Seborrheic keratoses (senile keratosis)

Seborrheic keratoses (senile keratosis) Seborrheic keratoses or senile keratoses, warty keratoses are benign tumor most common in older people. They have a variety of clinical presentations and develops by proliferation of epidermal cells. Although not yet identified the specific etiological factors, they appear mostly on areas exposed to sunlight.
They are usually asymptomatic, but may be itchy, or you can hang clothes and become inflamed. Patients are worried about their malignancy. It begins by the appearance of well-defined patches, light brown, flat. Lesions may be numerous and dispersed. As they grow develop a warty surface smooth with multiple follicles prominent. They can grow, cause itching or bleeding. Seborrheic keratoses are benign and pose no danger to human health. Lesions usually not resolved and grow and become tougher with time.
Medical treatment shows success in using trichloroacetic acid, ammonium lactate or other chemical substances peeling lesions. Teraapia surgery include cryotherapy with liquid nitrogen or carbon dioxide, and ciuretajul electrodesicarea, tangential biopsy, laser and dermoabraziunea.
Pathogenesis
The etiology of seborrheic keratoses development is not known. This shows the obvious histological proliferation. Increased cell replication was demonstrated in seborrheic keratosis. Reticulated lesions are seen on sun-exposed areas and may develop lesions of lentigo. Seborrheic keratosis shows a varied degree of pigmentation. In pigmented seborrheic keratosis keratinocytes triggers activation of melanocyte proliferation in the vicinity.
Case sebereice keratoses is not known. Some cases are inherited autosomal dominant. Sunlight seems to play a role in the development of seborrheic keratoses. The evidence shows that some of the lesions have a clonal nature. Activating mutations in the gene that encodes tyrosine kinase receptor is described in adenoid seborrheic keratoses 85%.
Signs and symptoms
Seborrheic keratoses are the most common benign tumors that occur in older people. They seem to increase with age. And young people are described. They are usually asymptomatic. Lesions may be itchy, you can hang it on clothes and become inflamed. They are unattractive and the patient shows negative psychological connotations and remembering his old age. Patients are often worried about malignizarii lesions. A person may submit multiple injuries and may not notice a dysplastic nevus or a malignant melanoma that develops between keratosis. A significant danger occurs when a person does not deteteaza malignant melanoma in its early stages.
Lesser-ral's sign is asociaerea keratozxa multiple seborrheic lesions erupted with internal malignancy. The most common sign is seen in adenocarcinoma, especially of the gastrointestinal tract, however, an eruption of seborrheic keratoses can occur after any inflammatory dermatitis (eczema, severe sunburn).
Init sebereica keratoses appear in the form of patches of flat, brown, well defined. Lesions may be numerous and dispersed. As they grow develop a warty surface followed by the appearance of numerous prominent follicles. Typically have an aspect of follicles introduced into the lesion. The color of the lesion can vary from light brown with shades of pink and black till dark brown. Evolution includes natural broadening with increasing induration slow and gradual development of new lesions. There is also a way of transmitting hereditary familial lesions in almost half of patients with autosomal dominant mechanism.
Physical Exam
Initially one or more patches appear brown, well defined, flat surface which develops a warty. more lesions on the surface shows stoppers keratins. They appear on normal skin. Ese initial size of less than 1 cm but can grow up to several cm. With time the lesions become hard and have the appearance of being planted on the skin. Some are covered by greasy scales and are supradenivelate grip. Sebereice keratoses feeling soft and fat. The shape is round or oval, and multiple lesions can be aligned in the direction pliutilor skin. Most small lesions are placed around the follicular openings, especially on the trunk. Most seborrheic keratoses hairiness shows a little skin that surrounds them. Sometimes the lesions can become large until 35x15 cm.
Surface luminescence microscopy showed lesions similar structures Globe. It is due to intraepidermal cysts filled with melanin cornificate cell. It resembles brown globules seen in neoplasms melanocitice nests of melanocytes is due to the junction dermoepidermica. The irritation can cause swelling and bleeding, inflammation crustificare and deeper coloration. Seborrheic keratoses can become inflamed when they are red-brown.
Variants include: Papulosa nigra dermatosis These injuries affect the face, especially cheeks and lateral orbital areas. They are small, Pedunculated and pigmented keratoses elements minimum. The onset of these lesions is usually early seborrheic keratoses from simple. These lesions appear to be caused by a defect pilosebacei nevoid follicular development. Histology shows hyperkeratosis and irregular acanthosis.
Stucco keratoses Some adults develop numerous lesions of keratosis gray-brown on the dorsal feet, ankles and the dorsal hands and arms. It is considered that they are a variant of seborrheic keratosis. Intraepidermal cysts are observed histologically.
Melanoachantomul Seborrheic keratosis is a deep pigmentation that match acantotica proliferation of large dendritic melanocytes. Probably represents a concomitant proliferation and activation of dendritic melanocytes and epidermal cells.
The differential diagnosis is made with the following conditions: actinic keratosis, arsenic keratosis, skin carcinoma, melanoma, Bowen's disease, papilomatozele, cutaneous horn, cutaneous manifestations of HIV, warts sebacate, melanocitici, prurigo nodularis, psoriasis, warts, lentigo.
Treatment
Keratolytic agents Ammonium lactate and alpha hydroxy acids have reported a reduction in seborrheic keratosis. Superficial lesions can be treated by careful application of trichloroacetic acid and repeated easily removed if not the first treatment of lesion thickness. Treatment with topical tazarotene applied twice daily for 16 weeks lead to clinical improvement of seborrheic keratoses.
Surgical Therapy There are a variety of techniques to treat seborrheic keratosis. These include cryotherapy with liquid nitrogen or carbon dioxide, electrodesicarea and curettage, only curettage, biopsy and tangential excision with scalpel, and laser dermoabraziunea. Some of these techniques destroy the lesion without allowing the taking of a specimen for histopathological diagnosis. Tangential biopsy allows histological sampling of material for accurate diagnosis and remove the intro meniera acceptable cosmetic damage at the same time. After a biopsy can be used as a scoop and remove keratotic material remaining. If you want an accurate biopsy electrodesicarea facilitate an abortion.
Freezing injuries with some ice or liquid nitrogen timber removes the need for surgical excision, however, complications include pigmentary changes, and occasionally freezing the scar. Curettage with liquid nitrogen has better results compared to liquid hnitrogen alone. Application of 70% glycolic acid for 3-5 minutes before curettage is also effective. Seborrheic keratoses are benign and do not represent a health hazard. The injuries do not resolve but indureaza grow in size and time.