Age warts – seborrhoeic keratosis

  • Best Results1-2 sessions
  • Treatment Recovery2-5 days
  • Procedure Time3-20 minutes
  • Skin SpecialistNurse
  • Duration of ResultsLong-term
  • AnaestheticNumbing
  • Back to WorkNext day
  • Cost$-$$

Age warts - seborrhoeic keratosis

Age warts are also known as seborrhoeic keratosis. As the name suggests, they increase with age. Treatments include freezing, surgical debulking, diathermy, as well as laser ablation. If you have age spots, discuss treatment options with your dermatologist.

FactsFacts on seborrhoeic warts

  • A minority of warts may have foci of superficial skin cancer
  • Simple treatments include freezing, curettage & shave excision
  • Cryotherapy should not be used on darker skin types
  • My clinical team primarily use high density CO2 lasers to treat warts
  • DIY treatments include salicylic & lactic acid solutions
  • The majority of seb warts are non-cancerous

What are age warts?

I refer to these as barnacles on the ship of life. Seborrheic keratosis are polymorphic, meaning they have many forms. These include-

  • Classic seborrheic warts: looks like a wart only brown/black.
  • Flat seb warts: looks like a mole or big freckles.
  • Dermatosis papulosa nigra: Tiny black bumps on the face & neck.
  • Cutaneous horn: Horn like projection.
  • Inflamed wart or regressing wart: Looks red/brown.
  • Idiopathic Guttate Hypomelanosis: white seb warts

If in doubt, see a dermatologist for a diagnosis & treatment plan.

Disclaimer: I do not treat warts. My work is procedurally based as I operate or laser complex conditions.

How do dermatologists manage age warts?

Dermatologists have many tricks to remove warts. The most common practices include-

  • Curettage with a blunt or sharp instrument
  • Shave with a blade
  • Cryotherapy
  • TCA-Phenol Chemical peels
  • Lasers including CO2, erbium & thulium
  • Excision
  • Diathermy

The type of treatment depends on the type of wart, the location & skin type of the patient. There are many doors to the same destination.

Which treatment do I prefer to remove warts?

I have taught my team to remove seborrheic keratosis with CO2 lasers & curettage. This technique gives the best results & cosmesis without any scarring. I do not treat seborrheic warts as my work is focused on complex procedures. Please see my colleagues or my clinical nurses. 

Will age warts & seborrheic keratosis increase in size & number?

Yes, they will, hence why they are called ‘age warts’. They will increase in size & number with increasing age. I refer to these as ‘barnacles on the ship of life.’

Davin’s Viewpoint on Seborrhoeic Warts

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.

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.

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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