| Seborrheic keratosis |
| Classification and external resources |
Many seborrheic keratoses on the back of a person with Leser–Trélat sign due to colon cancer.
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| ICD-10 |
L82 |
| ICD-9 |
702.1 |
| OMIM |
182000 |
| DiseasesDB |
29386 |
| MedlinePlus |
000884 |
| eMedicine |
derm/397 |
| MeSH |
D017492 |
A seborrheic keratosis (also known as "seborrheic verruca," and "senile wart"[1]:767[2]:637) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age.[3] In fact, they are sometimes humorously referred to as the "barnacles of old age".[4]
The lesions appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across.[5] They can resemble warts,[3] though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a "pasted on" appearance. Some dermatologists refer to seborrheic keratoses as "seborrheic warts"; these lesions, however, are usually not associated with HPV, and therefore such nomenclature is discouraged.
Contents
- 1 Epidemiology
- 2 Classification
- 3 Diagnosis
- 4 Treatment
- 5 Cause
- 6 Etymology
- 7 References
- 8 External links
Epidemiology[edit]
Presence and frequency increase with age: almost all elderly patients have some. An Australian study found 100% of the over-50-year-olds in their sample had at least one seborrhoeic keratosis (median number of 23 keratoses in the 51-75 year range, and 69 keratoses in the over-75-year-olds).[6]
Onset is usually in middle age, although they are a common finding in younger patients—found in 12% of 15-year-olds to 25-year-olds—making the term "senile keratosis" a misnomer.[7]
No difference in prevalence exists between the sexes. There is less prevalence in people with darker skin.[citation needed]
Classification[edit]
Seborrheic keratoses may be divided into the following types:[1]:769-770
- Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
- Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)
- Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic keratosis) -- Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.[8]
- Clonal seborrheic keratosis
- Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)
- Seborrheic keratosis with squamous atypia
- Melanoacanthoma (Pigmented seborrheic keratosis)
- Dermatosis papulosa nigra -- Commonly found among adult African Americans, presents on the face as small benign papules from a pinpoint to a few millimeters in size.[9]
- Inverted follicular keratosis[10]
Also see:
Diagnosis[edit]
Visual diagnosis is made by the "stuck on" appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas.[11] If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy.
Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, condylomas and seborrheic keratoses can be difficult to differentiate, even on biopsy.
Treatment[edit]
No treatment of seborrheic keratoses is necessary.[3] There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed.
Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodesiccation and curettage, shave excision, or cryosurgery. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in persons with dark skin tones.
Cause[edit]
The causes of seborrheic keratosis are unclear.[3] Because seborrheic keratoses are common on sun exposed areas such as the back, arms, face, and neck, ultraviolet light may play a role, as may genetics. However, they are also found on skin that has not been exposed to the sun. [12] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.[13]
Although no direct cause-effect relationship between physiological stress and tumors in general has been medically established, medically, stress is recognized as a potential factor in the exacerbation of preexisting tumors, including those which are benign. Therefore, physiological stress has the potential to worsen a preexisting condition such as seborrheic keratosis.[citation needed]
Seborrheic keratosis also may be one of the many symptoms of gastrointestinal malignancies.[citation needed]
Etymology[edit]
The term "seborrheic keratosis" combines the adjective form of seborrhea,[14] keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.[15]
References[edit]
- ^ a b Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ a b c d Moles, Freckles, Skin Tags, Benign Lentigines, and Seborrheic Keratoses from the Cleveland Clinic website
- ^ "Keratosis, seborrheic definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms". Medterms.com. 2012-03-19. Retrieved 2013-02-08.
- ^ Seborrheic keratosis: Symptoms, from the Mayo Clinic website
- ^ Yeatman JM, Kilkenny M, Marks R; The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency? Br J Dermatol. 1997 Sep;137(3):411-4. [abstract]
- ^ Gill D, Dorevitch A, Marks R; The prevalence of seborrheic keratoses in people aged 15 to 30 years: is the term senile keratosis redundant? Arch Dermatol. 2000 Jun;136(6):759-62. [abstract]
- ^ Raymond T. Kuwahara, MD. "Stucco Keratosis". Emedicine.medscape.com. Retrieved 2013-02-08.
- ^ Mehran Nowfar-Rad, MD. "Dermatosis Papulosa Nigra". Emedicine.medscape.com. Retrieved 2013-02-08.
- ^ Busam Klaus J., Dermatopathology s.341; 2010 Saunders ISBN 978-0-443-06654-2
- ^ http://www.dermadoctor.com/article_Seborrheic-Keratoses_91.html[dead link]
- ^ Seborrheic keratosis: Causes, from the Mayo Clinic website
- ^ Hafner C, Hartmann A, Vogt T (2007). "FGFR3 mutations in epidermal nevi and seborrheic keratoses: lessons from urothelium and skin". J. Invest. Dermatol. 127 (7): 1572–3. doi:10.1038/sj.jid.5700772. PMID 17568799.
- ^ Seborrheic, from Merriam-Webster's online medical dictionary
- ^ Suffix "-osis" from the Merriam-Webster website
External links[edit]
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Cutaneous keratosis, ulcer, atrophy, and necrobiosis (L82–L94, 700–701.5)
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| Epidermal thickening |
- keratoderma: Keratoderma climactericum
- Paraneoplastic keratoderma
- Acrokeratosis paraneoplastica of Bazex
- Aquagenic keratoderma
- Drug-induced keratoderma
- Paraneoplastic keratoderma
- psoriasis
- Keratoderma blennorrhagicum
- keratosis: Seborrheic keratosis
- Clonal seborrheic keratosis
- Common seborrheic keratosis
- Irritated seborrheic keratosis
- Seborrheic keratosis with squamous atypia
- Reticulated seborrheic keratosis
- Dermatosis papulosa nigra
- Keratosis punctata of the palmar creases
- other hyperkeratosis: Acanthosis nigricans
- Confluent and reticulated papillomatosis
- Callus
- Ichthyosis acquisita
- Arsenical keratosis
- Chronic scar keratosis
- Hyperkeratosis lenticularis perstans
- Hydrocarbon keratosis
- Hyperkeratosis of the nipple and areola
- Inverted follicular keratosis
- Lichenoid keratosis
- Multiple minute digitate hyperkeratosis
- PUVA keratosis
- Reactional keratosis
- Stucco keratosis
- Thermal keratosis
- Viral keratosis
- Warty dyskeratoma
- Waxy keratosis of childhood
- other hypertrophy: Keloid
- Hypertrophic scar
- Cutis verticis gyrata
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| Necrobiosis/granuloma |
| Necrobiotic/palisading |
- Granuloma annulare
- Perforating
- Generalized
- Subcutaneous
- Granuloma annulare in HIV disease
- Localized granuloma annulare
- Patch-type granuloma annulare
- Necrobiosis lipoidica
- Annular elastolytic giant cell granuloma
- Granuloma multiforme
- Necrobiotic xanthogranuloma
- Palisaded neutrophilic and granulomatous dermatitis
- Rheumatoid nodulosis
- Interstitial granulomatous dermatitis/Interstitial granulomatous drug reaction
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| Foreign body granuloma |
- Beryllium granuloma
- Mercury granuloma
- Silica granuloma
- Silicone granuloma
- Zirconium granuloma
- Soot tattoo
- Tattoo
- Carbon stain
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| Other/ungrouped |
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Dermis/
localized CTD |
Cutaneous lupus
erythematosus |
- chronic: Discoid
- Panniculitis
- ungrouped: Chilblain
- Lupus erythematosus–lichen planus overlap syndrome
- Tumid
- Verrucous
- Rowell's syndrome
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Scleroderma/
Morphea |
- Localized scleroderma
- Localized morphea
- Morphea–lichen sclerosus et atrophicus overlap
- Generalized morphea
- Atrophoderma of Pasini and Pierini
- Pansclerotic morphea
- Morphea profunda
- Linear scleroderma
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Atrophic/
atrophoderma |
- Lichen sclerosus
- Anetoderma
- Schweninger–Buzzi anetoderma
- Jadassohn–Pellizzari anetoderma
- Atrophoderma of Pasini and Pierini
- Acrodermatitis chronica atrophicans
- Semicircular lipoatrophy
- Follicular atrophoderma
- Linear atrophoderma of Moulin
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| Perforating |
- Kyrle disease
- Reactive perforating collagenosis
- Elastosis perforans serpiginosa
- Perforating folliculitis
- Acquired perforating dermatosis
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| Skin ulcer |
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| Other |
- Calcinosis cutis
- Sclerodactyly
- Poikiloderma vasculare atrophicans
- Ainhum/Pseudo-ainhum
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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Tumors: Skin neoplasm, Epidermis (C44.L12–L38/D23.L53-83, 173/216)
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| Tumor |
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Carcinoma
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BCC
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- Forms
- Aberrant
- Cicatricial
- Cystic
- Fibroepithelioma of Pinkus
- Infltrative
- Micronodular
- Nodular
- Pigmented
- Polypoid
- Pore-like
- Rodent ulcer
- Superficial
- Nevoid basal cell carcinoma syndrome
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SCC
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- Forms
- Adenoid
- Basaloid
- Clear cell
- Signet-ring-cell
- Spindle-cell
- Marjolin's ulcer
- Bowen's disease
- Bowenoid papulosis
- Erythroplasia of Queyrat
- Actinic keratosis
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Adenocarcinoma
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- Aggressive digital papillary adenocarcinoma
- Extramammary Paget's disease
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Ungrouped
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- Merkel cell carcinoma
- Microcystic adnexal carcinoma
- Mucinous carcinoma
- Primary cutaneous adenoid cystic carcinoma
- Verrucous carcinoma
- Malignant mixed tumor
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Benign
tumors
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Acanthoma
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- Forms
- Large cell
- Fissuring
- Clear cell
- Epidermolytic
- Melanoacanthoma
- Pilar sheath acanthoma
- Seboacanthoma
- Seborrheic keratosis
- Warty dyskeratoma
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Keratoacanthoma
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- Generalized eruptive
- Keratoacanthoma centrifugum marginatum
- Multiple
- Solitary
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Wart
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- Verruca vulgaris
- Verruca plana
- Plantar wart
- Periungual wart
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| Other |
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Epidermal nevus
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- Syndromes
- Epidermal nevus syndrome
- Schimmelpenning syndrome
- Nevus comedonicus syndrome
- Nevus comedonicus
- Inflammatory linear verrucous epidermal nevus
- Linear verrucous epidermal nevus
- Pigmented hairy epidermal nevus syndrome
- Systematized epidermal nevus
- Phakomatosis pigmentokeratotica
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Other nevus
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- Nevus unius lateris
- Patch blue nevus
- Unilateral palmoplantar verrucous nevus
- Zosteriform speckled lentiginous nevus
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Ungrouped
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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