Recent advances in managing and understanding seborrheic keratosis.

Uwe Wollina

doi:10.12688/f1000research.18983.1

Abstract

Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser–Trélat sign. New targeted cancer treatments can cause a pseudo-Leser–Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric–zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.

Highlights

Seborrheic keratoses (SKs) are very common benign epithelial skin tumors encountered in the adult population and show an increasing incidence with age, which reaches a peak at 60 years
Seborrheic keratosis (SK) in the genital area may be misinterpreted as human papillomavirus (HPV) lesions or extramammary Paget’s disease[3,4]
Dermatosis papulosa nigra is a clinical variant with multiple tiny lesions more common in patients with a Fitzpatrick skin type of at least 3 and in females

Summary

Introduction

Seborrheic keratoses (SKs) are very common benign epithelial skin tumors encountered in the adult population and show an increasing incidence with age, which reaches a peak at 60 years. Dermatosis papulosa nigra is a clinical variant with multiple tiny lesions more common in patients with a Fitzpatrick skin type of at least 3 and in females. Merkel cell polyoma virus (MCPyV) has been detected by polymerase chain reaction and fluorescence in situ hybridization in six out of 23 SKs. p16 expression was not associated with the presence of MCPyV27 Hyperkeratotic type This is the most common subtype (Figure 1). Tumor screening is recommended in case of abrupt development of multiple pruritic SKs. Pseudo-Leser–Trélat sign The inflammation of pre-existing seborrheic warts during chemotherapy of malignancies using drugs such as cytarabine, docetaxel, gemcitabine, or PD1 inhibitors like nivolumab has been coined pseudo-Leser–Trélat sign[42,43]. 155 patients with SKs are seen in practice, and one third exhibit more than 15 lesions On average, these dermatologists treat 43% of SK cases with cryosurgery as the most common method. A meta-analysis of topical vitamin-D analogues concluded that these compounds are ineffective for SKs67

Conclusion

Takenouchi T

PubMed Abstract

49. Wollina U

Findings

68. Wollina U