One morning, Bengaluru resident Chitra (surname withheld on request), 58, woke up to a light-brown lesion on her cheek. Even as she wondered if her face had got burnt without her knowledge — say, while cooking — she became anxious about going to work and meeting her colleagues.
“It was an oval-shape lesion on my right cheek, and I felt it appeared from nowhere,” says Chitra. “On the day when I first noticed it, I was shocked and applied concealer to cover it. I thought I might have burnt myself or got splashed by hot oil while cooking. I even applied some burn ointments for a few days.”
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But real relief was a few days away for Chitra. “When the scar got a little darker, I consulted a dermatologist — who informed me that it was a noncancerous senile wart and it was harmless,” she says.
What is seborrheic keratosis?
The brown or black patches on visible areas of the skin — especially among senior citizens — are typically harmless and appear as a common sign of ageing. These skin lesions require no treatment and are known as seborrheic keratoses or SK, a noncancerous skin condition that could appear as one or two lesions for some while others may have multiple lesions.
Seborrheic keratosis is also known as senile warts or wisdom warts, says Dr Gatha M Upadya, consultant dermatology, KMC hospital, Mangaluru, Karnataka. She says senile warts are usually diagnosed on time and do not lead to any complications. “People consult doctor for appearance and cosmetic corrections as these warts are visible on the face, neck and other exposed part of the body,” she says.
Dr Arya James, dermatologist, Aster Mother Hospital, Areekode, Kerala, says that SK is a common benign growth appearing on the skin. “People tend to get more of SKs as they get older,” says Dr James. “Males and females are equally affected.”
What causes seborrheic keratosis?
Dr Upadya says it is seen in elderly people, often in those above 60 years of age. “In most cases, the senile warts would have appeared in all the places of the body,” she says. “It is seen mostly in the sun-exposed area and commonly among people who work under direct sun. There is no exact cause for the condition, and it could result due to chronic sun damage.”
SKs usually present as asymptomatic, oval, raised brownish-to-black sharply demarcated plaques that appear stuck on to skin surface, says Dr James. “Usually seen on face, scalp, neck, inframammary fold, extremities and occasionally genitalia,” she says.
Bengaluru resident Chitra got the first lesion on the back of her neck a few months before she noticed it. “While I was talking to my husband, he pointed out the first one, which was on the back of the neck,” she says. “Though my husband doesn’t want me to get it removed, I am considering removing it.”
Other skin conditions
Differentiating between other similar skin conditions, Dr Upadya says that when warts are raised above the skin, it is called seborrheic keratoses and if it is only skin pigmentation, it is called stucco keratosis. Sometimes, there will be warts hanging from the skin surface, mainly seen on the neck, called DPN (dermatosis papulosa nigra).
Dr James says dermoscopy aids correct diagnosis. “Lesions with atypical appearance should be biopsied,” she says. “Seborrheic keratoses may be mistaken for warts, moles, skin tags, melanoma (a serious skin cancer), melanocytic nevi (birthmark), pigmented basal cell carcinoma (a type of skin cancer) and pigmented Bowen’s disease (another type of skin cancer),” she says.
Abrupt onset of seborrheic keratosis
Whenever there is a sudden eruption of senile warts, especially on the trunk, people need to immediately reach out to the doctors for further treatment and medication, says Dr Upadya. The sign of sudden eruption of SK is called Leser-Trelat.
According to Dr James, Leser-Trelat syndrome is characterised by sudden eruption of multiple seborrheic keratoses, mostly on the trunk, and may be associated with underlying adenocarcinoma (a type of cancer), most frequently of the stomach, colon, oesophagus, breast and lungs. A few cases of mycosis fungoides and Sezary syndrome (both are types of blood cancer) with signs of Leser-Trelat have been reported. Tumour screening is recommended in such cases.
When to seek a doctor’s help?
“Normally people get SKs over a period of time — one or two lesions in a month or a gradual increase over the years,” says Dr Upadya. “A classic case of seborrheic keratoses is identified immediately by the dermatologist. However, it is always good to get it checked and identified.”
According to Dr Upadya, any pigmented lesion which has excessive itching bleeding or change in colour and discharge should be immediately reported to the doctor as it is a clear sign and a warning that it could be an underlying melanoma. If left unattended, it can only increase in size and spread over the body and there will be no complications or risks associated to it.
“Seborrheic keratoses isn’t dangerous, but one shouldn’t ignore growths on the skin,” Dr James says. “It can be difficult to differentiate between harmless and dangerous growths. Something that looks like Seborrheic keratoses could be melanoma. Visit a dermatologist if there is a new growth or a change in the appearance of an existing growth.”
How to remove seborrheic keratosis?
When doctors are in doubt, they go for a biopsy and treat it accordingly, says Dr Upadya. “Usage of sunscreen may limit the increase or spreading across the body, but it will not stop,” she says. “It can only reduce the number of lesions. Once the senile warts start appearing there is no way to stop it. However, it can be removed through burn or weekly nitrogen therapy. Few lesions can be removed through electrical current.”