An update on the diagnosis and treatment of seborrheic keratosis

Seborrheic keratosis (SK) is a common benign epidermal neoplasm, particularly affecting the elderly. Although non-malignant, it often poses cosmetic and diagnostic challenges due to its resemblance to malignant skin tumors. This review aims to provide a comprehensive update on the recent advancements in the epidemiology, pathogenesis, diagnostic modalities, and therapeutic approaches for SK.

A narrative review of current literature was conducted, focusing on molecular insights, diagnostic innovations, and therapeutic options for SK. Sources were identified through searches in PubMed, ScienceDirect, and Google Scholar over the last decade using relevant keywords.

Molecular research has highlighted the role of oncogenic mutations, including AKT pathway alterations and amyloid precursor protein (APP) involvement. Non-invasive diagnostic tools such as dermatoscopy, reflectance confocal microscopy (RCM), and optical coherence tomography (OCT) have improved lesion differentiation. Artificial intelligence (AI)-based algorithms have further enhanced diagnostic precision. While conventional therapies such as cryotherapy, excision, electrodesiccation, and laser remain effective, they may cause post-inflammatory hypopigmentation. Recent non-invasive treatments, including 30%-50% aqueous nitric-zinc oxide solution with organic acids, 65 or 80% trichloroacetic acid (TCA) solution, and 0.3% Annona muricata L. seed extract cream have demonstrated efficacy with minimal side effects. Nano-Pulse Stimulation (NPS) technology emerges as a novel low-complication treatment.

Advances in molecular understanding and technology have transformed the diagnostic and therapeutic landscape for SK. There is a growing need for accessible, effective, and cosmetically favorable treatment options, especially with rising patient demand. Further research is warranted to validate long-term efficacy and broaden availability.