% for 20–29 years), whereas SK occurred more frequently in patients aged > 30 years (40.0% for 40–49 years; 39.4% for 50–59 years, 28.6% for 60–69 years, and 42.9% for 70–79 years).

Patients aged > 30 years with highly suspicious verruca plana (VP)-like lesions are more likely to be diagnosed as having seborrheic keratosis (SK). ( a ) Comparison of frequency of SK and VP according to chronological age distribution in the study population. ( b ) Comparison of prevalence of SK and VP among all categories of VP-like lesions according to chronological age distribution.

In cases with a grouped distribution, patients aged 30–59 years were more frequently diagnosed with SK (Fig.  4 A,B, 37.5% for 30–39 years; 29.3% for 40–49 years; 32.1% for 50–59 years). Regarding skin-colored lesions, patients aged 30–39 and 70–79 years had a higher prevalence of SK (Fig.  4 C,D, 36.3% for 30–39 years; 33.3% for 70–79 years).

Subgroup analysis of age distribution and prevalence of verruca plana (VP) and seborrheic keratosis (SK) in the subgroup with grouped or erythematous to skin-colored lesion. ( a ) Age distribution of VP and SK with grouped lesions. ( b ) Prevalence of VP and SK in grouped lesions subgroup. ( c ) Age distribution of VP and SK with erythematous to skin-colored lesions. ( d ) Prevalence of VP and SK in erythematous to skin-colored lesions subgroup.

In our study, among 503 patients with VP-like lesions, 34.6% were diagnosed with SK, whereas 26.2% were diagnosed with VP, based on histopathological results. If the patient is female, or if the lesion is on the face, less than 3 mm in size, has a brownish color, and is distributed in a scattered pattern, the likelihood of diagnosis of SK increases. Among patients with SK and VP, the average ages at the time of diagnosis were 39.3 and 35.4 years, respectively. In addition, the 30–39 age group showed a higher proportion of SK-diagnosed cases than VP-diagnosed cases. Both SK-diagnosed- and VP-diagnosed cases showed a similar prevalence in the 20–29 age group. These findings suggested that clinically presented VP-like lesions were mostly SK, and the prevalence proportion of SK should not be ignored in patients in their 1920s and 1930s.

SK mainly affects the elderly according to previous literature. According to some studies that have revealed the prevalence of SK, the mean age of patients with SKs has increased over time 15 , 16 . Roh et al. 16 investigated 206 Korean patients with SK who were diagnosed with biopsy-proven SK and found that the mean age among patients was 60.9 years. However, in a previous study that investigated 170 Australian individuals aged 15–30 years, the prevalence of SK was 32.3% in the 25–30-year group 12 . They suggested that SK is also common in young people, and that the term senile keratosis, another term for SK, was no longer appropriate.

An attempt was made to clarify the mismatched clinical diagnosis that was pathologically proven as SK, and the results showed that verruca vulgaris and VP were common clinical misdiagnoses in 26 cases of biopsy-proven SK 16 . Since some non-typical SK lesions are characterized as slightly raised or flat-topped light brown to skin-colored papules, they could be clinically misdiagnosed as VP. Kwon et al. investigated 303 Korean male patients with SK and reported that SK on sunlight-exposed skin was usually smaller than that on partly exposed skin, especially in the younger age groups 17 . They also found that the mean number of SK papules was higher in the sunlight-exposed areas than in the partly exposed areas 17 . These may result in more confusion in determining the diagnosis of VP-like lesions in the young population, especially in sun-exposed areas such as the face and neck, as SK is commonly represented as a solitary and larger lesion than VP (Fig.  2 ).

Patients often experience anxiety related to the transmission or aesthetic outcomes of VP 7 , 18 , 19 . In a study on French patients that investigated the psychological consequences of warts, 47.6% of patients reported feeling moderately to extremely anxious or depressed 19 . Furthermore, although VP usually requires treatment because of high risk of transmission to others, SK does not cause medical problems other than cosmetic concerns. Therefore, differentiation between these two diseases is required to relieve the patients from unnecessary distress and for medical counseling.

Previous studies have investigated the clinical characteristics that can be helpful in differentiating these two diseases 7 , 8 , 9 . Kim et al. 8 suggested that VP showed a more grouped or clustered distribution, red dots, or globular vessels in dermoscopic findings, and even-colored light brown to yellow patches than VP-like SK. Similarly, other studies have suggested that VP-like lesions that show a grouped distribution or a skin-like to pink color are more likely to indicate VP than VP-like SK 7 . However, in our study, even after distinguishing VP-like lesions for grouped distribution or erythematous to skin-like color, we revealed that differentiating VP from SK entirely based only on clinical findings could not be possible. Despite there have been several studies on clinical and dermoscopic findings to distinguish between SK and VP 6 , 7 , 9 , clinicians often encounter cases in the real world that are difficult to diagnose with only these findings (Fig.  1 ). Therefore, dermatologists should not hesitate to perform a skin biopsy in highly-suspected cases, in order to differentiate between these two conditions.

It has been known that senescent cells in skin are increasing with aging. Kim et al. 20 showed that both fibroblasts and keratinocytes increased significantly with age. Also, there have been evidences suggesting that keratinocytes of SK lesions are in a senescent condition 21 , 22 , 23 . Thus, unexpected development of SK in young patients may be caused by accelerated cellular senescence, rather than their chronological age. Further studies are needed to identify the association with pathogenesis of SK and cellular senescence.

Our study had several limitations. The study population did not include all VP-like lesions. Also, there may is a potential risk of selection bias, as the included patients were those who underwent biopsies, possibly indicating the presence of atypical VP-like lesions. However, since we included all cases in which biopsy was performed with the clinical impression of both SK and VP, we believe that our results are still meaningful because this study enrolled all cases in which biopsy was necessary to confirm the diagnosis of VP-like lesions, owing to the difficulty in differentiating between the two diseases. In addition, the study was conducted through a retrospective review of clinical photographs and electronic medical records and included patients from a single tertiary center. Finally, due to the limitations of the retrospective study design, we were unable to investigate the patients' Fitzpatrick skin type. This limitation prevented us from accurately reflecting the patients' UV exposure or skin color.

In the present study, we observed that lesions clinically diagnosed as VP in young adults were also commonly diagnosed as SK. Despite the common conception that SK is diagnosed mostly in the elderly, we suggest that SK can occur in individuals of all age groups. As patients could suffer from unnecessary anxiety assuming the spread of the virus, we think our observations will be helpful in reassuring young patients with lesions that may be confused with VP, such as multiple, grouped, or skin-colored lesions.

Materials and methods

Data sources and study population.

We retrospectively reviewed patients with VP-like lesions that were clinically diagnosed by a dermatologist and who underwent skin biopsy at Ajou University Hospital between January 2015 and May 2022. VP-like lesions were defined as “1–4 mm, slightly elevated, and flat-topped papules that have minimal scale” 2 . Tissue samples were histologically confirmed by a dermatopathologist, and clinical photographs of 503 patients were included. The medical records were examined for age and sex. The morphology and location of the lesions were assessed using clinical photographs. We classified the locations of these lesions as the face, neck, trunk, and extremities. The distribution of lesions was classified as grouped (> 5 lesions within 3.0 cm in diameter around the lesion) or scattered (only one lesion within 1 cm in diameter around the lesion or not meeting the criteria for grouped lesion) according to the dominant arrangement of lesions 9 . The lesions were also labelled as brown (including yellow) or skin colored (including pink). The number of lesions was categorized based on a value of 30, following findings from a previous study 7 . Similarly, the size of lesions was categorized using a threshold of 3 mm 7 . Heterogeneity of size was defined when less than 80 & of the lesion had equal size 8 . Among patients with VP-like lesions, we analyzed cases that were pathologically confirmed as SK or VP according to age. We also examined the prevalence of VP among those with a grouped distribution or erythematous to skin color, which are characteristics that suggest VP, as per previous studies 7 , 9 .

Statistical analysis

Descriptive analyses, such as the chi-square test for categorical data, were performed to evaluate statistical significance. Results were considered statistically significant when the two-tailed p-value was less than 0.05. Statistical analyses were performed using SPSS Statistics 20.0. for Windows (IBM Corp. Armonk, NY).

Ethical statement

The study design was reviewed and approved by the Institutional Review Board of the Ajou University Hospital (AJOUIRB-DB-2022-494). All experiments were performed in accordance with the relevant guidelines and regulations. Requirement for informed consent was waived by ethics committee of the Ajou University Hospital due to the retrospective nature of the study.

Data availability

The data that support the findings of this study are available on request from the corresponding author, JCK. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Kim, HS., Myeong, S.Y., Kang, H.Y. et al. Comparative study on the age-related incidence of seborrheic keratosis and verruca plana in patients with verruca plana-like lesions. Sci Rep 14 , 5223 (2024). https://doi.org/10.1038/s41598-024-55617-1

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Seborrheic Keratoses: The Rodney Dangerfield of Skin lesions, and Why They Should Get Our Respect

Jack l. arbiser.

1 Department of Dermatology, Emory School of Medicine, and Winship Cancer Institute, Atlanta, Georgia, USA

2 Dermatology Veterans Affairs Medical Center, Decatur, Georgia, USA

Michael Y. Bonner

Neel et al. have demonstrated that seborrheic keratosis, the most common of all skin tumors, is dependent on acutely transforming retrovirus AKT8 in rodent T-cell lymphoma signaling. The authors found that these lesions are hypersensitive to Akt inhibitors which bind to the ATP binding site of Akt. Cutaneous squamous cell carcinoma is resistant to Akt inhibitors. The implications of this study are not limited to seborrheic keratosis. The presence of wild type p53 (seborrheic keratosis) or mutant p53 (cutaneous squamous cell carcinoma) appears to dictate whether a lesion is sensitive to Akt inhibition or not.

Seborrheic keratoses are the “Rodney Dangerfield” of skin lesions. They are common manifestations of aging, warty in appearance, and they have virtually no malignant potential. For the practicing dermatologist, they are a nuisance, treated usually with cryotherapy on request of patients for aesthetic reasons, and they are of concern only because they can mimic melanoma in clinical appearance. They receive little respect from both patients and physicians.

Why should we respect seborrheic keratosis? First, they are the most common benign tumors in humans. Second, they contain mutations in oncogenes that are present in aggressive malignancies such as ovarian carcinoma and multiple myeloma ( Chesi et al., 1997 ; Shayesteh et al., 1999 ); yet, seborrheic keratoses rarely progress to malignancy. This raises two additional questions. First, what is the mutational stimulus that gives rise to these oncogenic mutations, as seborrheic keratoses.

The article “Akt activation is required to maintain cell viability in seborrheic keratosis, a benign epithelial tumor” by Neel et al. (2016) sheds light on the second question. We have demonstrated previously that tyrosine kinase profiling can be performed on benign tumors by establishing cell lines and examining their sensitivity to small molecule tyrosine kinase inhibitors ( Arbiser et al., 2002 ). Neel et al. (2016) have extended this work by demonstrating the efficacy of tyrosine kinase inhibitors on seborrheic keratoses after exposing the cells directly to the compounds, without establishing cell lines. Surprisingly, they found hypersensitivity to ATP competitive Akt inhibitors, whereas other inhibitors, including allosteric Akt inhibitors, had little or no effect ( Neel et al., 2016 ). The hypersensitivity to Akt inhibition appeared specific to seborrheic keratosis and not to squamous cell carcinoma or other keratinocytes. Second, they demonstrated a novel biomarker of the oncogenically activated but benign phenotype, FoxN1. Third, they established that Akt inhibition caused an increase in p53 protein expression, but not RNA expression, and that Akt-mediated apoptosis was dependent on p53 and FoxO3, a target of Akt.

What are the implications of this study for dermatology and oncology? First, the authors have demonstrated that a benign neoplasm, seborrheic keratosis, is dependent on Akt activation, regardless of mutational status. This argues for targeting a relevant signaling pathway rather than designing inhibitors to target specific mutations. Indeed, targeting mutant FGFR3 or PI3KA, so-called personalized medicine, had little effect on this system. Second, targeting Akt had little effect on squamous cell carcinoma, thus suggesting that direct Akt inhibitors might not be effective against squamous cell carcinoma. Third, in contrast to most cutaneous squamous cell carcinomas, mutations in p53 have not been observed in seborrheic keratosis ( Mandinova et al., 2009 ) ( Figure 1 ). The inhibition of Akt might lead to an increase in reactive oxygen specifically in seborrheic keratosis, which has wild-type p53, leading to superinduction of p53, and apoptosis. Of interest, in other studies, the combination of FGFR3 mutation and mutant p53 led to large mutant clones on sun-exposed blepharoplasty specimens that did not histologically resemble seborrheic keratosis, further supporting the hypothesis that p53 mutations may dictate the path of neoplasia, even with common driver mutations ( Martincorena et al., 2015 ). This phenomenon has been observed in the reactive oxygen-driven tumor, which uses low level reactive oxygen to inactivate wild-type p53 protein and activate Akt, but these tumors can be overwhelmed with reactive oxygen, leading to apoptosis ( Bonner and Arbiser, 2012 ).

The presence of p53 mutations may dictate downstream pathways in common skin tumors. Ceramide dysfunction is proposed as a common initiating event.

What are the therapeutic implications of these findings? First, Akt inhibitors might be especially effective for malignancies that have mutations in FGFR3 and PI3KA. It would be of interest to determine whether Akt inhibition induces reactive oxygen, and if this is the case, one would not want to use antioxidants with these therapeutic compounds. Second, the finding that Akt inhibition does not kill squamous cell carcinomas should be examined in other cells, such as in actinic keratoses. It may be that either Akt is not involved in cells with mutant p53, consistent with the phenotype of the reactive oxygen-driven tumor, or squamous cell carcinoma cells may be inherently more resistant. Finally, there is a potential role of ceramides in both seborrheic keratoses and sun-induced squamous cell carcinomas, and the mutational status of p53 in these different tumors may play roles in their distinct pathogenesis.

Ceramides are endogenous lipids that can induce reactive oxygen, and we have shown that nonhydrolyzable analogs of ceramide can inhibit Akt and induce reactive oxygen ( Karlsson et al., 2015 ). It may be that loss of ceramides could underlie both seborrheic keratosis, by allowing Akt activation, and actinic keratosis, by reducing endogenous levels of reactive oxygen and permitting growth of cells with mutant p53. Thus, seborrheic keratoses should no longer be regarded as the Rodney Dangerfield of cutaneous neoplasia, but a source of vital information on mechanisms and therapeutics.

Acknowledgments

JLA was supported by the grant RO1 AR47901 and P30 AR42687 Emory Skin Disease Research Core Center Grant from the National Institutes of Health, a Veterans Administration Hospital Merit Award, as well as funds from the Margolis Foundation, David Roberts, MD, Rabinowitch-Davis Foundation for Melanoma Research, and the Betty Minsk Foundation for Melanoma Research.

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Seborrheic keratosis of the vulva clinically mimicking a genital wart: a case study

• PMID: 22171841
• DOI: 10.1111/j.1365-4632.2011.05115.x

Publication types

• Case Reports
• Condylomata Acuminata / diagnosis*
• Diagnosis, Differential
• Keratosis, Seborrheic / diagnosis*
• Middle Aged
• Vulva / pathology
• Vulvar Diseases / diagnosis*

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Latest Research, Studies, and Medical Advancements in Treating Keratosis

April 26, 2024

Knowledge Base

Keratosis is a medical condition marked by the growth of keratin on the skin or on mucous membranes. Among its different types, actinic keratosis (AK) and seborrheic keratosis (SK) are common manifestations often dealt with by dermatologists.

With actinic keratosis serving as a potential precursor to skin cancer, dermatology has shifted its focus toward not just removing these lesions but preventing malignancies. On the other hand, while seborrheic keratosis is generally benign, it can be a cosmetic concern or occasionally indicative of underlying conditions.

Medical research continues to evolve the landscape of keratosis treatment .

A randomized trial compared different therapeutic approaches to manage actinic keratosis, offering insights into efficacy after a 12-month period.

Another aspect of innovation is in the integration of laser technology in treatment. Systematic reviews have explored laser-assisted photodynamic therapy as a viable option.

For seborrheic keratosis, minor surgical procedures like cryosurgery and laser removal have been the norm. However, the pursuit of medical approaches continues, bringing forth the need to assess their effectiveness regularly.

Guidelines for the management of keratosis have also seen updates, factoring in the latest research and the development of new drugs. Such guidelines help shape the standard of care, ensuring that both physicians and patients have access to information on the most current, proven treatment methods.

Understanding Keratosis

Keratosis encompasses a variety of skin conditions characterized by an abnormal growth of keratin on the skin.

Types of Keratosis

Seborrheic Keratosis: These are noncancerous skin growths that typically appear as brown, black, or light tan spots. They’re often found on the face, chest, shoulders, or back. Adults are more commonly affected, with UV exposure contributing to their development. They have a distinctive “stuck-on” appearance and are more prevalent in individuals with lighter skin, although a variant called dermatosis papulosa nigra is common in those with darker skin.

Actinic Keratosis: Known as a precursor to skin cancer, actinic keratosis is caused by prolonged sun exposure. These lesions are scaly and rough and typically found on sun-exposed areas of the skin. They are common among fair-skinned individuals over the age of 50.

Symptoms and Diagnosis

Symptoms include rough, scaly patches or waxy growths that may appear suddenly or develop over time. Diagnosis is typically done through a clinical evaluation, looking at the growth’s texture, color, and overall appearance.

A biopsy may be performed to rule out skin cancer, especially in the case of actinic keratosis , due to its potential to evolve into squamous cell carcinoma. Regular skin checks are important for managing and identifying keratosis early on.

Latest Treatment Techniques

The battle against keratosis has seen significant strides with new therapies enhancing patient care.

Topical Treatments

Recent medical advancements have led to the development of more effective topical treatments for keratosis. One breakthrough has been the optimal formulations of 5-fluorouracil, which is a chemotherapy drug that targets abnormal skin cells.

Studies show that when applied as a cream, it can be beneficial in treating actinic keratosis, with a substantial clearance rate of precancerous lesions. More information on current treatment statuses can be found here .

Cryotherapy

Cryotherapy remains a common and quick method to deal with troublesome keratotic growths. The application of extreme cold using liquid nitrogen can effectuate the destruction of keratotic lesions. This technique is highly advantageous for individual or isolated actinic keratosis, demonstrating high effectiveness with minimal treatment sessions.

Laser Therapy

In the realm of laser therapy, technologies have evolved to offer more controlled and precise treatments for keratotic lesions.

Erbium-doped and carbon dioxide (CO2) lasers provide an innovative solution that vaporizes the keratosis with minimal damage to surrounding tissues. This approach is typically reserved for thicker lesions or those not responding to other treatments. More insights into the management of actinic keratosis using laser therapy are discussed here .

Research in Pharmacotherapy

Pharmacotherapy for keratosis involves targeted treatments to manage the condition’s symptoms and progression. This section explores the effectiveness and advancements of various pharmacological agents.

Retinoids are potent derivatives of Vitamin A. They promote skin cell turnover, which can help in reducing the appearance of keratosis lesions.

Topical retinoids like tretinoin have been widely used, offering improvements in skin texture and pigmentation.

Immunomodulators

Immunomodulators function by modulating the skin’s immune response.

Agents such as imiquimod boost the immune system’s ability to fight off the abnormal keratotic growths, resulting in clearer skin. Their usage has become more prevalent as studies show promising outcomes in treating actinic keratosis.

Chemical Peels and Scrubs

Chemical peels and scrubs incorporating substances like salicylic acid or glycolic acid assist in exfoliating the skin.

These methods help to remove keratotic patches and promote healthier skin underneath. Professional application of chemical peels has shown notable success in managing this skin condition.

Surgical Advancements

Recent research has led to notable improvements in how surgeons treat keratosis, limited not only to refined techniques but also the integration of new technology.

Electrosurgery

Electrosurgery has become a precise tool for keratosis treatment. It uses high-frequency electrical currents to cut, remove, or destroy keratinized skin lesions. The procedure is quick, causes minimal damage to surrounding tissues, and can be performed in an outpatient setting.

Excision Techniques

The development of sophisticated excision techniques has given surgeons greater precision and efficiency.

These methods involve carefully removing the lesion and a small margin of healthy skin to ensure complete removal. The advances in excision also have improved the cosmetic outcomes for patients, lowering the potential for scarring.

Preventative Measures and Lifestyle

When considering the treatment of keratosis, lifestyle changes play a significant role in prevention. Key areas include sun protection and diet.

Sun Protection

One can’t underestimate the importance of sun protection in the prevention of keratosis. Using broad-spectrum sunscreen with an SPF of 30 or higher can shield the skin from harmful UV rays.

They should also seek shade during peak sun hours and consider wearing protective clothing, such as wide-brimmed hats and long sleeves, to reduce exposure.

Nutrition and Skin Health

The link between nutrition and skin health is also pivotal.

Foods rich in antioxidants can help protect the skin. For instance, tomatoes contain lycopene, an antioxidant that may reduce the risk of keratosis. Omega-3 fatty acids, found in fish and flaxseeds, are known for their anti-inflammatory properties and could be beneficial for maintaining healthy skin.

Innovations in Diagnosis

Recent advancements in the field have transformed the way keratosis is diagnosed, enhancing accuracy and expediting treatment decisions.

Digital Imaging

Digital imaging technologies have significantly advanced. They allow for greater precision in diagnosing keratosis.

High-resolution imaging tools can now detect minute changes in skin texture and coloration, often indicative of various forms of keratosis. This specificity aids dermatologists in distinguishing between benign lesions and those requiring further investigation.

Biopsy Improvements

When it comes to biopsy techniques, there’s been noteworthy progress.

Improvements include more refined methods for obtaining skin samples, which minimize discomfort and improve the accuracy of the diagnosis.

For example, techniques that use smaller needles and more targeted biopsy procedures ensure that only the most relevant skin tissue is sampled for pathological examination.

Case Studies and Clinical Trials

Recent studies and trials have shown progressive steps in the treatment of keratosis.

One notable clinical trial explores the efficacy of a new topical treatment designed to reduce the appearance of actinic keratosis, a precancerous skin lesion.

Participants using the treatment showed a significant reduction in lesion count compared to the control group.

A case study involving photodynamic therapy (PDT) highlights its potential as a treatment for keratosis.

Patients undergoing PDT exhibited not only clearance of existing lesions but also a decrease in the development of new ones over time.

Investigations into the genetic factors influencing the response to treatments have also been a focal point.

Researchers are looking into how individual genetic makeup can affect the success of therapy. They aim to personalize treatments for better results in patients.

Frequently Asked Questions

Exploring the latest advancements in keratosis treatment, this section answers some of the most common queries regarding recent research and medical breakthroughs.

What are the breakthroughs in managing actinic keratosis?

Innovations in the management of actinic keratosis (AK) include comprehensively reviewed guidelines suggesting the best practices for treatment. Techniques like photodynamic therapy have grown in acceptance due to their targeted approach.

Are there any newly developed creams effective for treating keratosis?

Recent years have witnessed the development of new topical treatments for keratosis, especially actinic keratosis. These treatments involve less invasive options with promising results. These treatments contribute to effective and convenient management of the condition.

How has the treatment of seborrheic keratosis evolved recently?

Treatment for seborrheic keratosis has advanced, with a better understanding of its pathogenesis leading to safer and more efficient removal techniques. Cryotherapy and topical treatments are commonly used.

What is considered the most effective treatment for keratosis as of this year?

For actinic keratosis, procedures such as cryotherapy, topical therapies, and photodynamic therapy are at the forefront. Their effectiveness often depends on the specific scenario and patient preferences.

Can you highlight some recent studies on keratosis treatments?

Yes, recent studies on keratosis treatments have been pivotal in improving management strategies. They focus on assessing the safety and efficacy of various treatments, with research indicating a high prevalence of keratosis and the necessity for effective solutions.

Are there any innovative medical procedures for keratosis gaining popularity?

Innovative approaches, such as laser therapy and new topical agents, have been growing in popularity. They are non-invasive and have promising outcomes in treating different types of keratosis. These methods cater to patient comfort and cosmetic considerations.

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