Hi!
Seborrheic keratosis is a benign skin growth that is one of the most common skin growths. Seborrheic keratosis generally increases in number and size with age, and may be related to accumulated sun damage.
How to remove Seborrheic Keratosis, and what should you expect during removal?
There are many ways to remove seborrheic keratosis. Personally, I favor the usage of ultrapulse CO2 laser ablation. This is because it is a very precise and controlled way to make sure the entire seborrheic keratosis is removed in 1 treatment (most of the time).
The ultra-short pulse of CO2 mainly results in ablation with minimal coagulation resulting in minimal collateral damage, reducing the downtime, risk of scarring and post-inflammatory hyperpigmentation (PIH). Other possible treatments can also be used but in my opinion, have certain limitations:
- Electrocautery - tends to have less uniform removal and slightly more collateral damage
- Surgical methods such as curettage or shave biopsy - there might be some bleeding hindering visualization and complete removal
- Cryotherapy with liquid nitrogen - hard to control the depth, may not completely remove the lesion, hence may require multiple treatments
- Focal chemical peel with trichloracetic acid - like cryotherapy, not very controlled
For ultrapulse CO2 laser ablation, firstly strong topical anaesthetic is applied on the area. Local anaesthetic injection may be necessary for patients who are more sensitive to pain or bigger seborrheic keratosis.
The CO2 laser is then used to ablate the seborrheic keratosis. Some burning smell may be present. The procedure is over in 5-10 min and the seborrheic keratosis will be visibly gone immediately after.
There will be a small patch of raw skin (about the same size as the seborrheic keratosis) that crusts over after 2-3 days. The scab will usually fall off after another 3-5 days depending on the size of the original seborrheic keratosis.
It is important to use the prescribed creams and avoid sun exposure, to prevent PIH and scarring.
Generally, ultrapulse CO2 laser ablation of seborrheic keratosis has a good outcome with no scarring and PIH provided proper care is taken.
Do seek a detailed consultation with a doctor who can discuss the various options and give you his experienced opinion.
Hope this helps!
Warmest regards,
Dr Wan Chee Kwang
References
1. Krupashankar et al. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008 Jan;74 Suppl:S61-7.
2. Fitzpatrick et al. Clinical advantage of the CO2 laser superpulsed mode. Treatment of verruca vulgaris, seborrheic keratoses, lentigines, and actinic cheilitis. J Dermatol Surg Oncol. 1994 Jul;20(7):449-56.
