Seborrheic keratosis (SK) – colloquially called senile wart – (synonyms: Basal cell papilloma; benign acanthokeratosis; skin wart; seborrheic keratosis; seborrheic senile wart; seborrheic keratosis; seborrheic wart; verruca seborrhoica; verruca seborrhoica senilis; verruca senilis; ICD-10: L82 – Seborrheic keratosis) is a benign (benign) growth of the horn-forming cells of normal skin. Age of manifestation (first age of onset): They occur in almost all people after the age of 40. Sex ratio: Men and women are equally affected. From the age of 50, almost everyone has at least one to hundreds of age warts. Course and prognosis: The course is favorable. There is no evidence of the development of malignancy (malignancy).
Symptoms – Complaints
Seborrheic keratosis occurs anywhere on the body with the exception of the palms of the hands and feet. Preferred body regions are the face, neck area, dorsal and thoracic skin, i.e., in the area of the anterior and posterior sweat grooves; occasionally disseminated (“seeded”) emphasized on the trunk. Note: palms and soles are always omitted!They can range from a few millimeters to 1-2 cm in size. Their color varies from skin-colored-yellowish to gray-brown to black. They are usually flat at the beginning, but in the course they can become raised, have a smooth or fissured surface. They usually occur in groups, rarely singly.They may be greasy to the touch and sometimes cause itching.According to Altmeyer, there are four types of seborrheic keratosis (SK):
- Lentiginous type – flat, pigmented non-raised (early) SK.
- Plaque type – flat raised pigmented or non-pigmented SK.
- Papillomatous type – pigmented papillomatous SK.
- Filiform type – pigmented or non-pigmented filiform SK.
Age warts sometimes appear cosmetically disturbing.
Differential diagnoses
- Malignant melanoma – highly malignant (malignant) neoplasm of the pigment cells (melanocytes), the so-called black skin cancer.
- Melanocytic nevus – benign tumors of the melanocytes.
- Pigmented basal cell carcinoma (BCC; basal cell carcinoma) – skin cancer originating from the basalis of the skin (basal cell layer of the skin) and the root sheaths of the hair follicles
- Pigmented Bowen’s disease – skin disease that belongs to precancerous lesions (precancerous lesions); is called intraepidermal carcinoma in situ and is considered a precursor of squamous cell carcinoma (spinocellular carcinoma; formerly: spinalioma, prickle cell carcinoma)
- Verrucae planae juveniles – flat warts that occur mainly in children and adolescents around puberty, but also earlier or later.
- Actinic keratosis (AK) – chronic damage to the keratinized epidermis, caused by many years of intense exposure to sunlight (actinic = caused by rays); AK can turn into an invasive squamous cell carcinoma (SCC) after a longer latency period.
- Angiokeratoma – benign skin lesions consisting of warty hyperkeratoses (excessive keratinization of the skin) combined with telangiectasias (“dilated veins”) or angiomas (malformations of the vessels)
Pathogenesis (disease development) – etiology (causes)
Seborrheic keratoses are not caused by viruses like common warts and, accordingly, are not contagious. The initial cells of these skin growths are keratinocytes (cells of the epidermis that produce the horny substance keratin) in the basal layer of the epidermis. Age warts have a distinct melanocytic hyperpigmentation. The cause of development is unknown. It is likely that a genetic predisposition plays a role. Cumulative UV exposure and aging processes of the skin are considered risk factors for seborrheic keratosis.
Consequential diseases
Age warts can bleed if irritated. In addition, there is a risk of local infection.
Diagnostics
Age warts are diagnosed by visual diagnosis. Dermoscopically (by reflected-light microscopy), horny beads are characteristically seen; otherwise, images of seborrheic keratosis vary widely.
Therapy
Age warts can be removed surgically, by electrical coagulation (electrical snare), curettage (scraping), sharp spoon, or cryotherapy (cold therapy).Removal is also very possible by erbium yag or CO2 laser.It is also possible that a 40% hydrogen peroxide solution can efficiently and safely remove seborrheic keratoses. Side effects were mostly mild local skin reactions. Three patients reported severe side effects (pain at the application site, burning and burning sensation after therapy). Note: Surgical removal requires a definitive diagnosis. Biopsy with histologic examination is advised.
