After the age of 40, with the drop in collagen and elastin production, the dermis becomes increasingly dry, spots, wrinkles and fine lines appear. But it does not finish here. Some people tend to have warts appear on their torso, armpits, neck, décolleté, scalp or eyelids. The first thing dermatologists clarify is to confuse both terms. “Verrucae are very often lesions caused by the Human Papillomavirus (HPV) infection that causes tissue growth. They are spread by direct contact and you should avoid touching them, scratching them or walking barefoot,” says Dr. Javier Pérez Diez from Clínica Premium Marbella. They are called common warts and must be treated, although many disappear spontaneously. “When the virus infects the skin or mucous membranes, it causes rough, white growths, sometimes large and shaped like cauliflower or coral. At the bottom of the wart you can see black dots that correspond to thrombosed capillaries and the patient usually mistakes them for some stuck foreign body; they hurt if pressed. They usually appear on the fingers, knees, palms of the hands, soles of the feet, and oral or genital mucosa. Many of them resolve spontaneously thanks to our immune system: up to 30% in six months and 40% after 2 years. It is recommended to treat them to avoid spread and contagion to other people, explains Dr. Pablo Fernández-Crehuet, dermatologist at the GEDET (Spanish Group of Aesthetic and Therapeutic Dermatology) of the AEDV.
So, what are those supposed “warts” that appear with age really?
The fine warts that appear in middle age are one of the main causes of visits to the dermatologist and have their origin in aging, genetics, hormonal changes or, in some cases, prolonged exposure to the sun. “They are not warts because they are not caused by any virus, nor are they contagious or self-inoculated. It is important that they be examined by a dermatologist because, although the most common thing is that they are seborrheic keratosis or skin tags [pequeños trozos blandos de piel que sobresalen en un tallo delgado]”We must rule out that it is actinic keratosis,” dermatologist Amparo Rodríguez, owner of the Amparo Rodríguez Dermatological Center, explains to S Moda.
The difference between them is important. “Seborrheic keratosis is a growth of the epidermis, the most superficial layer of the skin, and is part of the normal aging process. It does not pose any risk because it is benign, it is not contagious and it does not become malignant. Its appearance is like a papule, spot or raised lesion with very well-defined edges and a rough surface that gives it a greasy appearance (seborrhea). They can take many shapes and sizes, from a more yellowish to a more blackish tint, and sometimes they peel. They are found in the head, neck and trunk area. They are never on the palms of the hands or feet, and if it appears on the vaginal mucosa we must always make a differential diagnosis. The most important thing is that they are benign. They arise due to aging and there is a genetic predisposition, although, sometimes, they are related to sun exposure. In many families they appear at an early age and in large numbers without racial or sex differences,” says Amparo Rodríguez. Although they cannot be prevented, it is advisable to keep your skin free of oils, dirt and bacteria, in addition to protecting yourself from the sun.
“We don’t know very well why they appear, but it affects solar radiation and genetic predisposition. The diagnosis is very simple and, if we have doubts, we use epiluminescence, which is a high-resolution lamp to be able to see that it is seborrheic keratosis. In the most doubtful cases, a biopsy is recommended,” says Rodríguez.
The acocordones vs. actinic keratoses
Another type of lesions that appear with age are skin tags or fibromas. “They are not warts because they are not infectious. These are small elevated benign tumors with an irregular surface, which usually form in areas of the body with folds such as the neck, armpits, groin and eyelids. They are very similar to seborrheic keratoses, but they occur in areas with folds,” explains Dr. Pérez Diez.
However, actinic keratoses are different. “They are precancerous dysplastic lesions that appear in areas of chronic sun exposure for years without proper protection. They usually appear on the face, scalp, neck, neckline and back of the hands and are the manifestation of the stages prior to skin cancer. Actinic keratoses are rough, hard to the touch, whitish or flesh-colored, and bleed easily. When you remove them, they regenerate and reappear. They should be evaluated by a dermatologist since, although slowly, they could lead to non-melanoma skin cancer,” says Dr. Pablo Fernández-Crehuet.
Should seborrheic keratoses be removed?
This decision is always very personal. “As it is a benign lesion, it is treated only if the patient wants because it bothers, itches or bleeds. If they are in places of friction, such as the submammary area, they become macerated and are very uncomfortable. Normally spontaneous resolution, unless they are very small and we eliminate them by scratching, is very rare. Therefore, if we don’t want them we have to remove them. Furthermore, keratoses grow with age, which must be evaluated,” says Amparo Rodríguez. On the face, seborrheic keratoses can cause complexes. “Normally they are darker than the surrounding skin and, sometimes, they can appear in large numbers, constituting their own entity called Papulosa Nigra dermatosis, like those presented by the actor Morgan Freeman,” says Javier Pérez Díez, from Clínica Premium Marbella.
Methods to eliminate them
Seborrheic keratoses can be eliminated through cryotherapy, electrocoagulation, surgery, and laser therapy, among others. The most appropriate method depends on the location, size and characteristics of the wart, as well as the patient’s preferences or the doctor’s experience. The first thing dermatologists advise is to avoid home remedies such as applying adhesive tape, dressings, salicylic acid or other preparations in the form of creams or cosmetic liquids. “They are not recommended due to the risk of infection, pain or scars they can leave. Furthermore, they usually peel them off but cannot eliminate them, on the contrary, they usually leave marks,” adds Amparo Rodríguez. Expert dermatologists give us the safest and most effective methods.
· Cryotherapy: Cryotherapy consists of freezing the wart using liquid nitrogen (-192ºC) to destroy the affected cells. “It is a quick and simple procedure that is performed in the office. Afterwards, a wound may remain for a few days until the lesion disappears in one or two weeks, it is not instantaneous,” explains Dr. Antonio Carvajal, aesthetic doctor with a clinic of the same name in Oviedo. It is not advisable to do it in summer because it can leave residual hyper or hypopigmentation.
· Laser: “The use of ablative CO2 and Erbium: YAG lasers in pulsed and ultrapulsed modes (with very short repetitions) eliminate layer by layer with great precision. After the session, a thin scab remains for a week, then it falls off and leaves the area a little reddish, but little by little it acquires its normal color without leaving any mark or scar; That’s why it is the best solution. Afterwards, it is important to protect the area from the sun,” warns Dr. Javier Pérez Diez from Clínica Premium Marbella.
· Electrocoagulation: It consists of eliminating them with an electric scalpel. “Local anesthesia is placed in the area to be treated and the area is ‘burned’ with an electric scalpel. There is usually no scar, but the damage to the tissue is greater than with the laser, and there is a greater risk of leavin
g some mark. In small areas it can be done in summer if it is well protected from the sun with high factors afterwards,” describes Amparo Rodríguez.
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