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Seborrheic Keratosis

Updated : August 24, 2023





Background

Seborrheic keratosis is a common, benign skin growth that occurs when the skin cells produce excess keratin, a protein that helps protect and strengthen the skin. It is typically a harmless condition that does not cause pain or discomfort, but it may be cosmetically undesirable for some people.

Seborrheic keratosis can appear anywhere on the body, but it is most commonly found on the face, chest, and back. These growths can vary, ranging from a few millimeters to several centimeters in diameter. They are often oval or round and have a waxy, scaly, or crusty appearance. They may be tan, brown, black, or a combination of these colors.

Epidemiology

Seborrheic keratosis is a prevalent skin condition that affects people of all ages and races. It is estimated that around 83% of people will develop at least one seborrheic keratosis by age 70. The prevalence of seborrheic keratosis tends to increase with age, and it is more common in older adults. It is common in people with lighter skin tones and those with a family history of the condition.

It is unclear if there are any significant differences in the prevalence of seborrheic keratosis between different geographical regions or populations. However, the condition is thought to be more common in sunny climates, as sun exposure may play a role in its development.

Anatomy

Pathophysiology

The exact cause of seborrheic keratosis is not fully understood, but it is thought to be related to aging and genetics. Seborrheic keratosis is believed to develop when the skin cells in the affected area produce excess keratin. This excess keratin can accumulate and form a growth on the skin’s surface. It is not clear why some individuals’ skin cells produce excess keratin.

However, a combination of factors may contribute to the development of seborrheic keratosis. These may include aging, sun exposure, genetics. There may be a relation between the oncogenes PIK3CA and fibroblast growth factor receptor 3 (FGFR3).

In cases of spontaneous seborrheic keratosis, activating mutations in the tyrosine kinase receptor fibroblast growth factor receptor-3 (FGFR3) are frequent and are hypothesized to be responsible for the development of this benign tumor.

Etiology

Seborrheic keratosis is a benign skin growth that is common in older adults. The exact cause of is unknown, but they are thought to be related to a combination of factors, including genetics, sun exposure, and the body’s natural aging process. Some research suggests that it may be related to an overproduction of skin cells or alterations in how the body processes keratin.

There is also some evidence that seborrheic keratosis may be triggered by certain medications or medical conditions, such as hormonal imbalances or immune system disorders. However, more research is needed to understand the exact causes of seborrheic keratosis.

Genetics

Prognostic Factors

The prognosis for seborrheic keratosis is generally good, as these skin growths are benign and do not pose any significant health risks.

Seborrheic keratosis is not typically associated with severe health complications and does not typically spread or become cancerous. Most cases do not require any treatment, and they can be left alone if they are not causing discomfort or cosmetic concerns.

Clinical History

Clinical History

Seborrheic keratosis is a benign skin tumor with a rough, waxy appearance and can range in color from light to dark brown, yellow, and grey. They can appear as a single lesion or in clusters and can occur anywhere on the body except for the palms, soles, and mucous membranes. In some cases, they may cause inflammation, pain, itching, redness, and bleeding.

The rapid appearance of multiple seborrheic keratoses can indicate the presence of an underlying condition, such as cancer. The Leser-Trélat sign refers explicitly to this occurrence with certain types of malignancies, such as gastrointestinal tract cancers, leukemia, and lymphoma.

 

Physical Examination

Physical Examination

Using a dermatoscope can help distinguish benign seborrheic keratoses from potentially cancerous tumors. When examined with a dermatoscope, seborrheic keratoses typically have milia cysts, comedo-like openings, fissures, and ridges. If a patient has multiple overlapping seborrheic keratoses, it can be challenging to diagnose and monitor them accurately. These patients should be carefully screened for other types of skin cancer, such as melanoma or pigmented basal cell carcinoma, as they may have an increased risk of these conditions.

When evaluating a patient with a sudden eruption of multiple seborrheic keratoses, it is important to gather a thorough medical history and perform age-appropriate cancer screenings, as well as any additional laboratory tests based on the patient’s risk factors and history. It is also important to consider other potential causes of the condition, such as chemotherapy or inflammatory dermatitis.

 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential Diagnosis

Malignant melanoma

Lentigo maligna

Actinic keratosis

Squamous cell carcinoma

Melanocytic nevus

Pigmented basal cell carcinoma

 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Seborrheic keratosis is a benign skin growth that can be treated with topical or oral medications. Some common topical medications used to treat seborrheic keratosis include:

  • Salicylic acid: This medication is applied to the skin typically applied to the affected area one to three times a day and helps to soften and remove the growth. It is usually used in combination with other medications.
  • Imiquimod: Stimulates the immune system to attack seborrheic keratosis
  • Fluorouracil: Used to treat pre-cancerous and cancerous skin growths. It works by inhibiting the production of DNA in the cells of seborrheic keratosis, causing them to die.
  • Diclofenac: It helps reduce inflammation and pain associated with seborrheic keratosis.

Cryotherapy

Cryotherapy involves the application of liquid nitrogen to freeze the growth. The usual dose of liquid nitrogen for cryotherapy is based on the size, location, and number of seborrheic keratosis being treated.

Oral medications are not typically used to treat seborrheic keratosis. However, in rare cases, retinoids, such as isotretinoin and imiquimod are used.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

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References

Seborrheic Keratosis

Updated : August 24, 2023




Seborrheic keratosis is a common, benign skin growth that occurs when the skin cells produce excess keratin, a protein that helps protect and strengthen the skin. It is typically a harmless condition that does not cause pain or discomfort, but it may be cosmetically undesirable for some people.

Seborrheic keratosis can appear anywhere on the body, but it is most commonly found on the face, chest, and back. These growths can vary, ranging from a few millimeters to several centimeters in diameter. They are often oval or round and have a waxy, scaly, or crusty appearance. They may be tan, brown, black, or a combination of these colors.

Seborrheic keratosis is a prevalent skin condition that affects people of all ages and races. It is estimated that around 83% of people will develop at least one seborrheic keratosis by age 70. The prevalence of seborrheic keratosis tends to increase with age, and it is more common in older adults. It is common in people with lighter skin tones and those with a family history of the condition.

It is unclear if there are any significant differences in the prevalence of seborrheic keratosis between different geographical regions or populations. However, the condition is thought to be more common in sunny climates, as sun exposure may play a role in its development.

The exact cause of seborrheic keratosis is not fully understood, but it is thought to be related to aging and genetics. Seborrheic keratosis is believed to develop when the skin cells in the affected area produce excess keratin. This excess keratin can accumulate and form a growth on the skin’s surface. It is not clear why some individuals’ skin cells produce excess keratin.

However, a combination of factors may contribute to the development of seborrheic keratosis. These may include aging, sun exposure, genetics. There may be a relation between the oncogenes PIK3CA and fibroblast growth factor receptor 3 (FGFR3).

In cases of spontaneous seborrheic keratosis, activating mutations in the tyrosine kinase receptor fibroblast growth factor receptor-3 (FGFR3) are frequent and are hypothesized to be responsible for the development of this benign tumor.

Seborrheic keratosis is a benign skin growth that is common in older adults. The exact cause of is unknown, but they are thought to be related to a combination of factors, including genetics, sun exposure, and the body’s natural aging process. Some research suggests that it may be related to an overproduction of skin cells or alterations in how the body processes keratin.

There is also some evidence that seborrheic keratosis may be triggered by certain medications or medical conditions, such as hormonal imbalances or immune system disorders. However, more research is needed to understand the exact causes of seborrheic keratosis.

The prognosis for seborrheic keratosis is generally good, as these skin growths are benign and do not pose any significant health risks.

Seborrheic keratosis is not typically associated with severe health complications and does not typically spread or become cancerous. Most cases do not require any treatment, and they can be left alone if they are not causing discomfort or cosmetic concerns.

Clinical History

Seborrheic keratosis is a benign skin tumor with a rough, waxy appearance and can range in color from light to dark brown, yellow, and grey. They can appear as a single lesion or in clusters and can occur anywhere on the body except for the palms, soles, and mucous membranes. In some cases, they may cause inflammation, pain, itching, redness, and bleeding.

The rapid appearance of multiple seborrheic keratoses can indicate the presence of an underlying condition, such as cancer. The Leser-Trélat sign refers explicitly to this occurrence with certain types of malignancies, such as gastrointestinal tract cancers, leukemia, and lymphoma.

 

Physical Examination

Using a dermatoscope can help distinguish benign seborrheic keratoses from potentially cancerous tumors. When examined with a dermatoscope, seborrheic keratoses typically have milia cysts, comedo-like openings, fissures, and ridges. If a patient has multiple overlapping seborrheic keratoses, it can be challenging to diagnose and monitor them accurately. These patients should be carefully screened for other types of skin cancer, such as melanoma or pigmented basal cell carcinoma, as they may have an increased risk of these conditions.

When evaluating a patient with a sudden eruption of multiple seborrheic keratoses, it is important to gather a thorough medical history and perform age-appropriate cancer screenings, as well as any additional laboratory tests based on the patient’s risk factors and history. It is also important to consider other potential causes of the condition, such as chemotherapy or inflammatory dermatitis.

 

Differential Diagnosis

Malignant melanoma

Lentigo maligna

Actinic keratosis

Squamous cell carcinoma

Melanocytic nevus

Pigmented basal cell carcinoma

 

Seborrheic keratosis is a benign skin growth that can be treated with topical or oral medications. Some common topical medications used to treat seborrheic keratosis include:

  • Salicylic acid: This medication is applied to the skin typically applied to the affected area one to three times a day and helps to soften and remove the growth. It is usually used in combination with other medications.
  • Imiquimod: Stimulates the immune system to attack seborrheic keratosis
  • Fluorouracil: Used to treat pre-cancerous and cancerous skin growths. It works by inhibiting the production of DNA in the cells of seborrheic keratosis, causing them to die.
  • Diclofenac: It helps reduce inflammation and pain associated with seborrheic keratosis.

Cryotherapy

Cryotherapy involves the application of liquid nitrogen to freeze the growth. The usual dose of liquid nitrogen for cryotherapy is based on the size, location, and number of seborrheic keratosis being treated.

Oral medications are not typically used to treat seborrheic keratosis. However, in rare cases, retinoids, such as isotretinoin and imiquimod are used.

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