Seborrheic Keratosis Treatment
Primary Treatment Recommendation
For seborrheic keratosis, cryotherapy is the first-line treatment when removal is desired, though no treatment is medically necessary as these are benign lesions. 1
When to Treat
- Seborrheic keratoses are biologically benign and do not require removal for medical reasons unless histologic confirmation is needed or lesions become traumatized/symptomatic 1
- Most patients seek treatment for cosmetic concerns, particularly when lesions appear on the face 1, 2
- Among patients presenting to dermatologists, approximately 43% undergo treatment for lesion removal 1
Treatment Options by Modality
Cryotherapy (Most Common)
- Cryosurgery is the most commonly employed removal method by dermatologists 1
- Widely used but requires careful patient selection to optimize cosmetic results, particularly in patients with skin of color 1
Surgical Methods
- Shave excision, electrodesiccation, and curettage (or combinations) are effective alternatives to cryotherapy 1, 2
- These procedures can effectively remove lesions but carry potential drawbacks including post-procedure depigmentation, scarring, and recurrence 3
- Curettage under local anesthesia is considered a safe method for eradication 3
Laser Therapy
- Laser application represents another treatment option, though it may cause similar side effects as other destructive methods 2, 3
Emerging Topical Treatments
- Topical calcipotriol 0.005% ointment shows promise for flat seborrheic keratoses on the face, with complete regression achieved in 3-8 months and remission lasting 6-10 years in case series 4
- Topical keratolytics and vitamin D analogues are being investigated 5
- Currently, no FDA-approved topical therapeutic agent exists for seborrheic keratosis, representing an unmet clinical need 1, 5
Novel Technologies
- Nanosecond-pulsed electric field technology is a promising new technique with fewer side effects compared to traditional destructive methods 3
Important Clinical Considerations
Patient Selection Factors
- Lesion location matters: Facial lesions require particular attention to cosmetic outcomes 1, 2
- Lesion characteristics: Thick or numerous lesions may be more challenging to treat with certain modalities 1
- Skin type: Patients with darker skin types are at higher risk for post-treatment pigmentary changes with destructive methods 1
Common Pitfalls to Avoid
- Failing to confirm the diagnosis when clinical presentation is atypical - consider dermatoscopy or biopsy to exclude malignancy 2
- Using aggressive destructive techniques without considering cosmetic outcomes, particularly on the face or in darker skin types 1
- Not discussing that treatment is elective - patients should understand these are benign lesions with no medical necessity for removal 1, 2
Diagnostic Confirmation
- Diagnosis is usually made clinically 2
- Dermatoscopy serves as a noninvasive diagnostic technique to differentiate seborrheic keratosis from other benign and malignant tumors 3
- Histology should be obtained when clinical diagnosis is uncertain 1