Benign Hyperkeratotic Lesions

Overview

Benign hyperkeratotic lesions are non-cancerous skin growths characterised by thickened stratum corneum. These lesions include seborrheic keratosis and corns (helomata), both of which are commonly encountered in older adults or in areas of repeated friction and pressure. While mostly harmless, their appearance or discomfort may warrant medical attention. This page provides a concise overview of benign hyperkeratotic lesions, including morphology, clinical features, and management.

Seborrheic Keratosis

Aetiology

  • Common benign epithelial tumour of older age
  • Typically seen in patients >40 years

Pathogenesis

  • Proliferation of keratinocytes and melanocytes
  • Not related to sun exposure or viral infection

Morphology

Gross Appearance

  • Flat or raised oily plaques
  • Well-defined, round or oval borders
  • May be pigmented
  • “Stuck-on” appearance with a rough, warty surface
Benign Hyperkeratotic Lesions - SEBORRHEIC KERATOSIS
James Heilman, MD, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

Microscopy

  • Thickened, hyperplastic epidermis
  • Presence of keratin cysts
SEBORRHEIC KERATOSIS Micro
No machine-readable author provided. KGH assumed (based on copyright claims)., CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons

Clinical Features

  • Often referred to as “old-age spots”
  • Usually asymptomatic; may occasionally be itchy
  • No malignant potential
  • Can become inflamed or irritated

Management

  • No treatment required unless symptomatic or cosmetically concerning
  • Options include cryotherapy or surgical excision

Corns (Helomata)

Aetiology

  • Caused by chronic pressure or friction

Epidemiology

  • More prevalent in females
  • Common in patients with tight footwear or foot deformities

Pathophysiology

Clinical Features

  • Firm, painful keratotic papule
  • Often has a central hard core
  • Painful with direct pressure
  • Typically found on:
    • Toes (especially dorsal and plantar aspects)
    • Hands (in manual labourers)
Benign Hyperkeratotic Lesions - CORNS
Marionette, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

Management

  • Address underlying pressure source (e.g. orthotics, footwear modification)
  • Paring (shaving down thickened keratin)
  • Keratolytic agents or corn plasters (salicylic acid) may also be used

Summary – Benign Hyperkeratotic Lesions

Benign hyperkeratotic lesions such as seborrheic keratosis and corns are common and typically harmless. They reflect either ageing-related epithelial proliferation or pressure-induced keratin buildup. While treatment is often unnecessary, options are available for cosmetic or symptomatic relief. Recognising the appearance of benign hyperkeratotic lesions allows clinicians to reassure patients and avoid over-investigation. For a broader context, see our Skin & Dermatology Overview page.

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