Seborrheic Keratosis: Causes, Symptoms & Treatment

Seborrheic keratosis, often referred to as an age wart, is a benign skin tumor that occurs primarily in the second half of life. Nearly everyone develops seborrheic keratosis at some point, making senile wart the most common tumor of the skin.

What is seborrheic keratosis?

Seborrheic keratosis is also known as basal cell papilloma. The tumor tends to occur at older ages and affects both sexes equally. The tumor is an increased tissue growth of the uppermost skin layers with corneal growths and a formation of horny nodules in the uppermost layers of the skin. This is referred to as pseudo-horn cysts. Especially the so-called basaloid cells proliferate, i.e. grow faster and more numerous. Acanthosis is typical for seborrheic keratosis. Acanthosis is a widening of the spiny cell layer (stratum spinosum) of the uppermost epithelial layer of the skin. The histological picture also shows various characteristic growth patterns. Often the keratinocytes, specialized keratin-producing cells of the human skin, are hyperpigmented. The keratinocytes in seborrheic keratosis thus contain excessive amounts of melanin. Orthohyperkeratosis is also typical of basal cell papilloma. Here, the stratum corneum, the horny layer of the skin, is thickened.

Causes

The exact cause of seborrheic keratosis is still unclear. On the one hand, it is suspected that the tumors are simply age-related skin manifestations. Genetic predisposition seems to play a role. The influence of external factors such as UV radiation, chemicals or light exposure is still unclear. In 20 percent of all cases of seborrheic keratosis a link to human papilloma viruses could be found. Human papillomaviruses are viruses that infect the epithelial cells of the skin, where they cause uncontrolled cell growth. Age spots are under discussion to be the starting point of seborrheic keratosis, as the transitions between skin spots and skin tumors are clinically and histologically fluid.

Symptoms, complaints, and signs

The tumor occurs primarily on the face, upper body, dorsum of the hands, and front of the arms. Predilection sites on the upper body are the anterior and posterior sweat grooves. The anterior sweat groove runs along the sternum, and the posterior sweat groove is the furrow between the shoulder blades. Seborrheic keratosis presents as irregularly shaped tumors that are raised above the skin level. The tumors are usually sharply demarcated and brownish to black in color due to melanin deposits. Colorless variants are also known. In most cases, basal cell papilloma is rather small. The diameter ranges from a few millimeters to one centimeter. Only in rare cases does the tumor grow larger. The surface of seborrheic keratosis is dull, blunt or wart-like. In advanced stages, a fissured surface is found. Sebaceous secretions make the tumor feel greasy and lardy. In bends, for example in the armpit, seborrheic keratosis can also appear pedunculated. If numerous tumors suddenly appear, one speaks of Leser-Trélat syndrome. This may present as part of chronic inflammatory dermatoses or as a paraneoplastic syndrome suggestive of adenocarcinoma of the stomach.

Diagnosis and course of the disease

In diagnosis, it is important to differentiate seborrheic keratosis from malignant tumors of the skin, as seborrheic warts can be confused with basal cell carcinoma and malignant melanoma. In most cases, dermoscopy is used for differentiation. Here, the skin is examined with a reflected light microscope down to deeper skin layers. If the clinical classification is still unclear after dermoscopy, a histopathological examination is performed. Here, tissue is removed from the tumor by means of a fine biopsy and examined microscopically. If the tissue removed is that of a seborrheic keratosis, histological abnormalities such as the orthohyperkeratosis described above, pseudohorn cysts, or acanthosis will be seen. The prognosis of seborrheic keratosis is good. Since it is a benign skin lesion, the tumor does not metastasize. Only rarely does recurrence occur after removal. Occasionally, the tumor reappears in a different location.Only in very rare cases does basal cell papilloma develop into basal cell carcinoma, an infiltrating skin tumor. The development of a carcinoma in situ, i.e., a localized malignant tumor, is also observed only extremely rarely.

Complications

In this disease, there are usually various complaints on the skin. Complications do not have to occur in every case. Many people suffer from the disease, but do not experience any particular symptoms or discomfort. In most cases, there is reduced aesthetics, so that many patients feel uncomfortable or ashamed of the discomfort. Reduced self-esteem or inferiority complexes can also occur and have a very negative impact on the patient’s quality of life. The tumor usually retains its size and does not change. The tumor can cause discomfort, especially on the face or other clearly visible areas. However, pain or other discomfort does not occur. If the tumor is located in the stomach, it may cause stomach discomfort. In most cases, treatment of the disease is only necessary if the tumor changes color or size. In this case, the tumor can be removed. There are no particular complications and the course of the disease is usually positive. Life expectancy is also usually not negatively affected by the tumor.

When should one go to the doctor?

As a rule, a doctor should always be consulted for this disease. There can be no independent healing, so the affected person is always dependent on medical treatment. Thereby, especially an early diagnosis with an early treatment has a positive effect on the further course of the disease. To prevent the tumor from spreading to other regions of the body, regular checks and examinations by a doctor are also necessary. A doctor should be consulted if black dots or spots appear on the body. These can appear in various places and should be examined by a doctor. Often, a greasy layer on these spots also indicated seborrheic keratosis. A doctor should also be consulted especially if these patches change in shape, color or size. In this case, a dermatologist can be consulted. Further treatment will then depend on the exact symptoms and their severity. If the tumor is removed early, there will be no further complications or reduced life expectancy.

Treatment and therapy

Normally, no therapy is required for seborrheic keratosis. However, the skin growths are often found to be visually disturbing or cause pain due to mechanical irritation. If one of these factors applies and the diagnosis is clear, the tumor can be removed. In cauterization, the tumor is removed with an electric snare or a sharp spoon. In the eyelid area, carbon dioxide is used to ablate the tumor. Other methods of removal include icing (cryotherapy) or pathway laser. Before the tumor is removed, a biopsy with histological examination should always be performed. Otherwise, there is a risk of overlooking a malignant tumor. If this malignant tumor were removed with the described procedures, the superficial tumor tissue would be removed, but degenerate tissue could remain in the lower layers of the skin and metastasize from there unnoticed.

Prevention

Because the causes of basal cell papilloma are still unclear, reliable prevention is not possible. In order to differentiate benign seborrheic keratoses from malignant and more dangerous tumors of the skin, regular skin examinations should be performed by a dermatologist. From the age of 35, it is recommended to have a screening examination for skin cancer every two years.

Follow-up care

Seborrheic keratosis, also known as age warts because it usually appears in the second half of life, presents as a benign skin tumor that usually does not require medical treatment. However, if those affected feel particularly uncomfortable with it, cosmetic removal may be considered. However, if the keratoses are located in areas that are frequently exposed to mechanical irritation, it is advisable to have the age warts removed.Especially when dressing and undressing, it can quickly happen that the keratoses tear open due to uncoordinated movements, start to bleed and subsequently become unpleasantly inflamed. In order to ensure that the affected person is dealing with benign skin tumors, an examination by a dermatologist is advisable. The dermatologist will determine the harmlessness of the keratoses by means of a tissue sample. Normal age warts usually do not represent a health risk for the person affected. However, the focus here is often on the aesthetic aspect. If the keratoses appear on the face, this can place a psychological burden on those affected. In consultation with a dermatologist, there are various ways of successfully removing the keratoses and thus restoring the self-esteem of those affected. Medical treatment is also required if the skin tumors change shape or color.

What you can do yourself

Seborrheic keratosis does not necessarily require treatment, however, many people are uncomfortable with it. Those who find the age warts unpleasant should think about cosmetic removal. This is especially advisable if the keratoses are located in a place that quickly becomes inflamed. When shaving and sometimes also when dressing, the affected person quickly comes up against the skin spots, which then begin to bleed. Here, care should be taken not to inflame the spots. Therefore, in the context of self-help, the warts should not be scratched in any case. To make sure that the warts are not malignant skin tumors, an examination by a dermatologist is advisable. The dermatologist will take care of an exact tissue sample. The normal age warts do not pose any danger, but can cause certain discomfort such as irritation from clothing. Especially the aesthetic problems are an important aspect for most women and men. They feel unattractive with them and try to hide the dark spots. In everyday life, the spots on the face are the most disturbing. As long as they do not change their shape and color, there is no health risk, but regular check-ups with a doctor are still advisable.