Common Skin Growths
Skin tags, epidermoid cysts, sebaceous hyperplasia, and seborrheic keratosis are common benign skin neoplasms (growths). These skin growths all occur more frequently with age, and although they are not typically associated with health problems, it is sometimes preferable to remove them (Luba 2003). Actinic keratosis is a precancerous skin growth caused by chronic sun exposure and for which treatment is recommended (Cantisani 2013; Costa 2015).
Benign Skin Growths
Epidermoid (or inclusion) cysts. Epidermoid cysts are pockets under the skin surface in which keratin and skin cells are trapped. Although epidermoid cysts are sometimes incorrectly referred to as sebaceous cysts, they do not involve sebaceous glands. Epidermoid cysts may resolve without treatment, but sometimes become inflamed or infected, requiring incision and drainage (Luba 2003).
Sebaceous hyperplasia. Sebaceous hyperplasia is a benign enlargement of sebaceous glands. The cause of sebaceous hyperplasia is not known, but transplant patients taking cyclosporine (an immune-suppressing medication) and dialysis patients have a higher risk of sebaceous hyperplasia (Luba 2003).
Seborrheic keratosis. Seborrheic keratosis is characterized by pigmented growths that are said to appear “stuck on” to the skin surface. In rare cases, a sudden onset or increase in number of seborrheic keratoses can indicate an underlying malignancy such as stomach, colon, or breast cancer (Luba 2003).
Conventional Treatment of Benign Skin Growths
Benign skin growths are typically treated if they are a site of chronic irritation, discomfort, or concern to the patient (Ingraffea 2013; Costa 2015; NLM 2017b). Excision (surgical removal) or cryotherapy using liquid nitrogen are common techniques for removal (NLM 2017b; Rao 2007). Electrodessication is sometimes used along with excision (NLM 2017b). Laser therapy and photodynamic therapy can also be used to treat skin growths, but these techniques can cause scarring and pigmentation changes that are especially problematic in darker skin (Alexis 2013). Photodynamic therapy is discussed in more detail in the Novel and Emerging Therapies section.
In a clinical study in 20 subjects with sebaceous hyperplasia, treatment with isotretinoin (Accutane) at 1 mg/kg of body weight per day for two months was effective in 100% of participants at reducing the number of lesions and caused no severe side effects. The average number of lesions per subject dropped during the trial from 24 to two. Two years after the end of treatment, few lesions had recurred, and the average number of lesions per subject was four (Tagliolatto 2015).
Integrative Treatment of Benign Skin Growths
Studies using vitamin D3 to treat seborrheic keratosis have yielded promising results (Asagami 1996; Lu'o'ng 2013). In 116 individuals with seborrheic keratosis treated with topical vitamin D3 ointment for three months or longer, nearly 77% showed at least a 40% reduction in volume, and no side effects were observed (Mitsuhashi 2005).
Actinic keratosis is a precancerous lesion caused by ultraviolet light exposure from sunlight or tanning beds. It manifests as rough, scaly skin patches, typically on the face, ears, backs of the hands, forearms, scalp, and neck (Mayo Clinic 2017a). In addition to older age, risk factors for actinic keratosis include a history of outdoor work, male gender, baldness, fair complexion, tendency to develop sunburns, evidence of sun damage to skin (eg, wrinkles), and prolonged immune weakness (Flohil 2013; Green 2015; Speight 1994; Cox 1994; Trakatelli 2016). Unlike benign skin growths, chemical or surgical treatment is strongly recommended for actinic keratosis (Cantisani 2013; Costa 2015). Importantly, a small percentage of actinic keratoses may develop into skin cancer, so consultation with a dermatologist is important (Mayo Clinic 2017b). For more information about protecting skin and preventing skin cancer, please refer to the Skin, Hair, and Nail Health and Skin Cancer protocols.
Conventional treatments. Although many actinic keratoses disappear on their own, they often return with subsequent sun exposure. Also, since it is challenging to determine which lesions will progress to skin cancer, the lesions are usually removed as a precaution (Mayo Clinic 2017b).
Topical salicylic acid (Acnevir and various others) is an exfoliant and peeling agent used to treat actinic keratosis and other types of sunlight damage on the skin (Arif 2015; Uhlenhake 2013; Chetty 2015). Other treatment options are topical imiquimod (Aldara), an immune-modulator, and 5-fluorouricil (5-FU), an anti-proliferative agent (Hanna 2016; Kaur 2010; Werschler 2008). These treatments typically cause side effect such as localized redness, dryness, burning, itching, and swelling (Thappa 2016; Arif 2015; Costa 2015). In rare cases, salicylic acid overdose may occur, leading to dangerous and potentially fatal central nervous system toxicity (Arif 2015).
Retinoids, natural and synthetic vitamin A derivatives, may also be used for treatment or prevention of actinic keratosis. Retinoids are used in the prevention and treatment of non-melanoma skin cancer, but their use in actinic keratosis is less firmly established because fewer studies specifically on actinic keratosis have been conducted. Some studies have shown that organ transplant patients using retinoids to prevent skin cancer have a lower rate to actinic keratosis development compared with those treated with placebo. It is not clear whether topical or systemic retinoids are preferable for actinic keratosis prevention; both routs of administration have reduced the number of actinic keratosis lesions in small studies (although many of the studies have design or methodology limitations). Systemic retinoids may cause several side effects such as dry eyes and dry skin, and less frequently systemic side effects such as elevation of liver enzymes and cholesterol may occur. Importantly, retinoids may cause birth defects, so should not be used be women expecting to become pregnant (Ianhez 2013).
Integrative treatments. In a study that enrolled nine actinic keratosis patients, an analog of vitamin D3 was applied topically on half of the affected area of the face or scalp and the base cream without the vitamin D3 analog was used on the other half for 12 weeks. The number of actinic keratoses decreased where the vitamin D3 analog was used but did not change where the base cream alone was used (Seckin 2009).
Photodynamic therapy is one of the most effective treatments for actinic keratosis, but recurrences due to treatment-related immunosuppression or DNA damage are an ongoing concern. One study found that actinic keratosis patients who received an oral supplement containing an extract from the fern Polypodium leucotomos for six months after photodynamic treatment had fewer recurrences than those treated with photodynamic therapy alone (Auriemma 2015).