Your Guide to Managing and (Potentially) Removing Seborrheic Keratosis

Forget about “warts” or “skin cancer” – those little bumps cropping up on your skin are simply life leaving its mark, or as I like to call them, “wisdom spots.” 

Now, before you imagine wrinkled yogis covered in these things, let’s set the record straight: seborrheic keratosis (SKs for short) is a harmless skin growth as common as wrinkles and just as fascinating.

So, ditch the mystery and join me on this bumpy journey! 

We’ll explore what SKs really are, why they appear, and even how to deal with them if they’re bugging you (literally). And hey, maybe we’ll even discover that these bumps aren’t just annoyances but tiny tales etched on our skin, telling the story of a life well-lived.

Ready to unravel the mystery of SKs? Buckle up, and let’s get bumpy!

What is seborrheic keratosis?

Have you ever noticed those little bumps that pop up on your skin? Well, they might be seborrheic keratosis, or SKs for short. 

Think of them as tiny mounds made of extra skin cells. Don’t worry; they’re not warts or anything scary, just an overgrowth of keratinocytes, the most common type of skin cells in the outer layer of your skin (the epidermis).  

These bumps have a lot of nicknames, like “barnacles of aging” or my personal favorite, “wisdom spots,” but don’t let them fool you. They’re harmless and nothing to worry about. 

Except…

In some cases, SKs can be challenging to distinguish from melanoma, a serious type of skin cancer as well as other types of skin cancer, such as squamous cell carcinoma. So, if you have a bump that is changing quickly, looks uneven, is really dark, or is bleeding or sore to the touch, it’s always best to have your dermatologist take a look.

But for the most part, SKs are just little quirky bits of skin, perfectly content to live there without bothering you. 

What does seborrheic keratosis look like?

Spot those little bumps on your skin? Here’s a few tips on how to tell if maybe they’re “wisdom spots” (aka seborrheic keratosis):

Location

Seborrheic keratosis can pop up almost anywhere but most commonly appears on the chest (especially under the bra area), abdomen, arms, legs, back, shoulders, scalp, and even the face. Pretty much the only places they don’t occur are your palms, the soles of your feet, and your mucous membranes. 

Texture

Seborrheic keratosis typically begins as small, rough areas and progresses to develop a thick, wart-like surface. They often have a palpable “stuck-on” feeling and may also appear waxy and slightly raised.

Shape

The majority of seborrheic keratosis lesions are rounded or oval-shaped. Variations in shape are possible, although less common. They usually start small, but some can grow as big as a dive (or even a half-dollar, for the more ambitious ones!). 

Color

Color variation exists within this condition, with lesions usually presenting as brown, yellow, white, or black and sometimes skin-colored. Individual lesions may appear uniform in color or have a patchy appearance – they’re all unique! You can even have a variety of colors on your skin, some brown ones here, some skin-colored ones there, and then some mixture of colors in other places. This makes it challenging for the inexperienced and untrained eye to recognize that they are all seborrheic keratoses.

Although seborrheic keratosis is generally harmless, if you experience rapid and extensive growth, you should talk with your dermatologist to rule out any underlying medical conditions.

Who gets seborrheic keratosis?

Unfortunately, the exact trigger for seborrheic keratosis remains a mystery, making it difficult to say what causes them. So, while anyone can develop these growths, their appearance is most common after 50. In fact, roughly 30% of people in their 40s and 75% in their 70s have at least one seborrheic keratosis. 

In clinical practice, I find them pretty much on almost every midlife patient and beyond, so chances are you either have them now or will have them. It’s by far the most common skin lesion I get asked about during skin examinations.

Some additional factors can include:

• Genetics: Family history can also be a factor. Having close relatives with multiple growths suggests a possible inherited tendency.

• Skin Tone: Lighter skin types are more prone to classic seborrheic keratosis. However, a different variant called dermatosis papulosa nigra is common in darker-skinned individuals, particularly those of African, Asian, and Hispanic descent, and those are typically seen on the face and neck.

• Sun Exposure: Although not definitively proven, increased sun exposure may contribute to the development of seborrheic keratosis. However, they can also occur in areas where there is minimal sun exposure.

• Medications: Certain medications, such as immunosuppressants used after organ transplants, may increase the risk of developing these growths.

• Medical Conditions: Some medical conditions, such as pregnancy, HIV/AIDS, and Parkinson’s disease, have been associated with a higher prevalence of seborrheic keratosis.

Symptoms of Seborrheic Keratosis

Seborrheic keratosis usually doesn’t cause any symptoms, making them often go unnoticed. However, some people may experience:

• Itching: The rough surface of SKs can itch, especially when irritated by clothing or jewelry.

• Scratching: Scratching itchy SKs can worsen the inflammation and lead to secondary infection.

• Tenderness: In some cases, SKs can become tender or sore, especially if inflamed or infected.

• Appearance: The raised, wart-like appearance of SKs can be cosmetically bothersome to some people, mainly when located on visible areas like the face or neck.

Overall, most SKs are harmless and don’t cause any symptoms, although symptoms can vary from person to person.

Treatment and Removal of Seborrheic Keratosis

Diagnosing a Seborrheic Keratosis

Diagnosing seborrheic keratosis (SK) is usually relatively straightforward, thanks to its distinct appearance. 

The first step is a physical examination that looks at the growths, considering their location, size, shape, color, and surface texture.

Generally, a visual examination by your board-certified dermatologist is sufficient for diagnosing SKs. You will likely find that your dermatologist can diagnose these quickly and easily and sometimes won’t even need to take a very close look at them. 

Remember, they are used to looking at these on many patients, all day, every day, for years.

In rare cases, a biopsy may be recommended if the diagnosis is unclear or there are concerns about malignancy. This involves your dermatologist removing a small sample (biopsy) of the SK, which is sent to a lab for examination by a dermatopathologist under a microscope.

Treat, Manage, or Ignore Seborrheic Keratosis?

So, now that you know more about these quirky “wisdom spots,” the question remains: will you treat, manage, or ignore them? 

Many of my patients choose to simply manage or ignore their SKs, finding them more charming than bothersome. Keeping your skin hydrated and minimizing rubbing or scratching can reduce any itching or discomfort so that you and your wisdom spots can live together. 

For those patients who wish to have their SKs removed, there are several treatment options to consider. But keep in mind you will likely trade your SK for a potential scar. Also, sometimes, SKs are stubborn and either don’t go away completely or recur despite best efforts to remove them. There is currently no way to prevent getting new ones.

• Cryosurgery: Liquid nitrogen freezes and destroys the growth, ideal for localized lesions. 

• Electrosurgery: An electric current cauterizes and removes the growth, suitable for larger or thicker lesions.

• Curettage: A surgical instrument scrapes away the growth, often combined with electrosurgery for enhanced precision. 

• Shave biopsy: Similar to curettage, with a tissue sample collected for potential laboratory analysis. 

• Laser ablation: A targeted laser beam vaporizes the growth layer by layer, ideal for more delicate areas.

To prevent bleeding and potential infection, it’s important not to attempt to remove a seborrheic keratosis yourself by scratching or picking.

Reveal Your Skin’s Circadian Rhythm 

Seborrheic keratosis, those seemingly innocuous bumps that appear with age, are more than just skin markings. They offer a window into the profound connection between aging, skin health, and our internal clock. 

But my latest guide, the Chronobeauty Starter Guide, is here to help you harmonize your skin’s well-being inside and out. 

This guide illuminates the intricate dance between the skin and the circadian rhythm, offering comprehensive insights into:

• Aging skin and the circadian rhythm
• Harnessing the power of light
• Skin rituals aligned with your circadian rhythm
• Diet, skin, and sleep
• And mindfulness practices to boost your skin and sleep.

Sign up for the Chronobeauty Starter Guide today and learn how to optimize your skin’s vitality and embrace a holistic approach to well-being.

Want more?

Learn how to align your skin health with the rhythm and beauty of nature inside my SkinClock mini-course series.