Seborrheic and Actinic Keratoses - Symptoms, Causes and Treatment of Keratoses

Keratoses may also be seen in association with xeroderma pigmentosum and also in tar workers. Keratoses are comparatively more common among the white races than the colored. Amongst Indians, however, they are rather uncommon.

Keratoses are of three types:

1. Senile
2. Arsenical
3. Actinic.

Senile keratoses occur in elderly people with senile atrophy of the skin. They are seen on the exposed parts of the body, particularly the face and the dorsum of hands. They are usually multiple. Clinically they are characterized by irregular shape; firm or hard consistency; grey or brown color; crusts or scales that are dry, hard, and firmly adherent and cannot be rubbed off easily. Senile Keratoses have an embedded nature. The size varies from that of one split pea to that of a 5 to 10cm diameter, even bigger. Keratosis may take a conical or horny shape; when this happens, it is called horn. Keratosis has a tendency to become raised; there is induration at the base or signs of inflammation appear. In such cases an excision biopsy should be done to establish the diagnosis and exclude malignancy.

Keratosis develops prematurely in the sun burnt skin (actinic keratoses), radiodermatitis, xeroderma pigmentosum and in tar workers. Clinical features of such keratoses are the same as those of senile keratosis.

Arsenical keratoses are seen on the palms of the hands, soles of the feet and on the trunk in association with arsenical pigmentation, keratoderma and other features of arsenical intoxication. They are very prone to malignancy.

Differential diagnosis of Keratoses

It is made from seborrhoeic warts, epitheliomas, skin tags, warts and other benign tumors. An attempt should be made to establish the causative condition and exclude malignancy in every case before the lesions are labeled as keratoses.

Treatment for keratoses

• Prophylactic as for senile skin, solar dermatitis etc. Cream massage and vitamin A are also helpful.
• Curative
• For superficial ones, electrodessication followed by curettage under local anesthesia.
• Electro-excision or surgical excision for large lesions.
• Destruction with CO2 snow, trichloracetic acid etc.

Second technique is preferable because the histopathology can be studied while the electro-excision is being done. Dermabrasion has also given very good results.