Age warts

When the annoying skin bumps appear, it is particularly important to recognize them as age-related warts in good time and not to confuse them with other skin conditions – for example with dangerous skin cancer. Removing an age-related wart is no problem for trained doctors. However, anyone suffering from age-related warts should never undergo such a procedure themselves.

Overview: What are age warts?

Their name is misleading: age warts are not warts at all. This is because real warts are caused by viruses. Age warts, on the other hand, do not. The skin growths, also known colloquially as “age warts”, are called seborrhoeic keratosis in medical terminology. Skin is called “seborrheic” when it is oily due to particularly active sebaceous glands – this naming results from the historical assumption that warts are particularly rich in sebaceous glands due to their nature. Keratosis is a change in the uppermost layer of the skin (epidermis). Another medical name for an age-related wart is basal cell papilloma. Basal cells are certain cells of the cornea; a papilloma is a benign tumor in the upper layer of the skin. And that is exactly what an age-related wart is: a benign, non-infectious tumor on the surface of the skin.

The term “tumor” sounds alarming to many people. However, it refers to nothing other than the swelling or increase in tissue. A benign tumor such as seborrheic keratosis does not destroy adjacent tissue and does not form metastases. A tumor that does not cause any damage does not necessarily have to be removed. Nevertheless, it can be perceived as a nuisance and impair the quality of life.

Seborrheic keratosis is common in all countries, in women and men alike and becomes more frequent with increasing age from the age of 40. Only a minority of 70- or 80-year-olds are free of age warts. Occasionally, however, benign skin lesions appear at a younger age, and you are not safe from them at any age.

Age warts can occur in several (“multiple”) or as a single phenomenon (“solitary”). The areas of the body where age-related warts appear also vary from person to person. Areas of skin on the face are frequently affected, as well as the back of the hands, the front of the arms and legs, the chest and the back. However, seborrheic keratosis can occur on the entire body, with the exception of the palms of the hands and soles of the feet.

Symptoms: How do age-related warts appear?

Age warts have a roundish or oval shape and are usually half a centimeter to a centimeter in diameter. However, there are also smaller and larger seborrheic keratoses. They usually feel soft and slightly greasy, as if they were made of wax and glued on. Their surface is furrowed or jagged, it can be flat or raised. The age warts form a sharp demarcation to the neighboring tissue. Their color can look very different: light brown, dark brown or black. Reddish tones also occur.

Age-related warts are often just a “blemish”. However, they can become a medical problem if they are in an unfavorable position. If they are repeatedly mechanically irritated, for example by rubbing clothing, small bleedings or infections can occur.

In addition to the very common, typical age warts, there are also a number of less common variants. These include:

• The stucco keratosis. Age warts of this type are flat, rather light in color and about the size of a lentil. They have white scales that can be easily scraped off. These age-related warts usually occur in clusters, often on the back of the foot or on the ankle, also on the lower leg. Men are more frequently affected than women.
• Melanoacanthoma. Age-related warts belonging to this form are particularly dark (“heavily pigmented”).
• The Verruca plana type has a very flat shape and is rather dark. Age warts of this type often appear on the back of the hand and on the forearms. Especially in older people whose skin is damaged by UV radiation.
• Dermatosis papulosa nigra is a form of age wart that is more common in women and in darker skin types. It often appears on the face, neck, chest or neck. This seborrheic keratosis occurs more frequently in families.
• The reader-Trélat syndrome. Age warts of this type appear in large numbers within a short period of time and often cause annoying itching. Like all age warts, they are also benign, but in this variant they can occur as a side effect of cancer.

Diagnosis: How can age-related warts be detected?

These skin changes can often be identified as age warts by their appearance to the naked eye. However, this is not always possible. If your doctor wants to be sure, a special magnifying glass (a dermatoscope) can help with the diagnosis. If no clear diagnosis is possible, a tissue sample can be taken from the altered skin area. It is then analyzed in the laboratory, enabling a clear determination to be made. Often, age warts are first completely removed using a medical procedure and then analyzed more closely in the laboratory for control purposes.

Some age warts are of such a nature that they can easily be mistaken for another skin change. Also with a malignant tumor. Therefore, an exact diagnosis is very important in the assessment of seborrheic keratosis.

The following skin conditions can easily be confused with seborrhoeic keratosis:

• Dermatofibroma (=hard fibroma). This benign growth resembles a mole. It often occurs on the arms or legs, often also in young women. If you squeeze a hard fibroma, it sinks into the skin. (There are also soft fibromas, colloquially known as “stalk warts”).
• Bowen’s disease/actinic keratosis. The affected areas often appear in the form of reddish scaly skin with clear boundaries. Bowen’s disease is a precursor of white skin cancer. This means that although the cells in the uppermost layer of the skin have undergone malignant changes, they do not penetrate destructively into the deeper layers of the skin. They feel dry and rough.
• Spinocellular carcinoma. It is also known as prickle cell carcinoma or squamous cell carcinoma and is a form of malignant skin cancer. The altered areas of skin are reddened and crusty.
• Basal cell carcinoma. It is also called basal cell carcinoma. The malignant growths have the same color as their healthy surroundings, grow slowly and penetrate deeply.
• Black skin cancer, also known as melanoma. This aggressive cancer usually appears as a dark or black spot. However, it can also look reddish. Its shape is also not uniform – the skin growth can be flat or raised.

Causes and risk factors: How do age warts develop?

It is not conclusively known why age warts appear on the surface of a person’s skin. Genetic factors may play a role, but the statement that age warts are always inherited, for example from a parent to a child, is not generally true. Age warts usually appear for no apparent reason. They are not contagious.

A healthy diet, plenty of exercise, little alcohol – not even these recommendations, which are otherwise so often given to prevent diseases, seem to have a demonstrable influence on the development of seborrhoeic keratosis. With one exception: UV radiation is very likely to be a risk factor. Exposure to the sun too often, for too long or without protection could therefore promote the development of age-related warts. Several scientific studies indicate this.

Prognosis: How do age warts develop?

If they are not removed, seborrheic keratoses usually persist without further consequences. Occasionally, age warts fall off on their own. The benign tumors do not change into dangerous, malignant variants, but retain their largely harmless characteristics.

Further age-related warts often appear over time, but this is not essential. If a second age wart forms after the first one has appeared, this is not a proliferation but an independent new formation.

Treatment: How are age warts treated?

Doctors advise against attempting to treat or remove an age-related wart yourself for several reasons. Home remedies such as ointments or tinctures often do not have the desired effect on seborrhoeic keratosis. Above all, however, before any treatment is carried out, it should first be determined whether the skin change that has appeared is really an age-related wart. Just imagine if this were not the case – and you were trying to remove a malignant skin tumor based on a false assumption. This could have dangerous consequences.

The removal of age warts belongs in experienced hands. Only doctors trained for this have the instruments with which seborrheic keratosis can be safely removed. This is usually painless and without complications. Several methods are available:

• Ablation. The age wart is anesthetized locally and removed with a curette (a sharp spoon) or a scalpel.
• Laser treatment. Seborrheic keratosis is treated with a laser, which causes it to evaporate.
• Electrosurgery. The age wart is removed using a current-carrying snare.
• Icing. The age wart is sprayed with liquid nitrogen. This results in extremely cold temperatures. They cause the age wart to die and fall off by itself after a few days. This method is also known as cryotherapy.

You should discuss which of these procedures is most suitable for you with your doctor before treatment. Also ask about the advantages and disadvantages of each method. In most cases, the treatment of age warts goes smoothly and leaves no visible scars. Until the wound has completely healed, however, you should avoid exposing it to direct sunlight.