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Diseases

Seborrheic keratosis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Seborrheic keratoses are common, multiple, benign tumors of the skin.

  • They usually appear in the fourth and fifth decades of life and their prevalence increases with age and sun exposure.

  • They appear as well-circumscribed "stuck-on" plaques or papules and may look like warts.

  • Most important differential diagnosis, and of patient concern, is malignant melanoma.

  • They are usually asymptomatic but can become irritated and inflamed spontaneously or because of friction from clothing.

Seborrheic keratosis on the chest of an elderly woman
Seborrheic keratosis on the chest of an elderly woman
From the collection of Dr Braun and Dr Kolm, used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Seborrheic keratosis on the chest of an elderly woman

            Seborrheic keratosis on the chest of an elderly woman

          • Seborrheic keratosis of the chest: clinical overview image

            Seborrheic keratosis of the chest: clinical overview image

          • Seborrheic keratosis of the chest: clinical close-up image

            Seborrheic keratosis of the chest: clinical close-up image

          • Dermoscopic image of seborrheic keratosis on the chest

            Dermoscopic image of seborrheic keratosis on the chest

          • Clinical close-up image of seborrheic keratosis on the back of a 40-year-old man

            Clinical close-up image of seborrheic keratosis on the back of a 40-year-old man

          • Clinical overview image of seborrheic keratosis on the back of a 40-year-old man

            Clinical overview image of seborrheic keratosis on the back of a 40-year-old man

          • Clinical image of an example of a dark-brown pigmented seborrheic keratosis

            Clinical image of an example of a dark-brown pigmented seborrheic keratosis

          • Example of a dark-brown pigmented seborrheic keratosis. Dermoscopic image: see yellowish horn pearls

            Example of a dark-brown pigmented seborrheic keratosis. Dermoscopic image: see yellowish horn pearls and dark brown holes corresponding to so-called "pseudo-follicular openings"

          • ​Dermatosis papulosa nigra, a common subtype of seborrhoeic keratosis which is more prevalent in peo

            ​Dermatosis papulosa nigra, a common subtype of seborrhoeic keratosis which is more prevalent in people with brown or black skin (Fitzpatrick skin type IV, V or VI)

          • Typical dermoscopic appearance of seborrheic keratosis with milia-like cysts (black arrows) and come

            Typical dermoscopic appearance of seborrheic keratosis with milia-like cysts (black arrows) and comedo-like openings (blue arrows)

          Citations

            Key Articles

            • Seaton E, Madan V. Benign keratinocytic acanthomas and proliferations. In: Barker J, Griffiths C, Bleiker T, eds. Rook's textbook of dermatology. 10th ed. Hoboken, NJ: John Wiley & Sons, Ltd; 2024.

            • Patterson JW. Chapter 32: Tumors of the epidermis. In: Patterson JW. Weedon's skin pathology. 6th ed. Philadelphia, PA: Elsevier; 2025: 877-936.

            • Barthelmann S, Butsch F, Lang BM, et al. Seborrheic keratosis. J Dtsch Dermatol Ges. 2023 Mar;21(3):265-77.[Abstract][Full Text]

            Other Online Resources

            • BAD: seborrhoeic keratosis​
            • ​DermNet New Zealand Trust: seborrhoeic keratosis

            Referenced Articles

            • 1. Seaton E, Madan V. Benign keratinocytic acanthomas and proliferations. In: Barker J, Griffiths C, Bleiker T, eds. Rook's textbook of dermatology. 10th ed. Hoboken, NJ: John Wiley & Sons, Ltd; 2024.

            • 2. Patterson JW. Chapter 32: Tumors of the epidermis. In: Patterson JW. Weedon's skin pathology. 6th ed. Philadelphia, PA: Elsevier; 2025: 877-936.

            • 3. Yeatman JM, Kilkenny M, Marks R. The prevalence of seborrhoeic keratoses in an Australian population: does exposure to sunlight play a part in their frequency? Br J Dermatol. 1997;137:411-414.[Abstract]

            • 4. Gorai S, Ahmad S, Raza SSM, et al. Update of pathophysiology and treatment options of seborrheic keratosis. Dermatol Ther. 2022 Dec;35(12):e15934.[Abstract][Full Text]

            • 5. Holdiness MR. On the classification of the sign of Leser-Trelat. J Am Acad Dermatology. 1988;19:754-757.[Abstract]

            • 6. Schwartz RA. Sign of Leser-Trelat. J Am Acad Dermatol. 1996;35:88-95.[Abstract]

            • 7. Barthelmann S, Butsch F, Lang BM, et al. Seborrheic keratosis. J Dtsch Dermatol Ges. 2023 Mar;21(3):265-77.[Abstract][Full Text]

            • 8. Mirali S, Mufti A, Lansang RP, et al. Eruptive seborrheic keratoses are associated with a co-occurring malignancy in the majority of reported cases: a systematic review. J Cutan Med Surg. 2022 Jan-Feb;26(1):57-62.[Abstract][Full Text]

            • 9. Augustin M, Herberger K, Hintzen S, et al. Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers. Br J Dermatol. 2011 Oct;165(4):865-73.[Abstract][Full Text]

            • 10. Du Y, Doraiswamy C, Mao J, et al. Facial skin characteristics and concerns in Indonesia: a cross-sectional observational study. Skin Res Technol. 2022 Sep;28(5):719-28.[Abstract][Full Text]

            • 11. Jackson JM, Alexis A, Berman B, et al. Current understanding of seborrheic keratosis: prevalence, etiology, clinical presentation, diagnosis, and management. J Drugs Dermatol. 2015 Oct;14(10):1119-25.[Abstract]

            • 12. Bhat RM, Patrao N, Monteiro R, et al. A clinical, dermoscopic, and histopathological study of dermatosis papulosa nigra (DPN) - an Indian perspective. Int J Dermatol. 2017 Sep;56(9):957-60.[Abstract]

            • 13. Cheong KA, Lee AY. Guanine deaminase stimulates ultraviolet-induced keratinocyte senescence in seborrhoeic keratosis via guanine metabolites. Acta Derm Venereol. 2020 Apr 6;100(8):adv00109.[Abstract][Full Text]

            • 14. Xie F, Wang R, Chen Y, et al. A case of seborrhoeic keratosis and family survey. West Indian Med J. 2015 May 11;65(1):219-21.[Abstract][Full Text]

            • 15. Nakamura H, Hirota S, Adachi S, et al. Clonal nature of seborrheic keratosis demonstrated by using the polymorphism of the human androgen receptor locus as a marker. J Invest Dermatol. 2001 Apr;116(4):506-10.[Abstract][Full Text]

            • 16. Rayess H, Wang MB, Srivatsan ES. Cellular senescence and tumor suppressor gene p16. Int J Cancer. 2012 Apr 15;130(8):1715-25.[Abstract][Full Text]

            • 17. Alexandrova AK, Smolyannikova VA, Filatova VA, et al. Protein p16 role in seborrheic keratosis. Our Dermatol Online. 2016;7(4):377-380.[Full Text]

            • 18. Li Y, Wang Y, Zhang W, et al. Overexpression of amyloid precursor protein promotes the onset of seborrhoeic keratosis and is related to skin ageing. Acta Derm Venereol. 2018 Jun 8;98(6):594-600.[Abstract][Full Text]

            • 19. Kwon OS, Hwang EJ, Bae JH, et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol Photoimmunol Photomed. 2003;19:73-80.[Abstract]

            • 20. Hafner C, Hartmann A, van Oers JM, et al. FGFR3 mutations in seborrheic keratoses are already present in flat lesions and associated with age and localization. Mod Pathol. 2007;20:895-903.[Abstract]

            • 21. Kambiz KH, Kaveh D, Maede D, et al. Human papillomavirus deoxyribonucleic acid may not be detected in non-genital benign papillomatous skin lesions by polymerase chain reaction. Indian J Dermatol. 2014 Jul;59(4):334-8.[Abstract][Full Text]

            • 22. Huang J, Zhang L, Shi L, et al. An epidemiological study on skin tumors of the elderly in a community in Shanghai, China. Sci Rep. 2023 Mar 17;13(1):4441.[Abstract][Full Text]

            • 23. Garcia MS, Azari R, Eisen DB. Treatment of dermatosis papulosa nigra in 10 patients: a comparison trial of electrodesiccation, pulsed dye laser, and curettage. Dermatol Surg. 2010 Dec;36(12):1968-72.[Abstract]

            • 24. National Institute for Health and Care Excellence. Melanoma: assessment and management. Jul 2022 [internet publication].​[Full Text]

            • 25. Tschandl P, Codella N, Akay BN, et al. Comparison of the accuracy of human readers versus machine-learning algorithms for pigmented skin lesion classification: an open, web-based, international, diagnostic study. Lancet Oncol. 2019 Jul;20(7):938-947.[Abstract][Full Text]

            • 26. Braun RP, Rabinovitz HS, Krischer J, et al. Dermoscopy of pigmented seborrheic keratosis: a morphological study. Arch Dermatol. 2002;138:1556-60.[Abstract][Full Text]

            • 27. Ahlgrimm-Siess V, Cao T, Oliviero M, et al. Seborrheic keratosis: reflectance confocal microscopy features and correlation with dermoscopy. J Am Acad Dermatol. 2013;69:120-6.[Abstract]

            • 28. Wollina U. Recent advances in managing and understanding seborrheic keratosis. F1000Res. 2019 Aug 28;8:F1000 Faculty Rev-1520.[Abstract][Full Text]

            • 29. Bafounta ML, Beauchet A, Aegerter P, et al. Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol. 2001;137:1343-1350.[Abstract]

            • 30. Wang SQ, Rabinovitz H, Oliviero MC. Dermoscopic patterns of solar lentigines and seborrheic keratoses. Braun. In: Marghoob AA, Braun RP, Kopf AW, eds. Atlas of dermoscopy. London: Taylor and Francis; 2005:60-71.

            • 31. Izikson L, Sober AJ, Mihm MC Jr, et al. Prevalence of melanoma clinically resembling seborrheic keratosis: analysis of 9204 cases. Arch Dermatol. 2002;138:1562-1566.[Abstract][Full Text]

            • 32. Vinciullo C, Madan V. Basal cell carcinoma​. In: Griffiths C E M, Barker J, Bleiker T O, eds. Rook's textbook of dermatology. 10th ed. Hoboken, NJ: John Wiley & Sons Ltd; 2024.

            • 33. Cranwell WC, Sinclair R. Optimising cryosurgery technique. Aust Fam Physician. 2017;46(5):270-4.[Abstract]

            • 34. Wood LD, Stucki JK, Hollenbeak CS, et al. Effectiveness of cryosurgery vs curettage in the treatment of seborrheic keratoses. JAMA Dermatol. 2013;149:108-109.[Abstract][Full Text]

            • 35. Mardani G, Nasiri MJ, Namazi N, et al. Treatment of solar lentigines: a systematic review of clinical trials. J Cosmet Dermatol. 2025 Apr;24(4):e70133.[Abstract][Full Text]

            • 36. Natarelli N, Krenitsky A, Hennessy K, et al. Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review. J Dermatolog Treat. 2023 Dec;34(1):2133532.[Abstract][Full Text]

            • 37. Ortonne JP, Pandya AG, Lui H, et al. Treatment of solar lentigines. J Am Acad Dermatol. 2006;54(suppl 2):S262-71.[Abstract]

            • 38. Krupashankar DS; IADVL Dermatosurgery Task Force. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008;74(suppl):S61-7.[Abstract][Full Text]

            • 39. Polder KD, Landau JM, Vergilis-Kalner IJ, et al. Laser eradication of pigmented lesions: a review. Dermatol Surg. 2011;37:572-595.[Abstract]

            • 40. Jain S, Caire H, Haas CJ. Management of dermatosis papulosa nigra: a systematic review. Int J Dermatol. 2025 Mar;64(3):473-8.[Abstract]

            • 41. Murphy EC, Friedman AJ. Hydrogen peroxide topical solution, 40% (w/w) for the treatment of seborrheic keratoses: a review. Skin Therapy Lett. 2020 Jan;25(1):1-4.[Abstract][Full Text]

            • 42. Baumann LS, Blauvelt A, Draelos ZD, et al. Safety and efficacy of hydrogen peroxide topical solution, 40% (w/w), in patients with seborrheic keratoses: Results from 2 identical, randomized, double-blind, placebo-controlled, phase 3 studies (A-101-SEBK-301/302). J Am Acad Dermatol. 2018 Jun 1;79(5):869-877.[Abstract][Full Text]

            • 43. Funkhouser CH, Coerdt KM, Haidari W, et al. Hydrogen peroxide 40% for the treatment of seborrheic keratoses. Ann Pharmacother. 2021 Feb;55(2):216-221.[Abstract]

            • 44. Taylor SC, Averyhart AN, Heath CR. Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: a comparison of a skin protectant ointment and a topical antibiotic. J Am Acad Dermatol. 2011 Mar;64(3 suppl):S30-5.[Abstract][Full Text]

            • 45. Ethington E, Mitri A, Surprenant D, et al. Patient preferences and comparative outcomes regarding cryosurgery versus electrodesiccation in the removal of truncal seborrheic keratoses. J Clin Aesthet Dermatol. 2019 Sep;12(9):E53-6.[Abstract][Full Text]

            • 46. Mazzoni D, Muir J. A guide to curettage and cautery in the management of skin lesions. Aust J Gen Pract. 2021 Dec;50(12):893-7.[Abstract][Full Text]

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