Treatment of Seborrheic Keratosis
Seborrheic keratosis does not require treatment for medical reasons unless histologic confirmation is needed or lesions become symptomatic; when removal is desired for cosmetic concerns, cryosurgery is the most commonly employed first-line treatment. 1
When to Treat vs. Observe
- Seborrheic keratoses are biologically benign lesions that do not require removal for medical reasons. 1
- Treatment is indicated only when: (1) histologic confirmation of clinical diagnosis is required, (2) lesions are traumatized and/or symptomatic, or (3) patients request removal for cosmetic concerns. 1
- Among patients presenting to dermatologists with seborrheic keratosis, only 43% undergo treatment to remove lesions, indicating that observation is appropriate for the majority. 1
Primary Treatment Options
Cryosurgery (First-Line)
- Cryotherapy is the most common removal method used by dermatologists for seborrheic keratosis. 1, 2, 3
- This destructive technique is widely available, quick to perform, and effective for most lesions. 2, 4
Shave Excision
- Shave excision is commonly employed, particularly for thicker or raised lesions. 1
- This method provides tissue for histologic examination when diagnostic confirmation is needed. 1
Electrodesiccation and Curettage
- Electrodesiccation, curettage, or combination of these methods are frequently used alternatives. 1, 2, 3
- Curettage under local anesthesia is considered a safe method for eradication of seborrheic keratoses. 2
Laser Therapy
- Ablative laser therapy is an effective treatment option for seborrheic keratosis. 2, 4
- Laser treatment may be particularly useful for multiple lesions or cosmetically sensitive areas. 5
Important Treatment Considerations
Patient Selection and Side Effects
- Careful patient selection is required to optimize cosmetic results, particularly in patients with skin of color, thick lesions, or numerous lesions. 1
- Potential complications include post-procedure depigmentation, scarring, and recurrence. 2
- These procedures can cause cosmetic concerns if not performed appropriately, making technique selection critical. 1
Topical Treatments (Emerging)
- No effective topical therapeutic agent has been developed for seborrheic keratosis, representing an area of unmet need. 1
- Topical hydrogen peroxide 40% and nitric-zinc complex have been investigated but are not yet standard therapy. 4
- Topical keratolytics and vitamin D analogues have been explored but lack robust efficacy data. 5
Clinical Pitfalls to Avoid
- Do not confuse seborrheic keratosis with actinic keratosis or other premalignant/malignant lesions. The evidence provided includes extensive guidelines for actinic keratosis 6, 7, which is a completely different condition requiring different management.
- Ensure accurate clinical diagnosis before treatment, as seborrheic keratoses have remarkable variability in clinical presentation that can raise differential diagnoses. 4
- Consider dermatoscopy as a noninvasive diagnostic technique to differentiate seborrheic keratosis from other benign and malignant tumors before proceeding with treatment. 2, 3
Patient Demographics and Prevalence
- Seborrheic keratosis affects approximately 83 million Americans and is the most common benign skin tumor in middle-aged and elderly adults. 1, 5
- Dermatologists diagnose an average of 155 patients per month with seborrheic keratosis. 1
- Among patients presenting with seborrheic keratosis, 33% have more than 15 lesions and 67% have 15 or fewer lesions. 1