From the Research
Physical exam findings of an inflamed seborrheic keratosis include redness (erythema) surrounding the lesion, tenderness or pain when touched, swelling of the lesion and surrounding skin, and occasionally crusting or bleeding. The seborrheic keratosis itself typically appears as a well-demarcated, stuck-on, waxy or greasy plaque with a rough, warty surface that can range in color from light tan to dark brown or black. When inflamed, the lesion may become irritated due to friction, trauma, or infection, leading to pruritus (itching) 1. Some inflamed seborrheic keratoses may develop a halo of inflammation around them. In severe cases, there might be purulent discharge if secondary infection has occurred. These inflammatory changes are usually temporary and resolve with removal of the irritating factor, though persistent inflammation warrants evaluation to rule out malignant transformation (which is rare) or other dermatological conditions 2. No specific treatment is required for inflammation alone beyond avoiding further irritation, though removal of the seborrheic keratosis may be considered for symptomatic lesions. Key dermoscopic features of inflamed seborrheic keratosis include vascularization (91.3%), with a subset showing predominance of hairpin vessels, and a bluish hue in some cases 1. Given the potential for inflamed seborrheic keratoses to mimic malignancies, such as squamous cell carcinoma or melanoma, histopathological examination is crucial for definitive diagnosis in challenging cases 3, 4.
Important Considerations
- Inflamed seborrheic keratoses can pose a diagnostic challenge due to their variability in appearance and potential to mimic other skin tumors 5.
- Dermoscopy can aid in diagnosis but may not always provide conclusive evidence, highlighting the need for biopsy in uncertain cases 1, 2.
- The presence of unusual patterns or symptoms, such as recent changes in color, size, or the development of bleeding or ulceration, should prompt further investigation to rule out malignancy 3, 4.
Clinical Approach
- A thorough physical examination, including dermoscopic evaluation, is essential for assessing inflamed seborrheic keratoses.
- Consideration of the patient's history, including the duration of the lesion and any changes, is vital.
- Biopsy should be considered for lesions that cannot be confidently diagnosed as benign or for those with suspicious features or symptoms 1, 2.