Seborrheic keratoses are extremely benign, noninvasive and hyperplasic growths commonly found on the skin. This condition is most prevalent in individuals aged above 40 years. Most are located on the trunk but occasionally they occur on the proximal limbs and the genitalia. Seborrheic keratoses present as sharply marginated, square-shouldered, tan, brown, or black papules 10 to 15 mm wide and 2 to 10 mm tall. These attributes contribute to a characteristic stuck on appearance. The surface often contains visible scale and is often rough on palpation. However, in some instances, the surface has a smooth and waxy feeling.
The cause of this condition is not clear, but genetic and aging factors play a big role in the development of this condition. Growth factors may also be important causal agents. Specifically, a small proportion of seborrheic kerotoses contain mutations in the fibroblast growth factor receptor 3 genes and a larger proportion demonstrates activation of the same normal gene 4.
Diagnosis of this skin condition can be done through a pathological examination of various biopsy material depending on the classification of seborrheic keratosis. Various speciment can also be collected for a histological test. Estrogen therapy, acromegaly, and various other internal malignancies have been associated with the occurence of multiple keratoses.
The type of therapy employed for treatment of these lesions should be sinple and fast depending on the classification of seborrheic keratosis manifested by the patient. Irritable lesions can be treated effectively with liquid nitrogen without using anesthesia. Monsel’s solution. Gelfoam, weak acids,and exertion of presure is used for homeostasis. Light electrodessication is also applicable although it may leave a minimal scar. it is advisable to leave these scars uncovered or lightly covered. Superficial shave excision, laser surgery, and cryosurgery may also be used in the therapy.
Classification of Seborrheic keratosis gives rise to several types:
Inflamed seborrheic keratosis contains an abundant of inflammatory infiltrate with lichenoid qualities. They have an inflammatory infiltrate composed typically of mononuclear cells, melanophages, or both. In some extreme cases, the entire seborrheic keratosis undergoes regression, evidenced by remnants of the original lesion and a clinical history of a lesion that changed.
Irritated seborrheic keratoses are produced by trauma, often picking by the patient. They are associated with HPV infection, horn cysts and pseudonym cysts with a range of keratinization patterns, from fully orthokeratotic to mixed patterns to parakeratotic. Melanoacanthoma is characterized by an interspersed mixture of non-pigmented keratinocytes and dendritic melanocytes. The epithelial thickness is variable, but usually thicker than the adjacent skin.
Clonal sebprrheic keratosis contains numerous basaloid, pigmented keratinocytes with disintegrated desmosomes.
Melanotic seborrheic keratoses contain numerous basaloid, pigmented keratinocytes, in contrast with melanoacanthoma, in which melanin is contained in dendritic melanocytes. In Pleomorphic types, a considerable number of keratinocytes is detected, the significance of which is not fully known. Genital seborrheic keratoses are quite difficult to differentiate from both pigmented genital warts and HPV-related intraepithelial neoplasia.
Genital seborrheic keratoses occur in solitary, resemble pigmented basal cell carcinomas, and have scale. these features enable one to differentiate between different keratosis types.
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