Understanding Seborrheic Keratosis: Causes and Treatments

Seborrheic keratosis is a common, benign skin growth that often appears in middle-aged and older adults. Though typically harmless, its appearance can cause concern and prompt individuals to seek medical advice. In this comprehensive guide, we will delve into the pathology, causes, and treatments for seborrheic keratosis, ensuring you have a thorough understanding of this condition.

What is Seborrheic Keratosis?

Seborrheic keratosis is a non-cancerous (benign) skin lesion that usually manifests as a brown, black, or light tan growth. The lesions have a waxy, scaly, and slightly elevated appearance, often resembling a wart. They are most commonly found on the face, chest, shoulders, and back.

Pathology Outlines

From a pathological perspective, seborrheic keratosis is characterized by the proliferation of immature keratinocytes, the predominant cell type in the epidermis. These lesions exhibit hyperkeratosis, acanthosis, and papillomatosis.

• Hyperkeratosis: An abnormal thickening of the outer layer of the skin.
• Acanthosis: Increased thickness of the skin's prickle cell layer.
• Papillomatosis: The formation of numerous, small, wart-like projections on the skin surface.

Histopathologically, seborrheic keratosis can be classified into various subtypes such as acanthotic, hyperkeratotic, reticulated, and clonal types, each exhibiting distinct histological features.

Causes of Seborrheic Keratosis

Genetic Factors

Genetics play a significant role in the development of seborrheic keratosis. Individuals with a family history of the condition are more likely to develop it themselves. Specific genetic mutations in the FGFR3, PIK3CA, and RAS genes have been associated with the lesions.

Ageing

Seborrheic keratosis is predominantly seen in older adults, with the incidence increasing with age. The exact mechanism is not fully understood, but it is believed that cumulative exposure to environmental factors and intrinsic ageing processes contribute to lesion development.

Sun Exposure

Chronic sun exposure has been implicated as a contributing factor, although it is not a direct cause. UV radiation can induce DNA mutations in skin cells, which may promote the formation of seborrheic keratosis.

Hormonal Changes

Hormonal fluctuations, particularly during pregnancy or estrogen therapy, have been linked to the onset of seborrheic keratosis. The lesions may appear or become more pronounced during these periods.

Diagnosis and Classification

ICD-10 Coding

In the International Classification of Diseases, Tenth Revision (ICD-10), seborrheic keratosis is coded as L82. This code encompasses various forms of the condition, including inflamed and non-inflamed lesions.

Clinical Examination

Diagnosis is primarily based on clinical examination. Dermatologists look for characteristic features such as the lesion's colour, texture, and location. Dermoscopy, a non-invasive diagnostic tool, may be used to enhance visualization of the lesion's surface and subsurface structures.

Biopsy

In cases where the diagnosis is uncertain, a biopsy may be performed. A small sample of the lesion is removed and examined under a microscope to confirm the diagnosis and rule out malignancy.

Treatment Options

Cryotherapy

Cryotherapy involves freezing the lesion with liquid nitrogen. This method is effective for small and medium-sized lesions. It causes the lesion to blister and eventually fall off.

Curettage and Electrocautery

Curettage involves scraping the lesion of the skin's surface using a curette, a surgical instrument. Electrocautery uses an electric current to burn the lesion and control bleeding. These procedures are often combined for optimal results.

Laser Therapy

Laser therapy employs targeted beams of light to remove the lesion. Depending on the lesion's characteristics, various types of lasers, such as the CO2 laser and the erbium: YAG laser, can be used. Laser therapy is precise and minimizes damage to surrounding tissue.

Topical Treatments

Topical treatments, such as hydrogen peroxide solution (Eskata), can be applied directly to the lesion. These treatments work by inducing oxidative damage to the lesion, causing it to slough off over time.

Shave Excision

Shave excision involves using a scalpel to shave off the lesion at the skin's surface. This method is beneficial for larger lesions. Local anesthesia is typically administered to minimize discomfort during the procedure.

Post-Treatment Care

Wound Care

Post-treatment care is crucial for optimal healing and minimizing the risk of infection. Patients are advised to keep the treated area clean and dry, apply antibiotic ointment if prescribed, and avoid picking at the scab.

Monitoring for Recurrence

Although seborrheic keratosis lesions are benign and non-recurring, new lesions can develop over time. Regular skin examinations and monitoring for new growths are recommended, particularly for individuals with a history of the condition.

Sun Protection

Protecting the skin from UV radiation can help prevent the formation of new lesions. This includes using broad-spectrum sunscreen, wearing protective clothing, and avoiding excessive sun exposure.

Psychological Impact and Cosmetic Concerns

Seborrheic keratosis can have a psychological impact, mainly when lesions are visible and numerous. While the condition is benign, the appearance of lesions can cause distress and affect self-esteem.

Cosmetic Treatments

For individuals concerned about the cosmetic appearance of seborrheic keratosis, various treatment options are available to remove or reduce the visibility of lesions. Consulting with a dermatologist can help determine the most appropriate treatment plan based on individual preferences and lesion characteristics.

Support and Counseling

In some cases, psychological support or counselling may be beneficial for individuals experiencing significant distress due to seborrheic keratosis. Support groups and online communities can also provide a platform for sharing experiences and coping strategies.

Conclusion

Seborrheic keratosis is a common, benign skin condition with various treatment options. Understanding the pathology, causes, and treatments of seborrheic keratosis can help individuals make informed decisions about its care and management. 

By seeking appropriate medical advice and considering the available treatment options, individuals can effectively manage seborrheic keratosis and address any cosmetic or psychological concerns associated with the condition.

Frequently Asked Questions