Approach
Treatment is not always necessary because of the benign nature of seborrheic keratosis.[28] Lesions are generally asymptomatic but can become irritated and inflamed either spontaneously or because of friction from clothing. Treatment is given for cosmetic reasons and to decrease irritation.
Numerous methods are effective. The most frequently used methods are cryotherapy, curettage (shaving), and surgical excision.
Irritated and itching
Topical corticosteroids can be used symptomatically on irritated and itching lesions. Corticosteroids can be used alone or before other treatments.
Removal of raised lesions
Curettage (shaving) or cautery are used to remove raised seborrheic keratosis.[2] Curettage leaves a flat surface that becomes covered by normal epidermis in 1 week. Cautery is rarely used as it is more likely to leave scars. Cryotherapy with liquid nitrogen is not effective in the treatment of very thick lesions.[28]
Treatment of flat lesions
In most cases the best method for the treatment of solar lentigines/initial flat seborrheic keratosis may be gentle cryotherapy with liquid nitrogen. The lesion is frozen for 2 to 3 seconds and is then allowed to thaw before the cycle is repeated once more in the same session. The application of a healing ointment will encourage fast healing. If necessary, cryotherapy can be repeated after a few weeks. Use of sun protection following treatment is necessary to avoid hyperpigmentation. Cryotherapy and curettage have both been shown to be effective methods of removing seborrheic keratoses that result in highly satisfactory cosmetic outcomes; however, in one study, the majority of patients preferred cryotherapy for removal because of the decreased wound care involved.[29]
Other treatment options for flat seborrheic keratosis are chemical peels (for example, with focal trichloroacetic acid) or dermabrasion with fine sandpaper or wire brushes.[30][31] The application of topical retinoic acid (tretinoin) has also demonstrated good clinical results.[30][31]
Other options are treatment with erbium:YAG laser, pulsed carbon dioxide laser, or 532 diode laser, but these options may involve more patient discomfort and recovery time.[32][33]
Complications of treatments
Hyperpigmentation can occur after any treatment, but is common after cautery. Hypopigmentation can also occur after any treatment, but is common following cryotherapy. Scars and keloids can both occur after any treatment but are more common after cautery than curettage.
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