Seborrheic keratosis

The seborrheic keratosis, often called Age wart is a benign skin tumor that occurs mainly in the second half of life. Almost everyone develops seborrheic keratosis at some point, so the wart is the most common skin tumor.

What is seborrheic keratosis?

The seborrheic keratosis is also under the term Basal cell papilloma known. The tumor is more likely to occur in old age and affects both sexes equally. The tumor is an increased tissue growth in the uppermost layers of the skin with corneal growths and the formation of horn globules in the uppermost layers of the skin. One speaks here of pseudo horn cysts.

Above all, the so-called basaloid cells proliferate, so they grow faster and more numerous. Acanthosis is typical of seborrheic keratosis. Acanthosis is a widening of the prickly cell layer (stratum spinosum) of the top epithelial layer of the skin. The histological picture also shows various characteristic growth patterns.

The keratinocytes, specialized keratin-producing cells in human skin, are often hyperpigmented. The keratinocytes in seborrheic keratosis therefore contain an excessive amount of melanin. Orthohyperkeratosis is also typical of the basal cell papilloma. Here the stratum corneum, the horny layer of the skin, is thickened.

causes

The exact cause of seborrheic keratosis is still unclear. On the one hand, it is assumed that the tumors are simply age-related skin symptoms. Genetic predisposition seems to play a role. The influence of external factors such as UV radiation, chemicals or light exposure is still unclear. A connection to human papillomaviruses was found in 20 percent of all cases of seborrheic keratosis.

Human papillomaviruses are viruses that attack the epithelial cells of the skin and cause uncontrolled cell growth there. Age spots are under discussion as the starting point for seborrheic keratosis, since the transitions between the skin spots and the skin tumors are clinically and histologically fluid.

Symptoms, ailments & signs

The tumor occurs primarily on the face, upper body, back of the hand, and the front of the arms. Predilection points on the upper body are the front and rear sweat troughs. The front sweat groove runs in the area of ​​the sternum, the furrow between the shoulder blades is called the rear sweat groove. Seborrheic keratosis manifests itself in the form of irregularly shaped tumors that are raised above the skin level.

The tumors are usually sharply demarcated and brownish to black in color due to the melanin deposits. Colorless variants are also known. In most cases, the basal cell papilloma is rather small. The diameter ranges from a few millimeters to one centimeter. Only in rare cases does the tumor grow larger. The surface of seborrheic keratosis is dull, dull, or warty. In advanced stages there is a rugged surface.

The sebum makes the tumor feel greasy and greasy. In bends, for example in the armpit, seborrheic keratosis can also be pedunculated. If numerous tumors suddenly appear, one speaks of the Reader-Trélat syndrome. This can manifest itself in the context of chronic inflammatory dermatoses or, as paraneoplastic syndrome, provide an indication of gastric adenocarcinoma.

Diagnosis & course of disease

When making a diagnosis, it is important to differentiate seborrheic keratosis from malignant tumors of the skin, as seborrheic warts can be confused with basaliomas and malignant melanomas. In most cases, dermatoscopy is used to differentiate. The skin is examined with a reflected light microscope down to the deeper layers of the skin. If the clinical classification is still unclear after dermatoscopy, a histopathological examination is carried out.

Here, tissue is taken from the tumor by means of a fine biopsy and examined under the microscope. If the tissue removed is the tissue of a seborrheic keratosis, histological abnormalities such as the above-described orthohyperkeratosis, the pseudo-horn cysts or the acanthosis appear. The prognosis for seborrheic keratosis is good. Since it is a benign skin lesion, the tumor does not metastasize.

Relapse only rarely occurs after removal. Occasionally the tumor reappears in a different location. Only in very rare cases does the basal cell papilloma develop into a basalioma, an infiltrating, growing skin tumor. The development of a carcinoma in situ, i.e. a localized, malignant tumor, is also only observed extremely rarely.

Complications

This disease usually causes various skin complaints. Complications do not have to arise in every case. Many people suffer from the disease, but do not experience any particular symptoms or discomfort. In most cases the aesthetics are reduced, so that many patients feel uncomfortable or ashamed of the symptoms.

A reduced self-esteem or inferiority complexes can also occur and have a very negative effect on the patient's quality of life. The tumor usually retains its size and does not change. The tumor can cause discomfort, especially on the face or other clearly visible areas. However, pain or other complaints do not occur. If the tumor is in the stomach, it can lead to stomach problems.

In most cases, treatment of the disease is only necessary if the tumor changes in color or size. This can then be removed. There are no particular complications and the disease usually progresses positively. As a rule, life expectancy is also not negatively affected by the tumor.

When should you go to the doctor?

As a rule, a doctor should always be consulted with this disease. It cannot heal on its own, so that the person concerned is always dependent on medical treatment. Above all, an early diagnosis with early treatment has a positive effect on the further course of the disease. Regular controls and examinations by a doctor are also necessary to prevent the tumor from spreading to other regions of the body.

A doctor should be consulted if black spots or spots develop on the body. These can appear in different places and should be examined by a doctor. Often a greasy layer on these spots also indicated seborrheic keratosis. Above all, a doctor should be consulted if these spots change in shape, color or size. A dermatologist can be consulted. Further treatment then depends on the exact complaints and their severity. If the tumor is removed early, there are no further complications and also no reduced life expectancy.

Therapy & Treatment

Normally, no therapy is required for seborrheic keratosis. Often, however, the skin growths are perceived as visually disturbing or cause pain due to mechanical irritation. If one of these factors applies and the diagnosis is clear, the tumor can be removed. During cautery, the tumor is removed with an electric snare or a sharp spoon. In the eyelid area, the tumor is removed using carbon dioxide.

Other methods of removal are freezing (cryotherapy) or laser removal. Before removing the tumor, a biopsy with a histological examination should always be performed. Otherwise there is a risk that a malignant tumor will be missed. If this malignant tumor were to be removed using the methods described, the superficial tumor tissue would be removed, but degenerate tissue could remain in the lower skin layers and metastasize unnoticed from there.

prevention

Since the causes of the basal cell papilloma are still unexplained, reliable prevention is not possible. In order to be able to differentiate benign seborrheic keratoses from malignant and more dangerous tumors of the skin, skin examinations should be carried out regularly by a dermatologist. From the age of 35, it is recommended to have an early diagnosis of skin cancer every two years.

Aftercare

Seborrheic keratosis, also known as old age warts because it usually occurs in the second half of life, is a benign skin tumor that usually does not require medical treatment. However, if those affected feel particularly uncomfortable with it, cosmetic removal can be considered. If the keratoses are in areas that are often exposed to mechanical irritation, it is advisable to have the age warts removed.

Especially when putting on and taking off it can quickly happen that the keratoses tear open due to uncoordinated movements, start to bleed and then become uncomfortably inflamed. In order to ensure that the person concerned is dealing with benign skin tumors, an examination by a dermatologist is useful. This will determine the harmlessness of the keratoses by means of a tissue sample.

Normal age warts usually do not pose a health risk for those affected. However, the focus here is often on the aesthetic aspect. If the keratoses appear on the face, it can be psychologically stressful for those affected. In consultation with a dermatologist, there are various options for successfully removing the keratoses and thus restoring the self-esteem of those affected. Medical treatment is also required if the skin tumors change in shape or color.

You can do that yourself

Seborrheic keratosis does not necessarily require treatment, but many people feel uncomfortable with it. Anyone who finds age warts uncomfortable should think about cosmetic removal. This is particularly advisable if the keratoses are in a place that becomes inflamed quickly. When shaving and sometimes getting dressed, those affected quickly come up against the patches of skin, which then start to bleed. Care must be taken here that the areas do not ignite.

As part of self-help, you should not scratch the warts under any circumstances. In order to make sure that the skin tumors are not malignant, an examination by a dermatologist is useful. This takes care of an exact tissue sample.

Normal age warts do not pose a threat, but they can cause certain symptoms such as irritation from clothing. Aesthetic problems in particular are an important aspect for most women and men. It will make you feel unattractive and try to hide the dark spots.In everyday life, the spots on the face are the most disturbing. As long as these do not change their shape and color, there is no health risk, but regular check-ups with the doctor are advisable.