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Seborrhoeic Keratosis: Causes, Symptoms and Treatment

Seborrhoeic keratosis is a common, benign skin growth that typically appears in middle-aged and older adults. It is harmless and non-contagious.

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Things worth knowing about "Seborrhoeic Keratosis"

Seborrhoeic keratosis is a common, benign skin growth that typically appears in middle-aged and older adults. It is harmless and non-contagious.

What is Seborrhoeic Keratosis?

Seborrhoeic keratosis (also spelled seborrheic keratosis, or known medically as Verruca seborrhoica) is one of the most common benign skin tumours in adults. It originates from the outermost layer of the skin (the epidermis) and becomes increasingly prevalent with age. Despite its sometimes alarming appearance, it is completely harmless, non-contagious, and does not transform into skin cancer.

Causes

The exact cause of seborrhoeic keratosis is not yet fully understood. Several contributing factors have been identified:

Age: The condition becomes significantly more common with advancing age. Lesions rarely appear before the age of 30.
Genetic predisposition: A family tendency is well recognised. Mutations in the FGFR3 gene (fibroblast growth factor receptor 3) have been found in many cases.
UV radiation: Sun exposure may encourage the development of lesions, although they can also appear on sun-protected areas of the body.
Hormonal changes: Factors such as pregnancy may contribute to new lesions appearing.

Symptoms and Appearance

Seborrhoeic keratoses vary considerably in appearance and are sometimes confused with other skin conditions. Typical features include:

Colour: Light brown to dark black; occasionally skin-coloured or grey.
Surface: Rough, warty, scaly, or greasy-looking; often described as appearing stuck onto the skin.
Size: A few millimetres to several centimetres in diameter.
Location: Most commonly on the face, trunk, back, shoulders, and chest; less often on the hands or soles of the feet.
Symptoms: Usually painless; occasional itching or irritation from friction with clothing.

Diagnosis

Diagnosis is typically made by a dermatologist through a clinical skin examination. When the diagnosis is uncertain, the following methods may be used:

Dermoscopy: A magnified examination of the skin surface using a dermatoscope. Characteristic patterns such as horn cyst structures or comedo-like openings help distinguish seborrhoeic keratoses from malignant lesions such as melanoma.
Histological examination: If the diagnosis remains unclear, a skin biopsy is taken and examined under a microscope to rule out malignancy.

Important: The sudden appearance of a large number of seborrhoeic keratoses (known as the Leser-Trelat sign) may in rare cases indicate an internal malignancy and should be evaluated by a physician.

Treatment

Because seborrhoeic keratoses are benign, treatment is generally not medically necessary. Removal may be considered for cosmetic reasons or in cases of persistent discomfort:

Cryotherapy: Freezing with liquid nitrogen (–196 °C) to destroy the tissue. A quick and effective method.
Curettage: Mechanical scraping of the lesion using a curette, often combined with electrosurgery.
Laser therapy: Use of CO2 or erbium-YAG lasers for precise removal.
Electrosurgery: Removal using an electric current (electrocoagulation).
Shave excision: Tangential removal of the raised lesion with a scalpel.

After removal, temporary skin irritation, scarring, or altered pigmentation may occur. Health insurance providers typically cover costs only when there is a medical indication, not for purely cosmetic procedures.

Differentiation from Similar Conditions

Seborrhoeic keratosis must be distinguished from the following conditions:

Malignant melanoma: A serious form of skin cancer that can appear similarly pigmented.
Basal cell carcinoma: Another form of skin cancer.
Common warts (Verrucae vulgares): Skin growths caused by the human papillomavirus (HPV).
Solar lentigo (age spots): Flat pigmented spots without a raised structure.

References

Habif T. P. - Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Elsevier, 6th edition (2016).
Lallas A. et al. - Accuracy of dermoscopy in the diagnosis of seborrheic keratosis. In: Journal of the European Academy of Dermatology and Venereology, 2015.
American Academy of Dermatology Association (AAD) - Seborrheic keratoses: Overview and treatment. Available at: www.aad.org (accessed 2024).

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