Seborrheic keratosis: how to treat this common aesthetic concern

Seborrheic keratosis

Seborrheic keratosis are benign growths of the epidermis that look similar to warts or moles. Despite their name, they have no connection to the sebaceous glands or sebum.

What does seborrheic keratosis look like?

Seborrheic keratoses are round, usually brownish warts that are rough and sometimes scaly. They can be isolated or diffuse, appearing mainly on the trunk and face. This can cause the individual considerable aesthetic discomfort and may cause a sense of (premature) aging. They are not painful, but can become itchy.

Why do seborrheic keratosis form?

Seborrheic keratoses begin as small, grayish papules that are barely visible at first. Over time, they will grow to take on an increasingly wart-like appearance. Sometimes, seborrheic keratoses can cause concern to the individual, because of their size and extent to which they look like a wart.

In those who have a genetic predisposition, seborrheic keratoses tend to be numerous and fast-growing, which can cause aesthetic discomfort and physical discomfort when washing or dressing, and/or through itching.

Treating seborrheic keratosis: when and why

When to treat

Seborrheic keratosis are benign lesions, and are therefore removed only for cosmetic (e.g. to reduce a sense of aging) or functional purposes (to reduce friction or itching). In either case, as soon as a lesion forms, make an appointment with a dermatologist for their removal, especially as the smaller the lesion, the easier it is to remove and the better the cosmetic result.

Who should be treated

Women are more affected by seborrheic keratosis than men. The average onset age of the first lesions is around 50 years old, however, they may start appearing from the age of 30.
The image below is of a young woman in her 30s with the presence of some obvious lesions and a myriad of smaller, new proliferations that will inevitably grow.

Why should seborrheic keratosis be treated?

Seborrheic keratoses are benign growths that are not subject to tumor evolution, meaning they can be left untreated. However, due to aesthetics, a false sense of aging and considering the simplicity of the intervention, their elimination is advisable.

How seborrheic keratosis is treated

Seborrheic keratoses are very superficial and rest on the skin, with an almost ‘stuck-on’ appearance. It is therefore not necessary to remove them with scalpels, electrosurgery, laser therapy or cryotherapy. In fact, these procedures can leave scars or trigger recurrences of seborrheic keratosis.

Curettage: the removal technique of choice

Curettage is performed with a ring curette that removes the lesion without scarring.
In fact, as keratoses rest on the skin, they can be simply ‘scraped’ away and no surgery is required.
Curettage can be completed in an outpatient clinic, does not usually require anesthesia and can remove dozens of lesions within a single session.

Motorized curettage

Today, motorized curettage is a popular treatment option, whereby the curettage is moved by a reciprocating micromotor at about 10,000 oscillations per minute. With this instrument, the procedure is even more precise, gentler and healing takes place sooner. This sequence of images shows the removal of a large seborrheic keratosis on the face. Full repair has taken place within one week of removal, with no trace of a scar.

Conclusion

Seborrheic keratoses are benign skin growths, but many individuals with these lesions feel cosmetic discomfort. For optimum results, seborrheic keratoses should be eliminated when they are still small in size through curettage removal.