Received: 28 April 2023

| Revised: 27 June 2023

| Accepted: 29 June 2023

DOI: 10.1002/ccr3.7697

CASE REPORT

Seborrheic keratosis in an adolescent: A rare presentation

Pooria Zare1,2 | Mazaher Ramezani2,3

1
Students Research Committee,
Kermanshah University of Medical Key Clinical Message
Sciences, Kermanshah, Iran Seborrheic keratosis is a common benign epidermal lesion that typically occurs
2
Clinical Research Development Center, in the elderly population. Its occurrence in childhood and adolescence is rare
Imam Reza Hospital, Kermanshah
University of Medical Sciences,
and can pose a diagnostic challenge for clinicians and dermatopathologists. We
Kermanshah, Iran report a case of a 16-­year-­old boy with multiple brown, black oval-­shaped stuck-
3
Molecular Pathology Research Center, ­on lesions on his face, which were diagnosed as seborrheic keratosis based on
Imam Reza Hospital, Kermanshah
histological findings. The patient had no significant medical history or family his-
University of Medical Sciences,
Kermanshah, Iran tory of seborrheic keratosis. In this report, we discuss the differential diagnoses of
seborrheic keratosis-­like lesions in childhood and adolescence and explain why
Correspondence
they were not compatible with our case. We also review the available treatment
Mazaher Ramezani, Molecular
Pathology Research Center, Imam Reza options. Our case emphasizes the need for dermatologists to consider seborrheic
Hospital, Kermanshah University of keratosis in the differential diagnosis of cutaneous lesions in young patients.
Medical Sciences, Kermanshah, Iran.
Email: mazaher_ramezani@yahoo.com
KEYWORDS
adolescent, child, dermatology, keratosis, pathology, seborrheic

1 | I N T RO DU CT ION face measuring up to 1 cm in diameter (Figure 1), which

Seborrheic keratosis (SK) is a common benign epidermal
lesion that is typically seen in middle-­aged and elderly
individuals. It is characterized by well-­ circumscribed,
pigmented, waxy, and verrucous papules or plaques, com-
monly located on the face, trunk, and extremities exclud-
ing palms and soles. The incidence of SK increases with
age, and it is rarely seen in children and adolescents.1,2
Here we present a case of a 16-­year-­old boy with multiple
brown, black oval-­shaped stuck-­on lesions on his face that
was compatible with SK upon biopsy.
had been present since he was about 7 years old. The le-
sions had not changed in size or appearance in the past
2–­3 years. The patient had no other medical conditions,
had not used any medication, and had no familial history
of SK. A biopsy from one of the lesions was performed by
a dermatologist and referred to our pathology department
for examination, and upon microscopic findings, the le-
sions were compatible with SK. Basaloid keratinocyte pro-
liferation without dysplasia and hyperkeratosis with horn
pseudocyst formation were observed in the histological
examination (Figure 2).

2 | C A S E PR E SE N TAT ION 3 | LITERATURE REV IEW

A 16-­year-­old boy presented with multiple sharply de- There have been few studies on SK in childhood or ado-
marcated, waxy, brown-­black, oval-­shaped lesions on his lescence. Gill et al. studied 170 Australian people aged

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

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https://doi.org/10.1002/ccr3.7697
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15–­30 years and mentioned that 23.7% of participants had
at least one SK. Accordingly, they declared that the term
senile keratosis is not a suitable synonym for seborrheic
keratosis.3 In a case report by Ozbay et al., a 1-­year-­old boy
presented with SK in his external auditory canal.4
4 | DI S C USSION
Although SK is commonly seen in older adults, it can also
occur in younger individuals, particularly in those with a
familial history of the condition. Seborrheic keratosis is
rarely seen in childhood or adolescence, and when pre-
sent, it can pose a diagnostic challenge for clinicians and
dermatopathologists. The differential diagnosis of SK in
F I G U R E 1 Multiple sharply demarcated, waxy, brown-­black,
oval-­shaped papules and plaques with stuck-­on appearance.
F I G U R E 2 Histopathologic findings: (A) Low-­power view of hyperkeratosis with horn cysts and pseudocysts. (B) High-­power view of
basaloid keratinocyte proliferation without dysplasia and horn pseudocyst formation. (Hematoxylin–­Eosin stain).
20500904, 2023, 7, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ccr3.7697 by Nat Prov Indonesia, Wiley Online Library on [22/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ZARE and RAMEZANI
children and adolescents includes a variety of other be-
nign and malignant skin lesions that may resemble SK
clinically or histologically, such as acrokeratosis verruci-
formis of Hopf and epidermal nevus.2
In our case, the lesions were only located on the pa-
tient's face, specifically on his cheek, chin, and posterior
to his left ear. This is in contrast to the acrokeratosis verru-
ciformis of Hopf, which typically presents with lesions on
the limbs and trunk. Furthermore, our case did not have
the linear or whorled shape typically seen in epidermal
nevi, making that diagnosis unlikely.
5 | TREATMENT
Treatment for SK is typically not necessary, as the lesions
are benign and do not pose any health risks. However, if
the lesions are causing cosmetic concerns, they can be
removed via cryotherapy, electrocautery, or surgical exci-
sion.5 In our case, the patient was referred to his derma-
tologist for proper treatment.
6 | CONC LUSION
SK is a common cutaneous lesion found in elderly indi-
viduals; however, it should not be excluded from the dif-
ferential diagnosis list for skin lesions in young people.
Differential diagnoses for SK in the young age group in-
clude acrokeratosis verruciformis of Hopf and epidermal
nevi, but our case was not compatible with these diagno-
ses due to the location and shape of the lesions. Treatment
for SK is typically not necessary but can be done for cos-
metic reasons.

ZARE and RAMEZANI
AUTHOR CONTRIBUTIONS
Pooria Zare: Data curation; investigation; writing –­origi-
nal draft. Mazaher Ramezani: Conceptualization; su-
pervision; writing –­review and editing.
ACKNOWLEDGMENTS
The authors would like to express very great appreciation
to the patient and his family for their help in collecting the
data and allowing for the report. The authors also would
like to thank the Clinical Research Development Center
of Imam Reza Hospital for Consulting Services.
FUNDING INFORMATION
None.
CONFLICT OF INTEREST STATEMENT
None.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are availa-
ble on request from the corresponding author. The data are
not publicly available due to privacy or ethical restrictions.
ETHICS STATE MENT
This case report is ethical according to the world medical
association declaration of Helsinki.
CONSENT STATEMENT
Written informed consent is obtained from the patient to
publish this report.
|
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   3 of 3
ORCID
Pooria Zare https://orcid.org/0000-0003-1611-3010
Mazaher Ramezani https://orcid.
org/0000-0003-1897-7410
REFERENCES
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2. Weedon D. Weedon's Skin Pathology. 4th ed. Elsevier; 2015.
3. Gill D, Dorevitch A, Marks R. The prevalence of seborrheic ker-
atoses in people aged 15 to 30 years: is the term senile keratosis
redundant? Arch Dermatol. 2000;136(6):759-­762.
4. Ozbay M, Kiniş V, Firat U, Bakir S, Yorgancilar E. Seborrheic
keratosis of the external auditory canal in a 1-­year-­old boy. Turk
J Pediatr. 2012;54(5):543-­544.
5. Wollina U. Seborrheic keratoses-­ the Most common benign
skin tumor of humans. Clinical presentation and an update on
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How to cite this article: Zare P, Ramezani M.
Seborrheic keratosis in an adolescent: A rare
presentation. Clin Case Rep. 2023;11:e7697.
doi:10.1002/ccr3.7697