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Seborrheic Keratosis: Causes, Symptoms & Treatment

Seborrheic keratosis, commonly known as age warts, are benign skin growths that frequently appear with advancing age. They are harmless but should be evaluated by a doctor if they change.

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Things worth knowing about "Seborrheic keratosis"

Seborrheic keratosis, commonly known as age warts, are benign skin growths that frequently appear with advancing age. They are harmless but should be evaluated by a doctor if they change.

What is seborrheic keratosis?

Seborrheic keratosis -- commonly referred to as age warts or senile warts -- is one of the most common benign skin growths in adults. These non-cancerous lesions originate in the outer layer of the skin (epidermis) and most commonly appear after the age of 40. They are not contagious and pose no medical risk. However, any new or changing skin lesion should be assessed by a dermatologist to rule out skin cancer such as melanoma.

Causes and risk factors

The exact cause of seborrheic keratosis is not fully understood. The following factors are considered to play a role:

Age: The prevalence increases significantly with age.
Genetic predisposition: A familial tendency has been observed.
UV exposure: Long-term sun exposure may contribute to their development, although they can also appear on sun-protected areas of the body.
Hormonal changes: Discussed as a possible contributing factor.

Symptoms and appearance

Seborrheic keratoses can vary widely in size, color, and texture. Typical characteristics include:

Raised, waxy or warty surface with a characteristic "stuck-on" appearance
Color ranging from light tan to dark brown or black
Size from a few millimeters to several centimeters
Commonly located on the face, trunk, back, chest, and arms
Usually painless, occasionally causing mild itching or irritation from clothing friction

Diagnosis

Diagnosis is typically made through clinical examination by a dermatologist. Dermatoscopy (dermoscopy) is frequently used to identify characteristic structural features of seborrheic keratosis. Typical dermatoscopic findings include so-called pseudohorn cysts and comedo-like openings. If there is any diagnostic uncertainty, a skin biopsy may be taken and examined histologically to exclude malignancy.

Treatment

Since seborrheic keratoses are benign, medical treatment is generally not necessary. Removal may be considered for cosmetic reasons or if the lesion causes discomfort such as itching or friction. Available treatment methods include:

Cryotherapy: The lesion is frozen with liquid nitrogen and sloughs off.
Curettage: Mechanical scraping of the lesion under local anesthesia.
Laser therapy: Ablation using a laser, particularly suitable for sensitive areas.
Electrosurgery: Removal using electric current.
Shave excision: Cutting off the lesion with a scalpel under local anesthesia.

Cosmetic removal is generally not covered by standard health insurance plans.

When to see a doctor?

Although seborrheic keratoses are harmless, medical attention should be sought promptly if a skin lesion:

grows rapidly or changes in appearance,
bleeds or oozes,
has irregular borders or uneven coloration,
or causes pain.

In such cases, skin cancer must be ruled out by a qualified professional.

References

Hafner C., Vogt T.: Seborrheic keratosis. Journal der Deutschen Dermatologischen Gesellschaft, 2008; 6(8): 664-677.
Moll I.: Duale Reihe Dermatologie. 9th edition. Thieme Verlag, Stuttgart 2022.
Wollina U.: Seborrheic keratoses -- the most common benign skin tumor of humans. Open Access Macedonian Journal of Medical Sciences, 2021; 9(F): 1-10.

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