Age Warts – Seborrhoeic Keratosis – Dr Davin Lim

Seb keratosis is the most common skin lesion. They have many forms including raised, flat, white, black, brown, red. They can take on many shapes including a horn, a collision tumour or even a skin tag like lesion. Most warts can be diagnosed clinically. In some cases, your doctor may use a dermatoscope to identify the keratin pearls & whirls, as well as crypts. These are commonly encountered in these lesions if in doubt, a biopsy may be taken.

In Queensland, studies have shown that up to 10% or warts may contain skin cancer known as squamous cell carcinoma in-situ. This is also called Bowen disease or Intraepithelial Cancer. This is primarily seen in patients who exhibit extensive sun damage. The prognosis is excellent. Rare cases of other collision tumours have been described including BCCs & melanoma.

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The natural history of seborrheic warts is one of persistence & growth. Some cases involve in time or following inflammation. Examples include lichenoid keratosis.

Treatments can be super easy or very difficult, depending on the skin type of the patient, location of the wart, & morphology. Raised keratosis on the back can be treated with cryotherapy or a simple shave, whilst flat warts on the face in darker skin patients (including Asiatic skin) can be extremely complex to treat. In these cases, pico lasers are best, however for thicker lesions may require CO2 lasers.

There are two special variants of seborrheic warts that deserve a mention. Firstly DPN or dermatosis papulosa nigra or Morgan Freeman disease. These are variants of Seb keratosis that arise on the face in darker or ethnic skin types. Treatments are simple – curette, pin point diathermy or erbium lasers with a focal 1 mm spot.

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Another variant of Seb keratosis is called idiopathic guttate hypomelanosis. These lesions are white in colour & often flat. They occur on the arms & lower limbs, often after the age of 40. This form of age warts are difficult to treat.

DIY treatments can be effective for some cases. Compounded hydrogen peroxide, 30-40% can be effective, as can TCA 30-50%, phenol 88% as well as high strength salicylic acid. Obviously for warts in cosmetically sensitive areas, you are best treated by a dermatologist. Never-the-less, with a sensible approach, low risk seb keratosis can be a DIY job.

Disclaimer: I do not treat seborrheic warts in isolation. I may treat these if I am performing another procedure that requires a theatre list (laser ablation, medium to deep peels, surgical intervention). If you have warts or if you would like a diagnosis, please see my colleagues at Cutis.

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