What is the treatment for seborrheic keratosis?

Treatment of Seborrheic Keratosis

Primary Treatment Recommendation

For seborrheic keratosis requiring removal, cryotherapy is the first-line treatment, followed by shave excision, electrodesiccation, or curettage as alternative options, with the choice depending on lesion characteristics and patient skin type. 1, 2

When to Treat

• Seborrheic keratosis is a benign lesion with no medical indication for removal unless the lesion becomes traumatized, symptomatic, or requires histologic confirmation of diagnosis. 1, 2
• Most patients seek treatment for cosmetic reasons, with 61% of women attempting to conceal lesions with hairstyles, makeup, or clothing. 3
• Dermatologists treat approximately 43% of patients who present with seborrheic keratosis. 2

Treatment Selection Algorithm

For Single or Few Lesions:

• Cryotherapy (cryosurgery) is the most commonly employed and effective first-line treatment. 1, 4, 2
• Shave excision is appropriate when histologic confirmation is needed or for thicker lesions. 2
• Electrodesiccation and curettage are effective alternatives, often used in combination. 4, 2

For Multiple Lesions:

• Consider ablative laser therapy as an effective treatment option for numerous lesions. 4
• Topical hydrogen peroxide 40% solution (HP40) is an emerging option applied up to four times per lesion with 20-second applications and 1-minute intervals between applications, showing moderate success with minimal adverse effects. 3, 4
• Topical nitric-zinc complex has been investigated as another non-invasive option. 4

For Facial Lesions:

• Exercise particular caution with treatment selection due to cosmetic concerns and higher risk of visible scarring or pigmentation changes. 2
• Laser therapy may be preferred for facial lesions to optimize cosmetic outcomes. 4

Critical Treatment Considerations by Patient Population

Patients with Skin of Color:

• Careful patient selection is essential as cryotherapy, electrodesiccation, and curettage carry significant risk of post-procedure depigmentation and scarring in darker skin types. 2, 5
• Consider laser therapy or topical treatments to minimize pigmentation changes. 4, 5

Patients with Thick Lesions:

• Shave excision or curettage under local anesthesia is preferred over cryotherapy for thick, hyperkeratotic lesions. 2
• These methods allow for histologic examination to confirm diagnosis. 1

Elderly Patients (>70 years):

• All standard treatment modalities remain safe and effective. 3
• Topical hydrogen peroxide 40% may be particularly appealing as a non-invasive option. 3

Common Pitfalls and How to Avoid Them

• Potential complications include post-procedure pigmentation changes (both hypo- and hyperpigmentation), scarring, discomfort, and recurrence. 2, 5
• Cryotherapy may cause depigmentation, particularly problematic in patients with darker skin tones—consider alternative methods in these patients. 2, 5
• Ensure proper patient counseling that seborrheic keratosis is benign and treatment is elective for cosmetic purposes. 1
• When clinical diagnosis is uncertain or lesions show atypical features, obtain histologic confirmation through shave excision to rule out malignancy. 1, 2

Emerging Treatment Modalities

• Nanosecond-pulsed electric field technology represents a promising new technique with fewer side effects compared to traditional methods. 5
• Topical treatments remain an area of unmet need, with ongoing development of effective non-invasive therapeutic agents. 2
• While topical hydrogen peroxide 40% shows promise, it demonstrates only moderate efficacy and is not yet widely adopted as standard therapy. 3, 4