Seborrheic Keratoses

Seborrheic keratoses are benign, wart-like growths on the skin that often look crusty, scaly, and are brown, black, or tan. These skin lesions are extremely common, with up to three million new cases each year in the United States. Although seborrheic keratoses are noncancerous, their rough texture can sometimes catch on clothing, leading to irritation, itching, and bleeding. This prompts many patients to ask if there’s a way to remove the growths. Even when the dark brown spots do not irritate, some individuals opt to remove them for cosmetic reasons. Fortunately, several treatment options for removing seborrheic keratoses are available at the office of board-certified dermatologist Dr. Michele Green on the Upper East Side.

Whenever patients notice new skin growths, they should see an expert dermatologist like Dr. Green to determine if the lesion could be skin cancer, such as melanoma or basal cell carcinoma. Dr. Green will examine the skin and may perform a biopsy to diagnose the condition. For those with seborrheic keratoses, several treatment options are available at Dr. Green’s office, including laser therapy, prescription hydrogen peroxide, curettage, and electrocautery. Depending on whether the seborrheic keratosis lesion is raised or flat, Dr. Green may use one or a combination of treatments to achieve the best results. To find out which treatment is right for you, schedule an initial consultation with Dr. Michele Green.

Dr. Green is an internationally renowned, board-certified cosmetic dermatologist with over 25 years of experience offering some of the most discerning men and women worldwide the best non-invasive cosmetic treatments, including chemical peels, laser therapy, and prescription topical medications. Recognized for her dedication and expertise, she is frequently ranked among the top dermatologists in NYC by Castle Connolly, the New York Times, Super Doctors, and New York Magazine. When you consult with Dr. Green for facial rejuvenation, she will work with you to develop a personalized plan that combines in-office procedures with specially formulated topical products tailored to your specific needs and goals.

What are Seborrheic keratoses?

Seborrheic keratosis is a common skin condition characterized by oval-shaped, waxy skin lesions that develop gradually. Over 83 million Americans are affected by seborrheic keratosis, making it one of the most common skin lesions (J Drugs Dermatol). Its prevalence increases with age, affecting most adults over 50. These growths are benign skin tumors, meaning they are noncancerous and harmless. They are usually light tan, brown, or black and most often appear on the face, neck, chest, or back. Although seborrheic keratoses can look warty, they are not the same as warts; warts, like verruca, are caused by a virus, whereas seborrheic keratoses are not. Nearly 30% of people develop them by age 40, and about 75% by age 70. They are less common in people with darker skin; however, a subtype called “dermatosis papulosa nigra” frequently appears in darker-skinned individuals. Dermatose papulosa nigra is an acanthotic variation of seborrheic keratosis characterized by brown to black papules, which tend to increase in number with age and are mainly found on the face and neck. While seborrheic keratoses are harmless, it is always best to consult a dermatologist if you notice new or changing skin lesions.

What do Seborrheic keratoses look like?

Seborrheic keratoses can appear as flat or slightly raised spots with shades ranging from light tan to dark brown or black. Their surface often feels rough or scaly, and some may have an uneven, bumpy texture. A subtype called stucco keratosis often appears as small, white or gray lesions on the lower legs and feet, especially in older adults. Seborrheic keratoses can range from just a few millimeters to over an inch across, and new growths may develop gradually over the years. They commonly grow on the face, neck, chest, or back, either as single lesions or in small clusters, but can occur anywhere on the body except the palms and soles, according to the American Academy of Dermatology. Under a microscope, seborrheic keratosis can show different histological patterns. Some display thickening of the epidermis, while others show an adenoid pattern with cells forming interconnected strands within the growth. Although these growths are harmless, other skin conditions like actinic keratoses, epidermal nevi, solar lentigo, and squamous cell carcinoma can sometimes resemble them. Therefore, it is always best to have any new or changing growths evaluated by a board-certified dermatologist, such as Dr. Green, to ensure an accurate diagnosis and discuss safe treatment options if needed.

How big can a Seborrheic keratosis get?

Seborrheic keratosis can vary widely in size. Some remain very small, just a few millimeters across, while others can grow to over an inch in diameter. They often start small and grow slowly, and over time, new spots may appear on different areas of the skin as you age. Even larger lesions are still benign, but any spot that grows quickly or changes in color or shape should be examined to rule out other skin conditions.

How does Seborrheic keratosis start?

Most seborrheic keratoses begin as small, flat patches that match the skin’s color or are slightly darker and may go unnoticed initially. Over time, these patches thicken as layers of skin cells build up in the outer layer, the epidermis, giving the lesion its distinctive rough, raised appearance. This gradual buildup causes seborrheic keratoses to have an uneven, bumpy texture. Some remain small for years before becoming noticeable, while others gradually grow and develop the familiar look that distinguishes them from other skin spots.

What causes Seborrheic keratosis?

Seborrheic keratoses develop naturally over time, and although their exact cause isn’t completely understood, age and genetics are the main factors. These growths are much more common in adults over 40 and tend to appear gradually, often increasing in number as people age. Studies have associated certain skin-cell mutations, such as FGFR3 and PIK3CA, with the development of seborrheic keratoses, suggesting a genetic influence on this skin condition. Mutations in the fibroblast growth factor receptor 3 (FGFR3) gene are among the most commonly identified in seborrheic keratosis tissue samples. People with a family history of seborrheic keratoses are also more likely to develop them, and new lesions can appear throughout life. Unlike warts, which are caused by a viral infection, seborrheic keratoses are not contagious and do not result from bacteria, fungi, or other external irritants. They are considered normal, benign skin changes associated with aging. Unlike epidermoid cysts, which form beneath the skin due to a blocked hair follicle or oil gland, seborrheic keratoses develop on the surface of the skin and consist of excess keratin produced by keratinocytes.

Why am I getting so many Seborrheic keratoses?

Some people notice a sudden increase in seborrheic keratoses, which can result from factors beyond normal aging. Hormonal changes, especially fluctuations in estrogen levels during pregnancy and menopause, can make existing lesions more apparent or cause new ones to form. Research shows that in rare cases, rapid growth of many seborrheic keratoses, known as the Leser-Trélat sign, might indicate an internal malignancy, making medical evaluation crucial. Even when no underlying health issues are present, having numerous seborrheic keratoses is generally related to your skin’s biology rather than specific lifestyle factors.

Can you prevent Seborrheic keratosis?

There is no guaranteed way to prevent seborrheic keratoses because they are mainly linked to genetics and natural skin aging. These growths can appear even in people who take excellent care of their skin. Maintaining a consistent skincare routine and using sun protection can support overall skin health, but they won’t stop seborrheic keratoses from forming. The best approach is to watch your skin for any new or changing spots and schedule regular check-ups with a board-certified dermatologist for an accurate diagnosis.

Does Seborrheic keratosis grow?

Seborrheic keratoses tend to develop slowly and typically start to appear in middle age, around age 40. This gradual increase in epidermal cells causes the lesion to grow over time. The skin growths can range in size from a few millimeters to about one inch in diameter. Sometimes, only a single seborrheic keratosis develops, while in other cases, a cluster called the Leser-Trélat sign appears. Currently, researchers do not know for certain what triggers their growth. What is known is that patients have a higher risk of developing seborrheic keratoses if they have a family history of the condition.

Do Seborrheic keratoses grow quickly?

Seborrheic keratoses are characterized by slow, gradual growth of light tan, brown, or black skin lesions. Often, the waxy, scaly, wart-like texture changes over time, and the growth may stay flat or become raised. If you notice a growth that increases very quickly, it is best to see a healthcare provider as soon as possible, since fast-growing growths with irregular borders can be a sign of skin cancer. Some research has shown that rapid growth of seborrheic keratoses in a cluster can also indicate a form of internal cancer. Although the cause has not yet been fully proven, it is still best to have any rapid growths examined by a dermatologist.

Can Seborrheic keratoses be flat?

Seborrheic keratosis skin lesions can be flat or slightly raised as they gradually develop on the skin’s surface. Usually, seborrheic keratoses have a rough, scaly texture that can be felt with your finger and are often described as looking “stuck on.” Other growths, such as actinic keratosis, melanoma, and basal cell carcinoma, can resemble seborrheic keratoses, making it important to see a dermatologist if you notice any new skin lesions.

Is Seborrheic keratosis scaly?

Seborrheic keratoses are skin lesions that often appear scaly or “stuck on,’ resembling wax drippings on the skin. They can be flat or raised, but both types have a rough texture that you can feel when you touch them. This texture results from the hyperkeratotic nature of seborrheic keratosis, meaning there is a buildup of keratin on the skin’s surface—keratin is the same fibrous protein that makes up our fingernails. The thickened surface occurs due to an overgrowth of keratinocytes, the main cells in the epidermis responsible for producing keratin.

Why do Seborrheic keratoses itch?

Patients often wonder, “Why do seborrheic keratoses itch?” Seborrheic keratosis lesions have a rough, scaly texture that is often slightly raised. This means that the lesions can catch on clothing and cause discomfort from rubbing. Friction from clothing can make skin lesions itch and cause discomfort. Clothes and jewelry rubbing against a seborrheic keratosis can irritate it, making it turn red, crusty, or scaly and increasing discomfort. Although seborrheic keratosis is not dangerous, patients experiencing itching and irritation may choose to have the lesions removed.

Are Seborrheic keratoses contagious?

No. While seborrheic keratoses are a very common skin condition, with as many as 3 million new cases in the United States each year, they are not contagious. Unlike warts, which are caused by the human papillomavirus (HPV), seborrheic keratosis does not result from a bacterial, viral, or fungal infection. Although the exact cause of seborrheic keratosis is unknown, there is a strong link to family history, indicating a hereditary component. Additionally, seborrheic keratosis lesions will not spread across the body. New growths may develop after one seborrheic keratosis lesion has formed, but not due to any spread of a virus or bacteria.

Can Seborrheic keratosis become cancerous?

Patients often ask, “Are seborrheic keratoses cancerous?” Seborrheic keratoses are benign skin growths, meaning they are neither precancerous nor cancerous. During an evaluation with a dermatologist, a differential diagnosis is used to rule out conditions like melanoma, actinic keratosis, and basal cell carcinoma. Seborrheic keratoses do not become cancerous and differ from melanoma in various ways, including the number of lesions, texture, shape, and rate of growth and change. While seborrheic keratoses often appear in clusters, melanoma typically presents as a single lesion. Seborrheic keratoses tend to have a rough, scaly texture with a well-defined border, whereas melanoma usually appears smooth with an irregular border. Although seborrheic keratosis lesions grow gradually, melanoma lesions tend to grow rapidly and change quickly. However, seborrheic keratosis lesions can resemble other precancerous growths, such as actinic keratosis. Actinic keratoses are pigmented, precancerous growths caused by sun exposure and are often crusty and scaly, similar to seborrheic keratoses. Therefore, it is always best to consult a dermatologist about any new skin growth.

Can Seborrheic keratosis turn into melanoma?

Melanoma is a serious form of skin cancer that originates from pigment-producing cells called melanocytes and can spread to other parts of the body if not detected early. Seborrheic keratoses do not turn into melanoma, but they can sometimes look like it, especially if they are darkly pigmented or have a textured surface. Because of their similar appearance, dermatologists may recommend a biopsy of any lesion showing changes in color, shape, or texture to confirm the diagnosis. Detecting melanoma early is vital for successful treatment, so it’s important to have all growths examined.

Are Seborrheic keratosis dangerous?

No. A seborrheic keratosis is a benign, noncancerous skin growth, meaning it is not harmful. Because these lesions have a rough, scaly texture, friction from rubbing against clothing can lead to irritation, itching, and bleeding. If this occurs, Dr. Green recommends removing the lesion. Seborrheic keratosis may also look like potentially dangerous skin conditions, such as actinic keratosis. Therefore, it’s always best to have new growths examined and diagnosed by a dermatologist.

Are Seborrheic keratoses genetic?

Although the exact cause of seborrheic keratosis remains unknown, research has identified family history as a significant risk factor for developing this skin condition. Some genetic mutations may play a role in the development of seborrheic keratoses in certain individuals. Additionally, people with one seborrheic keratosis lesion are more likely to develop additional growths. This is probably related to family history as well, since 50% of cases with multiple seborrheic keratoses occur within families.

What causes a Seborrheic keratosis on the breast?

Seborrheic keratoses rarely appear on the breasts. Instead, the most common locations for seborrheic keratosis are the back, face, neck, and chest. If you notice a pigmented growth on your breast, it is important to schedule an examination promptly. Any pigmentation on the breast could indicate invasive breast carcinoma. During your appointment with Dr. Green, she will perform a biopsy by shaving off a portion of the growth with a scalpel for further testing.

Is Seborrheic Keratosis a wart?

Although seborrheic keratoses often look verrucous or “wart-like,” they are not warts. Warts are caused by a virus, such as human papillomavirus (HPV), and can be contagious. In contrast, seborrheic keratoses are not caused by a virus or bacteria and are not contagious. Therefore, seborrheic keratoses and warts should be treated differently. During an in-person consultation with Dr. Green, she will identify the type of skin lesion and provide appropriate treatment.

Can I use wart remover on Seborrheic keratoses?

Most wart removers contain salicylic acid, which can help diminish the appearance of seborrheic keratosis. However, they may also include other ingredients, such as alcohol, that can dry out the skin and further irritate the lesion, possibly causing scabbing and scarring. Since seborrheic keratoses are not caused by viruses like warts, at-home wart removal treatments are not only ineffective but can also harm the surrounding skin. If you’re unsure about the type of growth you have, it’s best to get it properly identified by an expert before trying any treatment.

Are Seborrheic keratoses the same as Seborrheic dermatitis?

Seborrheic keratosis is different from seborrheic dermatitis — they are two distinct skin conditions that require different diagnoses and treatments. While seborrheic keratoses appear as small, scaly, wart-like patches mostly on the face, neck, back, and chest, seborrheic dermatitis usually affects the scalp or other oily areas of the face, such as the eyebrows, beard, armpits, or mustache. It presents with scaly patches, irritated skin, and dandruff, and can also cause itching, flaking, and discomfort. Although it is not contagious, it can be distressing and often prompts patients to seek treatment. If you have seborrheic dermatitis, the best first step is to schedule a consultation with a board-certified dermatologist like Dr. Green, who can prescribe medicated shampoos or other topical remedies.

Where does Seborrheic dermatitis come from?

Currently, healthcare professionals are not entirely sure of the root cause of seborrheic dermatitis. Researchers hypothesize that the condition may occur due to excess oil on the skin, the presence of the yeast Malassezia, or a weakened immune system. Several other risk factors that can trigger the onset of seborrheic dermatitis symptoms include stress, weather changes, fatigue, depression, immune system disorders, or sudden traumatic medical conditions.

Where is Seborrheic dermatitis commonly seen?

Patients often ask, “Where is seborrheic dermatitis commonly seen?” It most often affects oily areas of the face and body, including the scalp, beard, eyebrows, mustache, armpits, ears, eyelids, sides of the nose, and chest. These visible areas can make many patients feel self-conscious. Fortunately, Dr. Green’s dermatology office offers several treatment options, such as prescription topical creams and shampoos.

Will Seborrheic keratosis go away?

Seborrheic keratoses typically do not disappear on their own. Once a growth appears, it usually stays on the skin unless treated. However, seborrheic keratosis is benign, meaning it is not harmful and does not need to be removed. Some patients might find that the texture of seborrheic keratosis causes the lesions to be uncomfortable against their clothing. Sometimes, this friction can result in itchiness, skin irritation, and bleeding. For these patients, removing the lesion can help alleviate these symptoms.

Should Seborrheic keratoses be removed?

Removal is usually unnecessary for most seborrheic keratoses because they are completely benign and do not develop into skin cancer. Many people choose to leave them alone if they do not cause discomfort. However, removal might be advised if the growths become irritated, itchy, catch on clothing, or bleed. Some patients also opt to have them treated for cosmetic reasons if the lesions are very visible or bothersome. Although these growths are harmless, it is always best to have any new or changing spots evaluated by a board-certified dermatologist before removal to ensure that the lesion is not something more serious.

How to treat Seborrheic keratosis?

If you notice any new skin lesions, it is best to make an appointment with a board-certified dermatologist like Dr. Green, who can diagnose the skin condition to ensure it is not dangerous. Patients with seborrheic keratosis may want to remove the lesions for cosmetic reasons or because the texture causes itchiness, irritation, or bleeding. Depending on the shape and texture of the seborrheic keratosis, Dr. Green will choose from several treatment options, including electrocautery, which uses an electric current to destroy the growth; laser therapy; scraping with a curette blade to remove the growth; shave excision to shave the growth off; prescription hydrogen peroxide to dissolve it; or freezing the growth with cryotherapy or cryosurgery.

Who removes Seborrheic keratoses?

When needing to diagnose and remove a skin growth, it is best to consult an expert, board-certified dermatologist like New York City-based Dr. Michele Green. Dr. Green begins by examining the growth to ensure it is not dangerous. Usually, simply inspecting the growth is enough to identify if it is a seborrheic keratosis, but in some cases, Dr. Green might perform a biopsy to test for skin cancer. A skin biopsy involves removing some or all of the lesion for lab analysis. In some cases, dermoscopy can be used to closely examine a lesion. Seborrheic keratosis can resemble other skin conditions, such as actinic keratosis, which may be precancerous. Skin cancer is generally treatable if caught early, so it is best to consult with a board-certified dermatologist immediately when you notice any new growths or changes to existing lesions.

How do dermatologists remove Seborrheic keratoses?

Dermatologists have several methods for removing seborrheic keratosis lesions, including:

Laser Treatment: Laser therapy to remove seborrheic keratosis lesions can be either ablative, which removes part of the outer skin layer, or non-ablative, which uses an energy source like light to burn the lesion away. Laser treatments are highly effective in removing seborrheic keratosis lesions, especially ablative laser therapies. Ablative lasers may require some recovery time.

Prescription Hydrogen Peroxide: Recently, the FDA approved the use of prescription-strength 40% hydrogen peroxide for treating seborrheic keratosis lesions. Patients will receive an applicator pen to apply the medication at home. Some patients experience skin irritation around the treated area as a common side effect.

Curettage: Curettage involves using a scalpel blade to remove the growth. Depending on the shape and size of the seborrheic keratosis, Dr. Green might combine curettage with electrocautery or cryosurgery.

Electrocautery: Electrocautery uses an electric current to burn the lesion, effectively destroying it. When a seborrheic keratosis lesion has thicker growth and a rougher texture, electrocautery can be combined with curettage for better results.

Cryotherapy: Cryotherapy is a treatment that uses liquid nitrogen to freeze off seborrheic keratoses. Usually, Dr. Green avoids liquid nitrogen because there is a risk of hypopigmentation in the treatment area for patients with darker skin tones. Also, cryotherapy may not yield the best results.

What dissolves Seborrheic keratosis?

The most effective treatment for dissolving seborrheic keratoses is the recently FDA-approved 40% hydrogen peroxide. Due to its high concentration, 40% hydrogen peroxide is only available with a prescription from a dermatologist, such as Dr. Green. The solution is applied with an applicator pen to avoid contact with other areas of skin. Prescription hydrogen peroxide may cause skin irritation at the application site, but this side effect is usually mild and well-tolerated.

Will fluorouracil remove Seborrheic keratosis?

No. Fluorouracil is a topical treatment used for seborrheic keratosis. Studies show that although fluorouracil can reduce the appearance of seborrheic keratosis lesions over time, it is less effective than in-office procedures such as laser therapy, electrocautery, curettage, or cryotherapy.

How to remove Seborrheic keratosis at home

The best treatment for seborrheic keratosis is to book an appointment with a board-certified dermatologist, who can accurately diagnose the condition and recommend a topical or in-office treatment. Some topical options are available over the counter, such as alpha-hydroxy acids like glycolic and salicylic acids, 1% hydrogen peroxide, and 0.1% tazarotene cream. While these at-home treatments can improve the look of seborrheic keratoses, they are generally less effective than professional in-office treatments.

How to treat Seborrheic keratosis on the face

When treating seborrheic keratosis on the face, the approach should be gentle yet effective. Facial skin is thinner and more sensitive than other areas, so treatment options must be selected carefully to protect the surrounding skin and minimize scarring and pigmentation changes. Common choices include prescription hydrogen peroxide, curettage, and electrocautery. However, the best treatment depends on several factors, such as the size, texture, and location of the lesion. After treatment, patients should keep the area clean, moisturized, and protected from the sun to promote smooth healing.

How to remove Seborrheic keratosis naturally

There are no proven natural remedies that can safely and completely remove seborrheic keratosis. While some over-the-counter products containing glycolic acid, salicylic acid, or low-concentration hydrogen peroxide may help reduce the appearance of the growth, they do not fully eliminate the lesion and can cause irritation. Natural remedies such as applying apple cider vinegar, essential oils, and herbal pastes lack scientific support and may damage the surrounding skin or lead to scarring. For safe and effective removal, especially for growths on the face or in sensitive areas, treatments performed by a board-certified dermatologist are the safest, most reliable option.

How to get rid of Seborrheic keratosis on the scalp

Seborrheic keratoses on the scalp are often seen during haircuts or styling because they can be hidden under the hair. When these growths become irritated by combs, brushes, hats, or helmets, removal might be recommended. Since the scalp has many hair follicles, treatments are chosen to target the lesion precisely without damaging the surrounding area. Methods such as gentle curettage, targeted laser therapy, or electrocautery can remove the growth without harming nearby skin and hair. These procedures are performed in-office and are customized based on the size, thickness, and location of each lesion.

Can a Seborrheic keratosis grow back?

Once a seborrheic keratosis is fully removed, it usually does not return in the same spot. However, since seborrheic keratosis is associated with factors like age and genetics, new lesions often appear over time in different areas. If removal is incomplete and a small part of the growth remains, that area can gradually thicken and grow back to its original size or larger. Even after complete removal, many patients still develop new spots over the years, which is a normal part of the condition.

Will Seborrheic keratoses fall off?

Seborrheic keratoses are generally firmly attached to the skin unless removed. The surface may become flaky, but the lesion itself rarely detaches completely on its own. In rare instances, scratching or friction from clothing, hats, or grooming tools can cause part of the growth to fall off and lead to irritation. If this occurs, it is best to consult a board-certified dermatologist to remove the lesion entirely and prevent further irritation safely.

How to Treat Seborrheic Keratoses

Seborrheic keratosis is a common skin condition affecting up to 3 million Americans each year, mainly in patients over age 50. It features oval-shaped, flat or raised light tan, brown, or black lesions, and is noncancerous. These lesions often appear on the face, back, chest, and neck. Although they pose no health risk, some patients dislike their appearance or find the scaly, wart-like texture irritating when it rubs against clothing. Fortunately, many treatment options are available at Dr. Green’s New York City dermatology office, including laser treatments, prescription topical treatments, curettage, and electrocautery. To determine the best treatment for your seborrheic keratosis, schedule a consultation with Dr. Green.

Dr. Michele Green is an internationally acclaimed, board-certified dermatologist with over 25 years of experience providing her patients with top non-invasive treatment options. She takes a holistic approach and follows a less-is-more philosophy, creating personalized skincare routines and treatment plans tailored to each patient’s specific concerns and aesthetic goals. She is regularly recognized as one of New York’s leading dermatologists by Castle Connolly, New York Magazine, and Super Doctors for her commitment and expertise. Please call us at 212-535-3088 or email our New York City-based office today to schedule a consultation with Dr. Michele Green and find out the best seborrheic keratoses treatment option for you.