Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

irritated or itching lesions

1st line – corticosteroids

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ACUTE
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irritated or itching lesions
1st line – 

corticosteroids

Topical corticosteroids can be used symptomatically on irritated and itching seborrheic keratosis. Corticosteroids can be used alone or before other treatments.

Primary options

betamethasone dipropionate topical: (0.05%) apply sparingly to the affected area(s) once or twice daily for 4-5 days

OR

mometasone topical: (0.1%) apply sparingly to the affected area(s) once daily for 4-5 days

ONGOING

raised seborrheic keratosis

1st line – curettage or cautery

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ONGOING
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raised seborrheic keratosis
1st line – 

curettage or cautery

Curettage leaves a flat surface that becomes covered by normal epidermis in 1 week. Cautery is used scarcely as it is more likely to leave scars. Other complications of both curettage and cautery are hyperpigmentation, hypopigmentation, and keloids.

flat seborrheic keratosis

1st line – cryotherapy

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ONGOING
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flat seborrheic keratosis
1st line – 

cryotherapy

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 has been shown to be an effective method of removing seborrheic keratoses that results in highly satisfactory cosmetic outcomes.[29]

2nd line – curettage

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ONGOING
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flat seborrheic keratosis
2nd line – 

curettage

Curettage leaves a flat surface that becomes covered by normal epidermis in 1 week. Curettage has been shown to be an effective method of removing seborrheic keratoses that results in highly satisfactory cosmetic outcomes.[29]

3rd line – laser, dermabrasion, chemical peels, or tretinoin

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ONGOING
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flat seborrheic keratosis
3rd line – 

laser, dermabrasion, chemical peels, or tretinoin

Laser treatments including erbium:YAG laser, pulsed carbon dioxide laser, or 532 diode laser have been used for cosmetic removal with good results, but they may involve more patient discomfort and recovery time.[32][33]

In dermabrasion, the skin is planed by mechanical means such as fine sandpaper or wire brushes.[30][31]

Another treatment option is chemical peels (for example, with focal trichloroacetic acid). The application of topical retinoic acid (tretinoin) has also demonstrated good clinical results.[30][31]

Primary options

trichloroacetic acid topical: consult specialist for guidance on dose

OR

tretinoin topical: consult specialist for guidance on dose

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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