​Kembara Xtra - Medicine - Seborrheic Keratosis

​Kembara Xtra - Medicine - Seborrheic  Keratosis 
Frequently appears in multiples on the head, neck, and trunk (sparing the palms and soles) of older people, but may occur on any hair-bearing area of the body. It typically presents as multiple, well-circumscribed, yellow to brown raised lesions that feel greasy, velvety, or warty and is often described as having a "stuck-on" appearance. Clinical variants include the following:
Common seborrheic keratosis; Dermatosis papulosa nigra; Stucco keratosis; Flat seborrheic keratosis; Pedunculated seborrheic keratosis; Integumentary system affected; Synonym(s): SK, verruca seborrhoica; Seborrheic Wart; Senile Wart; Basal Cell Pap

Epidemiology 

Predominant sex: slightly more common and more extensive involvement in males; Predominant age: appear most commonly in those aged 31 to 50; incidence increases with age, peaking at age 60; Predominant race: most common among Caucasians, with the exception of the dermatosis papulosa nigra variant, which typically manifests in darker skinned individuals
The prevalence rate rises with aging, ranging from 69 to 100% in people over the age of 50.

Pathophysiology and Etiology 

The etiology is still mostly unknown, however ultraviolet (UV) light and genetics are thought to play a part, and the human papillomavirus may also play a part.
Genetics An autosomal dominant mode of inheritance is proposed.

Risk factors include advanced age, exposure to UV rays, and genetic predisposition.

Prevention 

Seborrheic keratoses may be avoided by using sun protection measures.

Accompanying Conditions 

A quick breakout of several seborrheic keratoses is a paraneoplastic condition called Leser-Trélat that is frequently accompanied by an internal cancer, most frequently an adenocarcinoma. Seborrheic keratosis may go away with cancer treatment and come back if the tumor returns.
It has been documented that seborrheic keratoses can coexist with other cutaneous lesions such basal cell carcinoma, malignant melanoma, or squamous cell carcinoma. It's unclear exactly how the lesions are related.


History 

Although the lesion is typically asymptomatic, trauma or irritation to the area can cause pruritus, erythema, bleeding, discomfort, and/or crusting.

clinical assessment 
As they mature, they may develop into thicker, elevated, uneven, verrucous-like papules, plaques, or peduncles with a waxy or velvety surface and appear "stuck on" to the skin. They typically start as oval- or round-shaped, flat, dull, sharply demarcated patches. However, they may appear on any hair-bearing skin.
Usually appear as multiples; patients having >100 is not uncommon. Vary in color (black, brown, tan, gray to white, or skincolored) as well as size, ranging from several millimeters to several centimeters, but the average diameter is 0.5 to 1.0 cm.
Common clinical variants include: - Common seborrheic keratoses: on hair-bearing skin, typically on the face, neck, and trunk; verrucous-like, waxy, or velvety lesions that appear "stuck on" to the skin - Dermatosis papulosa nigra: small black papules that typically appear on the face, neck, chest, and upper back; symmetric distribution most common in darker skinned people,
- Age-related increases in flat seborrheic keratoses, which are oval-shaped, tan to brown patches or macules on the face, chest, and upper extremities. Seborrheic keratoses with pendulations On places of friction (such as the neck and axilla), hyperpigmented peduncles occur.

Multiple Diagnoses 

If the seborrheic keratosis is, take into account the following conditions:
Malignant melanoma, melanocytic nevus, angiokeratoma, and pigmented basal cell carcinoma are all examples of pigmentation.
Basal cell carcinoma: Lightly pigmented
- Bowen syndrome
Acrochordon - Acrokeratosis verruciformis of Hopf - Follicular infundibulum tumor - Condyloma acuminatum - Fibroma - Verruca vulgaris - Eccrine poroma - Invasive squamous cell carcinoma - Flat - Solar lentigo - Juvenile verrucae planae - Hyperkeratotic - Actinic ker


Laboratory Results 

Initial examinations (lab, imaging) Initial examinations are typically not necessary unless the diagnosis is murky or cancer is suspected.

Other/Diagnostic Procedures
Biopsy and histologic examination should be carried out if the seborrheic keratosis is atypical, has recently been inflamed, or has changed in appearance.
In cases when the diagnosis is unclear, dermoscopy can help confirm the diagnosis. Common features include pigment networks, pigmented globules, streaks, homogeneous blue patterns, cysts that resemble milia, blotches, blue-whitish veils, and hairpin veins.


Interpretation of Tests

There are several histologic variations, some of which include:

"Squamous eddies" or clusters of squamous epithelial cells; Acanthosis and papillomatosis brought on by basaloid cell proliferation; Horn cysts; Hyperkeratosis; Pseudocysts;

Management Treatment is frequently administered for cosmetic issues, while it is usually not necessary.
Seborrheic keratoses should be removed if they are: - Undesirable or visually unappealing (a typical patient worry, however excision for this reason is not always reimbursed by insurance).
- They exhibit symptoms, such as being easily irritated or becoming tangled in jewelry or clothing.
- Their connection to cancer raises some alarm.

Medication Typically, surgical methods are preferred over medical therapy as a first line of treatment.
The FDA has approved HP40 (Eskata), a 40% hydrogen peroxide solution, as the first topical treatment for increased seborrheic keratosis. The application of the treatment can need two clinic visits, and it hasn't demonstrated superior cosmetic outcomes to other procedures.
Topical vitamin D analogs do not appear to be useful in treating seborrheic keratoses, according to several findings on the use of tazarotene, diclofenac gel, imiquimod, calcitriol, and dobesilate.


Referral A seborrheic keratosis gets inflamed or alters in appearance. New seborrheic keratoses that arise suddenly, especially if several do so within a short period of time.

Surgical Procedures Depending on the doctor's preference and the treatment's availability, a surgical approach to treatment is typically favored.
The following steps can be used in real life:
Spray flat lesions with liquid nitrogen for 5 to 10 seconds using this method; if the seborrheic keratosis is thicker, it may take longer or require further treatments.
Scarring, hypopigmentation, and recurrence are among the potential consequences.
- Cultism
To remove the lesion, use a curette, a metal hand instrument with a tiny scoop at the tip.
Electrodessication is necessary for local anesthesia.
 A device with a metal tip resembling a needle that uses electricity to burn away damaged tissue
 Local anesthetic is necessary - Shave excision
Lesion can be removed with a flexible razor blade or a scalpel.
Laser - Requires local anesthetic
 The lesion is burned and vaporized using strong laser beams.
 Chemical peel requires local anesthesia
To remove the top layer of skin, a chemical solution, such as trichloroacetic acid, is applied.
 Despite the fact that most patients preferred cryotherapy over curettage due to the reduced need for wound care following the operation, there were no statistically significant differences in patient judgments of cosmetic appearance between cryotherapy and curettage in a short study of 25 patients.


Patient Follow-Up Monitoring
In most cases, follow-up is not necessary after the first diagnosis unless inflammation or discomfort occurs.
The way they look has changed.
Seborrheic keratoses abruptly start to develop.

Patient Education – Sun protection measures may slow the growth of seborrheic keratoses.

Seborrheic keratoses typically do not progress to malignancy.
Leser-Trélat sign typically indicates a dismal outlook.

Complications 

Hypopigmentation, hyperpigmentation, scarring, partial removal, and recurrence are all potential side effects of surgical treatment. Mechanical stimulation from clothing and jewelry can also cause irritation and inflammation.
(Rare) Misdiagnosis

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