What is the recommended treatment for seborrheic keratosis?

Treatment Options for Seborrheic Keratosis

For seborrheic keratosis, the recommended treatments include cryotherapy, shave excision, electrodessication, curettage, or a combination of these methods, with treatment selection based on lesion characteristics and patient preferences. 1, 2

Understanding Seborrheic Keratosis

Seborrheic keratosis (SK) is the most common benign epidermal tumor in dermatological practice. Unlike actinic keratosis, SK is not premalignant and typically requires treatment only for cosmetic reasons or if lesions become symptomatic.

Key characteristics:

• Affects approximately 83 million Americans 2
• Can occur anywhere except palms and soles, most commonly on face and upper trunk 1
• Typically diagnosed clinically, sometimes requiring dermatoscopy or histology 1
• Tends to gradually increase in size, thickness, and/or pigmentation over time 2

Treatment Approaches

1. Procedural Treatments

• Cryotherapy: Most commonly used method 2

  • Advantages: Quick, effective for smaller lesions
  • Disadvantages: May cause hypopigmentation, especially in darker skin types

• Shave Excision:

  • Advantages: Provides tissue for histologic confirmation
  • Disadvantages: Risk of scarring

• Electrodessication and Curettage:

  • Advantages: Effective for thicker lesions
  • Disadvantages: Requires local anesthesia, risk of scarring

2. Emerging Topical Treatments

• Calcipotriol (0.005% ointment):

  • Recent evidence shows complete regression of facial SK lesions after 3-8 months of treatment
  • Remission lasted 6-10 years in follow-up 3
  • Advantage: Non-invasive option for facial lesions

• Hydrogen Peroxide (40%) and Nitric-zinc complex:

  • Under investigation as topical options 4
  • May provide non-invasive alternatives in the future

3. Laser Therapy

• Effective ablative option for multiple lesions 4
• Particularly useful for patients with numerous lesions

Treatment Selection Algorithm

1. Assess the lesion:

   • Size, thickness, location, and number of lesions
   • Rule out malignancy if atypical features present

2. For thin, small lesions:

   • First-line: Cryotherapy
   • Alternative: Topical calcipotriol for facial lesions 3

3. For thicker lesions:

   • First-line: Shave excision or curettage
   • Consider electrodessication for very thick lesions

4. For multiple lesions:

   • Consider laser therapy for widespread treatment 4
   • Cryotherapy for selected troublesome lesions

5. For facial lesions:

   • Consider gentler approaches (lighter cryotherapy or calcipotriol) to minimize scarring and pigmentation changes 3

Important Considerations

• Diagnostic confirmation: If clinical diagnosis is uncertain or malignancy is suspected, shave biopsy is recommended 1

• Patient education: Inform patients that:

  • SK is benign and treatment is primarily for cosmetic reasons
  • New lesions may develop over time requiring additional treatments
  • Some treatments may cause temporary inflammation or pigmentation changes

• Treatment limitations: No current treatment prevents new lesions from forming 2

• Special populations: In patients with darker skin types, care must be taken with cryotherapy to avoid post-inflammatory hypopigmentation 2

While there is significant interest in developing effective topical treatments for SK, this remains an area of unmet need, with most current effective treatments being procedural 2.