Most raised age spots are seborrheic keratoses, waxy or rough-textured growths that sit on the skin’s surface like they’ve been stuck on with glue. They are completely benign, but they don’t respond to the brightening creams marketed for flat sun spots. Removing them requires a physical or chemical approach, and dermatologists have several well-tested options ranging from in-office freezing to prescription-strength topical solutions. Which method works best depends on the size and location of the growth, your skin tone, and how many spots you’re dealing with.
What Raised Age Spots Actually Are
The term “age spot” gets used loosely to describe everything from flat brown sun spots (solar lentigines) to the thicker, bumpy growths that tend to multiply after age 40. If your spots are raised, textured, or have a waxy or scaly surface, they are almost certainly seborrheic keratoses (SKs). These are overgrowths of skin cells, not just pigment changes. Research into what happens at the cellular level shows that age spots involve roughly twice the melanin content of surrounding skin, along with actively proliferating keratinocytes in the deeper skin layers.1Wiley Online Library (Experimental Dermatology). Molecular and histological characterization of age spots That extra structural material is why these spots are raised and why surface-level lightening products can’t flatten them.
SKs come in a range of appearances. Some are light tan and smooth, others are dark brown or nearly black with a rough, crumbly texture. A large study examining their microscopic structure found that the most common subtype is the acanthotic type, followed by mixed, hyperkeratotic, and several rarer variants, including an unexpectedly high rate of a heavily pigmented type called melanoacanthoma.2PubMed Central. Clinical and Histopathological Investigation of Seborrheic Keratosis The variety in how they look is one reason people worry about them and why a proper evaluation before treatment matters.
Why You Should Get Them Checked First
Raised age spots are harmless on their own, but a small number of skin cancers can look similar. Lentigo maligna, a form of melanoma that develops on sun-damaged skin, can be mistaken for a seborrheic keratosis or a flat sun spot, and vice versa. Dermatologists use a handheld magnifying tool called a dermatoscope to distinguish between the two. Specific patterns visible under magnification, such as asymmetric pigmented follicular openings and dark rhomboidal structures, can identify lentigo maligna with about 89% sensitivity and 96% specificity.3Frontiers in Medicine. Dermoscopy of Melanoma and Non-melanoma Skin Cancers – Section: Lentigo Maligna and Lentigo Maligna Melanoma Those numbers mean the exam catches the vast majority of melanomas while rarely flagging a harmless growth as suspicious.
This is worth doing even if you’re confident a spot is benign. A dermatologist can give you a quick once-over and flag anything that needs a biopsy rather than removal for cosmetic reasons. It also means you’ll have a professional assessment on file if a spot changes in the future.
Cryotherapy and Curettage
For a single raised spot or a handful of them, cryotherapy (liquid nitrogen) is the most common first-line treatment. The dermatologist sprays or dabs liquid nitrogen on the growth for a few seconds. The frozen tissue blisters, scabs, and falls off over a week or two. It’s fast, doesn’t require anesthesia, and works well on small to medium-sized SKs. The downside is that it can leave a lighter patch of skin where the spot used to be, which is more noticeable on darker skin tones.
Curettage, where the growth is scraped off the skin’s surface with a small blade-like instrument, is another straightforward option. Because seborrheic keratoses sit on top of the skin rather than growing deep into it, they can often be scooped away cleanly. Sometimes a light touch of electrodesiccation (a tiny electric current) is applied afterward to stop bleeding and smooth the base. Both cryotherapy and curettage typically leave minimal scarring when performed by an experienced practitioner, though healing time and cosmetic results depend on the spot’s size and location.
Laser Removal
For people with many seborrheic keratoses or spots in cosmetically sensitive areas like the face, laser treatment offers more precision. Erbium lasers have been used for skin lesion removal for decades. They ablate tissue in very thin, controlled layers, and research spanning 25 years of clinical use found that raised lesions like seborrheic keratoses could be treated effectively at low energy settings with minimal damage to surrounding tissue.4PubMed Central. Erbium Laser for Skin Surgery: A Single-Center Twenty-Five Years’ Experience – Section: Results CO₂ lasers are another option and work on a similar principle, though they penetrate slightly deeper and may carry a marginally higher risk of scarring.
Laser treatment generally costs more per session than cryotherapy or curettage, and insurance rarely covers it when the reason is cosmetic. However, for someone with dozens of spots across the face and chest, treating them all in one or two laser sessions can be faster and more uniform than freezing each one individually.
Topical Hydrogen Peroxide
For years, the only way to remove a seborrheic keratosis was a physical procedure. That changed with the approval of a concentrated hydrogen peroxide solution (40%) applied directly to the growth in a dermatologist’s office. This was the first FDA-approved drug specifically for raised SKs.5PubMed. Eskata (40% Hydrogen Peroxide Solution) for the Treatment of Seborrheic Keratoses The solution is dabbed onto each lesion with a pen-like applicator, and it works by chemically breaking down the excess tissue.
It sounds appealing, but the clinical trial results are worth looking at closely. In two large phase 3 trials, the proportion of patients whose treated spots all cleared completely was modest: about 4% and 8% across the two studies at roughly three and a half months after treatment. A higher share saw most of their spots clear or nearly clear, with roughly half of treated spots reaching that endpoint. Local skin reactions like redness and swelling were common but mostly mild and resolved on their own.6Journal of the American Academy of Dermatology. Safety and efficacy of hydrogen peroxide topical solution, 40% (w/w), in patients with seborrheic keratoses: Results from 2 identical, randomized, double-blind, placebo-controlled, phase 3 studies (A-101-SEBK-301/302) – Section: Results In practical terms, the treatment may reduce the size and roughness of a spot more than completely erase it, and some patients need multiple treatment visits.
It’s also worth noting that the product (marketed as Eskata) was voluntarily withdrawn from the U.S. market in 2020 for commercial reasons, not safety concerns. Whether a concentrated hydrogen peroxide option is currently available to you depends on your location and your dermatologist’s practice. Either way, the complete clearance rates in trials were low enough that many dermatologists still reach for cryotherapy or curettage first.
What About Over-the-Counter Products
Walk through any drugstore skincare aisle and you’ll find products claiming to fade age spots. Most of these contain ingredients like hydroquinone, glycolic acid, retinoids, or vitamin C. These work on flat hyperpigmentation by suppressing melanin production or increasing cell turnover. They can genuinely lighten a flat sun spot over weeks of consistent use. But for a raised seborrheic keratosis, they won’t do much. The problem isn’t just pigment sitting in the top layer of skin. It’s a physical mound of extra skin cells. No cream dissolves that away.
You’ll also find online tutorials recommending home use of apple cider vinegar, tea tree oil, or even drugstore-strength hydrogen peroxide (3%) applied with a cotton swab. There’s no clinical evidence these work, and applying caustic substances to a growth you haven’t had evaluated carries obvious risks, including chemical burns, scarring, and the possibility of delaying diagnosis of something more serious. The clinical-strength hydrogen peroxide that was FDA-approved is more than ten times the concentration of the drugstore bottle and was designed for precise, controlled application by a trained provider.
Special Considerations for Darker Skin
Seborrheic keratoses affect people of all skin tones, but a closely related condition called dermatosis papulosa nigra (DPN) is especially common in people with darker skin. DPN presents as small, dark, raised papules clustered on the cheeks, forehead, and around the eyes. These are essentially a variant of seborrheic keratosis, and the treatment options are similar: excision, curettage, electrodesiccation, cryotherapy, and laser.7PubMed. Management of dermatosis papulosa nigra: a systematic review
The major concern in darker skin is post-inflammatory hyperpigmentation (PIH), where the treated area heals darker than the surrounding skin. A systematic review of DPN treatments found that PIH is the most common adverse effect and a frequent cause of patient dissatisfaction.7PubMed. Management of dermatosis papulosa nigra: a systematic review Cryotherapy tends to be the biggest offender here because the freezing isn’t as precisely controllable as some alternatives. Research on low-intensity electrodesiccation in African patients found it to be a safe and cost-effective method for treating DPN, noting that higher-energy lasers like CO₂ and Nd:YAG are generally less safe for darker skin types.8PubMed Central. Treatment Outcomes for Dermatosis Papulosa Nigra Using Low-Intensity Electrodesiccation Device in African Patients
If you have darker skin and are considering removal, it’s worth having a specific conversation with your dermatologist about which method carries the lowest PIH risk for your skin type. Gentler approaches with lower energy settings tend to do better, even if they require an extra session or two. PIH from dermatologic procedures is preventable with the right measures before, during, and after treatment.9Journal of the American Academy of Dermatology. Postinflammatory hyperpigmentation: A comprehensive overview: Treatment options and prevention – Section: Prevention of postinflammatory hyperpigmentation
What to Expect After Treatment
Regardless of the removal method, the treated area typically forms a small scab that falls off within one to three weeks. The new skin underneath may be pink or slightly lighter than the surrounding area, and that color difference can take weeks to months to even out. You’ll want to keep the area clean, moisturized, and protected from sun exposure during healing. Sunscreen on a freshly treated spot isn’t optional; UV exposure on healing skin is a direct trigger for PIH and can also darken the new skin permanently.
Some growths recur after treatment. This is more common with very thick or deeply pigmented SKs and with methods that don’t fully destroy the base of the lesion. Cryotherapy has a somewhat higher recurrence rate than curettage or laser because the depth of tissue destruction is harder to calibrate with a spray of liquid nitrogen than with a blade or a light beam. If a spot comes back, retreatment is straightforward and doesn’t carry any special risk compared to the first round.
Most people heal without complications, but infections can happen with any procedure that breaks the skin. Redness, warmth, and increasing pain after the first couple of days are signs to call your dermatologist. Scarring is uncommon for small growths but more likely with larger lesions on the chest or back, where skin tension during healing can widen scars.
When a Sudden Crop of Spots Warrants Attention
One uncommon but medically important scenario involves the sudden appearance of many seborrheic keratoses over a short period. This is known as the sign of Leser-Trélat, a paraneoplastic phenomenon consisting of a rapid eruption of SKs associated with an internal malignancy.10British Journal of Dermatology. H04 The sign of Leser–Trélat: an eponymous misnomer? The association is rare, and the sign itself has been debated in dermatology for decades, with some researchers questioning how strong the link really is. But if you or someone you know suddenly develops dozens of seborrheic keratoses in a matter of weeks, especially alongside unexplained weight loss or fatigue, it’s worth flagging to a doctor. In the vast majority of cases, new SKs appearing gradually over months and years is just part of aging and has no sinister significance.
Can You Prevent New Ones From Forming
The honest answer is only partially. Seborrheic keratoses have a genetic component; they tend to run in families and become more numerous with age regardless of what you do. Sun exposure plays a role, though the relationship is less direct than it is with flat sun spots. SKs appear on both sun-exposed and covered skin, which suggests UV light isn’t the only driver. Still, broad-spectrum sunscreen and sun-protective clothing won’t hurt and may slow the accumulation of new spots on exposed areas.
There’s no supplement, diet, or skincare routine proven to prevent seborrheic keratoses. If anyone is marketing a product with that claim, the evidence doesn’t support it. The practical strategy is to protect your skin from UV damage for its many other benefits, get an annual skin check with a dermatologist, and deal with bothersome spots as they appear. For most people, one or two office visits every few years is enough to keep things under control.