Seborrheic Keratosis: Questions and Insights from a Dermatologist

Inquiry Consultation

Dear Dr.
Wu,
Hello.
I have two pink lesions on my left shoulder that are very close together, appearing as a long, narrow protrusion, measuring approximately 0.4 x 0.1 cm.
They are slightly firm, non-painful, non-itchy, and not red or swollen, having appeared over the past few years.
After my long-term observation and research, I believe these lesions are seborrheic keratosis.
I would like to ask Dr.
Wu the following questions:
Q1.
The seborrheic keratosis on my left shoulder has recently developed a black scab covering its tip.
When I touch it with a cotton swab dipped in water, some of the black scab comes off.
I previously applied a product containing salicylic acid, "Strongly Shimei," to the seborrheic keratosis.
In your opinion, is the appearance of the black scab related to the medication I applied, or is it a result of the growth of the seborrheic keratosis, or could it be due to another reason?
Q2.
Generally speaking, is it normal for seborrheic keratosis lesions to develop black scabs?
Q3.
Can the application of a salicylic acid-containing ointment like "Strongly Shimei" effectively eliminate seborrheic keratosis lesions?
Thank you, Dr.
Wu.

Axiang, 40~49 year old female. Ask Date: 2023/08/20

Dr. Wu Yuxin reply Dermatology

You should first consult a dermatologist to confirm whether it is seborrheic keratosis; otherwise, the following discussion will be meaningless.
Applying potent topical corticosteroids will not be helpful.

Reply Date: 2023/08/20

More Info

Seborrheic keratosis (SK) is a common benign skin condition characterized by the appearance of raised, wart-like lesions that can vary in color from light tan to black. These growths are usually painless and non-itchy, and they often develop in middle-aged and older adults. Your description of the lesions on your left shoulder aligns with typical characteristics of seborrheic keratosis.

Q1: Black Scab Formation on Seborrheic Keratosis
The sudden appearance of a black scab on the tail end of your seborrheic keratosis could be related to several factors. First, it is possible that the black scab is a result of irritation or trauma to the lesion, which may have occurred when you applied the salicylic acid-containing product. Salicylic acid is known for its exfoliating properties and can cause the outer layer of the skin to shed, potentially leading to the formation of a scab if the underlying tissue is exposed or irritated.

Alternatively, the black scab could represent a natural progression of the seborrheic keratosis itself. These lesions can sometimes develop a crusty or scaly surface, particularly if they are subjected to friction or irritation. If the scab is easily removable and the underlying skin appears healthy, it is likely a benign change. However, if you notice any changes in color, size, or if the lesion becomes painful or starts to bleed, it is advisable to consult a dermatologist for further evaluation.

Q2: Is Black Scab Formation Normal?
In general, the formation of black scabs on seborrheic keratosis can be considered a normal phenomenon, especially if the lesion has been irritated or traumatized. However, it is essential to monitor the lesion for any changes. If the scab persists, becomes larger, or is accompanied by other symptoms such as pain, itching, or bleeding, it is crucial to seek medical advice. A dermatologist can perform a thorough examination and, if necessary, a biopsy to rule out other skin conditions.

Q3: Effectiveness of Salicylic Acid on Seborrheic Keratosis
Salicylic acid is often used in dermatological treatments for various skin conditions, including acne and psoriasis, due to its keratolytic properties. While it may help in softening and exfoliating the outer layer of the skin, its effectiveness in completely removing seborrheic keratosis is limited. SK lesions are generally resistant to topical treatments, and while salicylic acid may improve the appearance of the skin, it is unlikely to eliminate the lesions entirely.

For more definitive treatment options, procedures such as cryotherapy (freezing the lesion), curettage (scraping it off), or laser therapy may be recommended by a dermatologist. These methods can effectively remove seborrheic keratosis and provide a more permanent solution.

Conclusion
In summary, the black scab on your seborrheic keratosis may be a benign change related to irritation or a natural progression of the lesion. While salicylic acid may help improve the appearance of the skin, it is not a guaranteed method for removing seborrheic keratosis. If you have concerns about the lesions or notice any changes, it is always best to consult with a dermatologist for personalized advice and treatment options. Regular skin checks and monitoring any new or changing lesions are essential for maintaining skin health.

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