Seborrheic keratoses usually are asymptomatic, but they can be annoying. Lesions can itch and rub or catch on clothing, thereby becoming inflamed. Lesions often are unattractive and serve as negative psychological connotations—daily reminders of aging.

Although lesions may resolve on occasion, spontaneous resolution does not ordinarily occur. Seborrheic keratoses usually begin with the appearance of one or more sharply defined, light brown, flat macules. The lesions may be sparse or numerous.

As they initially grow, they develop a velvety to finely verrucous surface, followed by an uneven warty surface with multiple plugged follicles and a dull or lackluster appearance. They typically have an appearance of being stuck on the skin surface.

The color of the lesions can vary from pale brown with pink tones to dark brown or black.

A familial trait exists for the development of multiple seborrheic keratoses in about half of the patients, with an autosomal dominant mode of inheritance.