Understanding Scaly Skin
By Darrel Arthurs, ARNP, DCNP
Over the years, I have seen many people in the office asking about crusty Seborrheic keratosis (SK). These scaly, popular, bumpy growths occur on most people who are middle-aged or older. They are odd looking, with varying colors and configurations. Scale can come off them, and they frequently catch on clothing and get irritated. When I first started working in dermatology, a little old lady called them barnacles, because they resembled the growths that occur in the ocean. SK's of the body are similar to warts in structure in that they are made up of extra layers of skin cells, which are both living and dead. Since SK's are made up from your own skin layers, it indicates that some skin care products can help to alleviate these growths. Also, a few skin care tips can be taught to help decrease or even completely remove these growths.
SK's begin to form on many people after the age of 30. There is no predilictation to male or female. Both sexes are equally affected; however, there is a genetic predisposition to getting large numbers of growths across the body. These growths all have a stuck-on appearance and feel that way as well. Frequently they are darker than the surrounding skin, but they can be skin colored, yellow, gray, light brown, brown, mixed or even red. SK's can form on any part of the skin not just in the seborrheic distribution of the body, such as the scalp, mid-face, chest or upper back. SK's form because your skin grows excessively, and it develops a little mound or papule that is raised higher than the remainder of the skin. The papule is made up of living cells as well as excessive layers of dead skin cells, which is called the stratum corneum. This is why they have a crusty appearance and feeling as well as appearing stuck on, like a barnacle.
In-office treatment for SK's includes liquid nitrogen, which is used on thinner lesions. Occasionally, these lesions will need to be treated on a repeat basis until resolved. Curettage or scraping off the lesion with a sharp circular blade (curette) can be done, as well as a shave biopsy of the lesion. Electrocautery as well as ablative laser surgery can be used to treat some lesions that are not too large. Intralesional lidocaine will need to be used for all of these procedures. Finally, chemical peels may be beneficial some thinner lesions as well. Many of these procedures are not covered by insurance any longer since SK's are benign growths. Often, patients will need to pay cash for the removal of these lesions.
SK's can be irritating to patients and adversely effect their lives. Frequently, patients will ask if there are home remedies, which can be done to lessen the severity of these lesions. Since SK's are stuck on to the surface of the skin, the key to treatment is exfoliating with physical buffing and to use alpha hydrox acid (AHA) products, which will soften and frequently entirely loosen these growths. We will touch on these home remedies further in the next blog.
Arthurs' passion for dermatology developed while he was serving in active duty in the U.S. Navy. Since then he has accumulated over 11 years' experience in medical and surgical dermatology. Currently he works independently in a small city in northeastern Oklahoma. Arthurs is on the NADNP Board of Directors.