Treatment is not always necessary because of the benign nature of seborrhoeic keratosis.[7]Barthelmann S, Butsch F, Lang BM, et al. Seborrheic keratosis. J Dtsch Dermatol Ges. 2023 Mar;21(3):265-77.
https://onlinelibrary.wiley.com/doi/10.1111/ddg.14984
http://www.ncbi.nlm.nih.gov/pubmed/36892019?tool=bestpractice.com
Lesions are generally asymptomatic but can become irritated and inflamed either spontaneously or because of friction from clothing. Treatment is given for cosmetic reasons and to decrease irritation.
Numerous methods are effective. The most frequently used methods are cryotherapy, curettage (shaving), and surgical excision.
Irritated and itching
Topical corticosteroids can be used symptomatically on irritated and itching lesions. Corticosteroids can be used alone or before other treatments.
Removal of raised lesions
Curettage (shaving) or cautery are used to remove raised seborrhoeic keratosis.[1]Seaton E, Madan V. Benign keratinocytic acanthomas and proliferations. In: Barker J, Griffiths C, Bleiker T, eds. Rook's textbook of dermatology. 10th ed. Hoboken, NJ: John Wiley & Sons, Ltd; 2024. Curettage leaves a flat surface that becomes covered by normal epidermis in 1 week. Cautery is rarely used as it is more likely to leave scars. Cryotherapy with liquid nitrogen is not effective in the treatment of very thick lesions.[33]Cranwell WC, Sinclair R. Optimising cryosurgery technique. Aust Fam Physician. 2017;46(5):270-4.
http://www.ncbi.nlm.nih.gov/pubmed/28472571?tool=bestpractice.com
Treatment of flat lesions
In most cases the best method for the treatment of solar lentigines/initial flat seborrhoeic keratosis may be gentle cryotherapy with liquid nitrogen. The lesion is frozen for 2 to 3 seconds and is then allowed to thaw before the cycle is repeated once more in the same session. The application of a healing ointment will encourage fast healing. If necessary, cryotherapy can be repeated after a few weeks. Use of sun protection following treatment is necessary to avoid hyperpigmentation. Cryotherapy and curettage have both been shown to be effective methods of removing seborrhoeic keratoses that result in highly satisfactory cosmetic outcomes; however, in one study, the majority of patients preferred cryotherapy for removal because of the decreased wound care involved.[34]Wood LD, Stucki JK, Hollenbeak CS, et al. Effectiveness of cryosurgery vs curettage in the treatment of seborrheic keratoses. JAMA Dermatol. 2013;149:108-109.
http://jamanetwork.com/journals/jamadermatology/fullarticle/1557760
http://www.ncbi.nlm.nih.gov/pubmed/23324775?tool=bestpractice.com
Other treatment options for flat seborrhoeic keratosis are chemical peels (for example, with focal trichloroacetic acid) or dermabrasion with fine sandpaper or wire brushes.[35]Mardani G, Nasiri MJ, Namazi N, et al. Treatment of solar lentigines: a systematic review of clinical trials. J Cosmet Dermatol. 2025 Apr;24(4):e70133.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11948172
http://www.ncbi.nlm.nih.gov/pubmed/40145274?tool=bestpractice.com
[36]Natarelli N, Krenitsky A, Hennessy K, et al. Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review. J Dermatolog Treat. 2023 Dec;34(1):2133532.
https://www.tandfonline.com/doi/10.1080/09546634.2022.2133532
http://www.ncbi.nlm.nih.gov/pubmed/36215682?tool=bestpractice.com
The application of topical retinoic acid (tretinoin) has also demonstrated good clinical results.[37]Ortonne JP, Pandya AG, Lui H, et al. Treatment of solar lentigines. J Am Acad Dermatol. 2006;54(suppl 2):S262-71.
http://www.ncbi.nlm.nih.gov/pubmed/16631967?tool=bestpractice.com
[38]Krupashankar DS; IADVL Dermatosurgery Task Force. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008;74(suppl):S61-7.
https://ijdvl.com/standard-guidelines-of-care-co-2-laser-for-removal-of-benign-skin-lesions-and-resurfacing
http://www.ncbi.nlm.nih.gov/pubmed/18688106?tool=bestpractice.com
Other options are treatment with erbium:YAG laser, pulsed carbon dioxide laser, or 532 diode laser, but these options may involve more patient discomfort and recovery time.[38]Krupashankar DS; IADVL Dermatosurgery Task Force. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008;74(suppl):S61-7.
https://ijdvl.com/standard-guidelines-of-care-co-2-laser-for-removal-of-benign-skin-lesions-and-resurfacing
http://www.ncbi.nlm.nih.gov/pubmed/18688106?tool=bestpractice.com
[39]Polder KD, Landau JM, Vergilis-Kalner IJ, et al. Laser eradication of pigmented lesions: a review. Dermatol Surg. 2011;37:572-595.
http://www.ncbi.nlm.nih.gov/pubmed/21492309?tool=bestpractice.com
[40]Jain S, Caire H, Haas CJ. Management of dermatosis papulosa nigra: a systematic review. Int J Dermatol. 2025 Mar;64(3):473-8.
http://www.ncbi.nlm.nih.gov/pubmed/39367526?tool=bestpractice.com
Complications of treatments
Hyperpigmentation can occur after any treatment, but is common after cautery. Hypopigmentation can also occur after any treatment, but is common following cryotherapy. Scars and keloids can both occur after any treatment but are more common after cautery than curettage.