Photodynamic therapy combined with CO2 laser for the treatment of seborrheic keratosis in the auricle: A case report.

Seborrheic keratosis(SK) is a very common skin tumor which is mostly frequently observed in the trunck, head, neck. SK in the auricle is rare and this condition should be excluded the possibility of malignancy by pathologic diagnosis. We report a case of 66-year-old man who presented with a brownish, papillomatous, verrucous mass in the auricle for the past seven years, which began to growing faster during the previous year. Dermoscopy and histopathological examination were performed and the patient was diagnosed with SK. He was treated with the carbon dioxide(CO2) laser and aminolevulinate photodynamic therapy (ALA-PDT). The CO2 laser was used for the removal of the thick hypertrophic lesions and to enhance the transdermal absorption efficiency of ALA. A 20% ALA cream(118 mg/cm2) was applied to his lesion and sealed for 3 h without light, followed by irradiation with 630-nm LED light (96 J/cm2, 80 mw/cm2). We use fluorescent diagnosis with aminolevulinic acid to define the tumor margins at the first session of ALA-PDT. After 4 sessions of ALA-PDT, the lesion was completely removed and did not recur. Therefore, we consider that ALA-PDT combined with CO2 laser is a safe and effective choice for the treatment of seborrheic keratosis in the auricle.

Effectiveness and safety of topical calcipotriol in the treatment of flat seborrheic keratosis on the face.

Seborrheic keratosis is the most common slow-growing, benign epithelial tumour, usually appearing on sun-exposed areas. Treatment modalities for seborrheic keratosis may be uncomfortable and/or time-consuming. We present a case series of 12 patients with solitary seborrheic keratosis localized on the face treated with 0.005% calcipotriol ointment. The treatment lasted 3-8 months and resulted in complete regression of the lesions. Remission (follow-up period) lasted from 6 to 10 years. We conclude that topical calcipotriol may be a useful treatment option for seborrheic keratosis.

Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review.

Seborrheic keratoses (SKs) are benign epidermal neoplasms presenting as waxy, brown to black papules and plaques. Patients often seek removal for cosmetic reasons or irritation. The objective of this systematic review is to assess the efficacy and safety of topical treatments for SKs. Studies involving any topical medication indicated for SK removal were retrieved from Embase, Scopus, PubMed, and Cochrane. The final search was conducted on November 9, 2021, and 26 reports met inclusion criteria. A quality rating scheme was utilized to assess evidence quality. Heterogeneity of treatments and outcome measures precluded meta-analysis. Topical treatments that yielded a good-to-excellent response include hydrogen peroxide, Maxacalcitol 25 µg/g, BID Tazarotene 0.1% cream, 5% potassium dobesilate cream, 1% diclofenac sodium solution, urea-based solution, and 65% and 80% trichloroacetic acid. Local skin reactions were often mild and transient. Topical hydrogen peroxide showed the greatest evidence for clinical clearance of SKs, although there are no studies to our knowledge that directly compared hydrogen peroxide to current first-line treatments (e.g. cryotherapy or shave excision). The results of this review suggest viable and safe treatment of SK with topical therapies; however, there remains demand for topical treatments that reliably equate or exceed the efficacy of current first-line therapies.Key PointsQuestion: Are safe and efficacious topical treatments for seborrheic keratoses available?Findings: Topical treatments for seborrheic keratoses yield different responses and may be associated with local skin reactions. Topical hydrogen peroxide shows the greatest evidence for clinical clearance of seborrheic keratoses and may be a viable option for patients requesting noninvasive removal. No studies to our knowledge directly compare hydrogen peroxide to current first-line treatments.Meaning: There remains demand for topical treatments that reliably equate or exceed the efficacy of current first-line therapies.

Utility of 30% hydrogen peroxide in the treatment of seborrheic keratosis.

BACKGROUND: Hydrogen peroxide (H2 O2 ) has been used in medicine as an antiseptic, but at a higher concentration of 40%, it is used as a chemical cauterant for seborrheic keratoses (SKs). Its action and hence utility at 30% is unexplored. It can serve as a relatively inexpensive modality of treatment for SKs. OBJECTIVES: To evaluate the efficacy and side effects of 30% H2 O2 as a chemical cauterant in SKs. METHODS: Seborrheic keratoses were treated with 30% H2 O2 methodically. Posttreatment assessment was done for the lesion thickness, patient satisfaction, and side effects like burning, itching, edema, crusting, vesiculation, erosion, ulceration, and pigmentary changes. RESULTS: Complete clearance was noted in 25 (49%) lesions, after a single session. Five (9%) lesions responded poorly. Patient satisfaction was excellent with 34 (66.7%) lesions. Side effects noted were burning, pruritus, erythema, edema, and crusting. However, none of them was severe. Dryness, vesiculation, and scarring were reported by none. CONCLUSIONS: H2 O2 30% can be used as a chemical cauterant with minimal side effects.

Effectiveness of a cosmetic device containing a combination of alpha- and beta-hydroxy acids, urea, and thuja for the treatment of seborrheic keratoses.

BACKGROUND: Seborrheic keratosis is a benign epidermal tumor of cosmetic concern-as it progressively increases in size, thickness, and pigmentation-on which topical treatments are poorly effective. Considering its keratotic component, effective products may include active principles with keratolytic action. AIMS: Evaluate the efficacy and tolerability of a topical cosmetic product with urea and hydroxy acids, in the treatment of seborrheic keratoses. PATIENTS AND METHODS: Twenty patients were enrolled in an observational, prospective, open-label study. The topical device was applied on seborrheic keratoses twice daily for 30 days. We evaluated the progression of the treatment by clinical examination-using Daily Life Quality Index-and epiluminescence microscopy at baseline and day 30. RESULTS: After 30 days of treatment, we documented a significant reduction in seborrheic keratosis thickness and number, which was confirmed also by epiluminescence microscopy. On day 30, global Daily Life Quality Index improved by 99.95%. The tolerability of the cosmetic device was considered excellent, according to 19/20 subjects (95%). CONCLUSIONS: The results of our study showed the efficacy and tolerability of this cosmetic device. Its active compounds favor gradual removal of seborrheic keratoses, even in case of pigmented variants. This non-invasive treatment represents an alternative to surgical procedures, mainly for fragile patients and delicate skin areas. It is possible to speculate its usefulness in the topical treatment of circumscribed hyperkeratosis, palmoplantar keratoderma, and thick psoriatic plaques.

Photodynamic therapy combined with carbon dioxide laser for successful treatment of cutaneous squamous cell carcinoma within a long-standing and huge seborrheic keratosis.

Seborrheic keratosis (SK) is a common benign lesion in which malignancies like cutaneous squamous cell carcinoma (cSCC) can arise rarely. We report a case of an 81-year-old man who presented a well-demarcated reddish-brown plaque with central raised coarse nodules on the top of his head. Dermoscopy and reflectance confocal microscopy (RCM) showed the possibility of malignant transformation. cSCC was confirmed by histopathology and immunohistochemistry. Considering the fact of local low-risk cSCC within a large SK lesion, carbon dioxide (CO2) laser was used to treat the SK lesion, and reduce the thickness of local cSCC simultaneously. Three sessions of 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) were performed after CO2 laser. Finally, no atypical cells were found by multi-point biopsy after treatment, and follow-up was continued for one year. Therefore, malignant changes of SK are relatively uncommon, but should be suspected when abnormal appearance or symptoms occurred. ALA-PDT combined with CO2 is a safe, effective, and minimally invasive treatment for cSCC arising from a huge SK.

Comparison of efficacy and safety of 30% hydrogen peroxide with 50% trichloroacetic acid in seborrheic keratosis: a randomized controlled study.

BACKGROUND: Seborrheic keratosis is a benign skin tumour. None of the common therapies is satisfactory. This study compared the efficacy of 30% hydrogen peroxide versus 50% trichloroacetic acid in treatment of seborrheic keratoses. METHODS: This unblinded, comparative interventional study was conducted on 85 patients of seborrheic keratosis. Lesions were graded using physician's lesion assessment (PLA) scale (0, clear; 1, nearly clear; 2≤1 mm thick; 3≥1 mm thick). Patients were randomly assigned into two groups: A and B. Five target seborrheic keratosis lesions with PLA score of three were selected in each patient. Group A was treated with 30% hydrogen peroxide and group B with 50% trichloroacetic acid. Both groups received treatment every week up to 5 weeks or till complete resolution of lesions. Clinical photographs of all patients were taken every 2 weeks. RESULTS: Both the groups were comparable in terms of age and sex. At the end of 6 weeks, lesions were cleared completely in 41.8% of patients in group A and in 23.8% in group B. Mean PLA score decreased significantly in group A from 3 to 1.79 (40.3%) at 2 weeks and to 0.63 (79%) at 6 weeks (P<0.001). The decrease in PLA score in group B was 2.41 (19.7%) and 1.13 (62.3%) at 2, and 6 weeks respectively (P<0.001). Hydrogen peroxide produced greater clearance of seborrheic keratosis (P=0.017) than trichloroacetic acid. Also, no major adverse effects were observed in the two groups. CONCLUSIONS: Application of 30% hydrogen peroxide appears to be more efficacious as compared to trichloroacetic acid (50%) for treatment of seborrheic keratosis.

Hydrogen Peroxide 40% for the Treatment of Seborrheic Keratoses.

OBJECTIVE: Hydrogen peroxide 40% (HP40) was approved by the US Food and Drug Administration for topical treatment of seborrheic keratosis (SK) in December 2017. This article will review phase II and III clinical trials to assess the drug's efficacy, safety, and clinical application. DATA SOURCES: A systematic literature review was performed using the terms "Eskata AND seborrheic keratosis," and "hydrogen peroxide AND seborrheic keratosis" in the OVID MEDLINE, PubMed, Cochrane Library, EMBASE, and Web of Science databases. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. STUDY SELECTION AND DATA ABSTRACTION: Articles written in English between January 2000 and mid-June 2020 discussing phase II and phase III clinical trials were evaluated. DATA SYNTHESIS: In 2 phase III clinical trials, 4% and 8% of patients treated with HP40 had a Physician Lesion Assessment score of zero for all 4 SKs, respectively, compared with 0% in both vehicle groups at the primary end point of day 106 (P < 0.01; P < 0.0001). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: HP40, although less effective, has a better safety profile than other treatment options. It should be especially considered for treatment of facial SKs, where it is most efficacious and where other treatment modalities, such as cryotherapy, are more challenging. CONCLUSIONS: HP40 is a new, safe alternative treatment for SKs, although it is expensive and only modestly effective, both of which somewhat limit its overall utility. HP40 is a promising topical alternative, particularly for cosmetically sensitive locations, such as the face.

Assessing Patients' Satisfaction With Hydrogen Peroxide Topical Solution, 40% for Treatment of Raised Seborrheic Keratoses.

OBJECTIVES: Assess participants’ satisfaction following treatment with a proprietary hydrogen peroxide topical solution 40%, w/w (HP40) for raised seborrheic keratoses (SKs). METHODS: In this Phase 4, open-label study, eligible participants aged 30–75 years had clinically typical raised SKs including 2 target SKs (Physician’s Lesion Assessment™ [PLA] grade of ≥2 [0 = clear; 1 = near clear; 2 = thin (≤1 mm); 3 = thick (>1 mm)]; 5–15 mm diameter) on the face and 1 target SK on the neck or décolletage. SKs received HP40 treatment on day 1. All SKs with PLA grade ≥1 were retreated on days 15 and 29. Endpoints included patients’ satisfaction with their skin’s appearance at day 113, relationships between patients’ satisfaction and lesion PLA grade (evaluated by chi-square test), and patients’ satisfaction with their treatment experience. RESULTS: Forty-one patients (mean [range] age, 62.4 [46–73] years) completed the study. 95% of patients were at least moderately satisfied with their skin’s appearance and 90.2% of target lesions were clear. A statistically significant association was observed between the number of target lesions achieving clearance and patients’ satisfaction with skin appearance level (χ2=22.03; P=0.001). 93% of patients were at least moderately satisfied with their HP40 treatment experience. Eight patients experienced treatment-emergent adverse events (TEAEs), most of which were mild or moderate; 4 experienced TEAEs considered treatment-related. CONCLUSIONS: Most patients with SKs on the face, neck, and décolletage were satisfied or very satisfied with both their skin’s appearance and their treatment experience following HP40 treatment. These results support the use of HP40 for raised SKs. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.4974.

Comparative evaluation of topical diclofenac sodium versus topical ibuprofen in the treatment of seborrheic keratosis.

In 2016, a case of seborrheic keratosis was successfully treated with diclofenac gel 3%. Diclofenac gel mechanism of action is most likely through induction of apoptosis. This study included 30 patients with multiple seborrheic keratosis. One lesion was treated with topical diclofenac sodium gel 1% and another lesion with topical ibuprofen gel applied twice daily for 8 weeks. Adobe photoshop CS6 was used to measure the surface area of the lesions before treatment and after 8 weeks. There was a highly statistically significant difference in the surface area of the lesions before and after treatment with topical diclofenac 1% gel (P = .001) but there was no statistically significant difference with topical ibuprofen gel (P = .057). There was a highly significant difference between the two treatment regimens as regard the percentage of change in surface area of the lesions, with higher change in the diclofenc 1% gel-treated group (P = .001). No patients complain from any side effect from either treatment.

Aminolevulinate photodynamic therapy (ALA-PDT) for giant seborrheic keratosis of the head: A case report.

Although Seborrheic keratosis of the head is very common, giant seborrheic keratosis is rare. This condition should be distinguished from other skin malignant tumors by skin histopathological and immunohistochemistry. We report a case of a 61-year-old woman who presented with a large, dark-brown, well-demarcated plaque on the top of her head of seven years duration which then progressed rapidly for one year. Dermoscopy, histopathological examination and immunohistochemical examination were performed successively. The patient was diagnosed with seborrheic keratosis. She was treated with aminolevulinate photodynamic therapy (ALA-PDT). The lesion was reduced and thinned following treatment. Therefore, we believe that ALA-PDT is a choice for the treatment of giant seborrheic keratosis, especially in some special areas that affect appearance and function.

Nondestructive Evaluations of Melanin-related Compounds in the Skin Using Electron Paramagnetic Resonance and Permeability Measurements.

Melanin-related compounds in paraffin-embedded tissue specimens of basal cell carcinoma (BCC), seborrheic keratosis (SK), malignant melanoma (MM), and nevus pigmentosus (NP) were nondestructively investigated using permeability measurements (light penetration into pigmented lesion), X-band (9.4 GHz) electron paramagnetic resonance (EPR), and EPR imaging (EPRI). The paramagnetic species in BCC, SK, MM, and NP specimens were analyzed using intensity, linewidth, spectral pattern, and X-band EPRI. The EPR spectra of BCC, SK, and NP showed a single line pattern. The EPR signal intensities of the BCC, SK, and NP samples corresponded to the permeability values that are directly related to pigment color tone, except for MM. The correlation coefficient between EPR and permeability was supported by the high degree of linear relation in the range. We further analyzed MM and speculated that MM contains an additional signal of the pheomelanin radical. In MM and NP samples, two-dimensional (2D) EPRI revealed paramagnetic species distribution and different magnitudes. The paramagnetic (radical) species are directly related to the pigmented lesion site. To conclude, spectroscopic analyses suggest that pheomelanin-related compounds may exist in malignant melanoma.

Hydrogen Peroxide Topical Solution, 40% (w/w) for the Treatment of Seborrheic Keratoses: A Review

HP40 (Eskata™) is a stabilized, topical solution of 40% hydrogen peroxide (H2O2) packaged in an applicator pen that is US FDA-approved to treat seborrheic keratoses (SKs). By harnessing the oxidative capabilities of H2O2 , 1-2 treatments with HP40 produced a higher rate of clearance of four SKs per patient compared to vehicle in two phase 3 trials. The clearance rate was higher for the face than the trunk and extremities. Similarly, the risks of pigmentary changes and scarring from HP40 were lower for the face than other locations. Further, based on an ex vivo study, HP40 may be less cytotoxic to melanocytes than cryotherapy, but clinical trials comparing these therapies are needed. Limitations of HP40 are its low efficacy and requirement of multiple treatments, which can result in elevated costs. The application can also be time-consuming, though extenders or even staff members can apply it. Therefore, HP40 may be better reserved for the treatment of facial SKs.

Unusual clinical manifestation of seborrheic keratosis on the scalp successfully treated with topical trichloroacetic acid: an atypical case report.

Seborrheic keratoses (SKs) are benign tumor of the skin. They can occur anywhere, except the palms and soles. SKs commonly present as multiple, pigmented papules which is classically described as verrucous stuck-on papules or plaques. A case with multiple nodular appearance is a rare case and to our knowledge has never been reported. Here we report a rare case of multiple SKs on the scalp. On clinical evaluation, multiple, erythematous hyperkeratotic nodules were present. Dermoscopic and histopathological examination supported SKs. The patient was successfully treated with topical application of 80% TCA solution.

Eskata (40% Hydrogen Peroxide Solution) for the Treatment of Seborrheic Keratoses

"Barnacles", "liverspots", "age spots": Seborrheic keratoses (SKs) have many different names, sizes, and clinical presentations in our patients. The only commonality among SKs is that patients despise them. While patients are initially concerned about their malignant potential, once they are reassured, most patients quickly transition from relief to request: "Can you get rid of them?" An observational study conducted across multiple dermatology practices found that SKs have a significant impact on quality of life, causing patients to adopt strategies to cover them and seek treatment for asymptomatic lesions.1 Given their benign potential, the only reason to remove an asymptomatic raised SK is cosmetic. When doing a cosmetic procedure, the acceptable risk is often lower given that the benefit for treatment is aesthetic. Ideally, a cosmetic intervention would have a wealth of evidence-based data and a favorable side effect profile. Eskata 40% hydrogen peroxide topical solution, the only FDA-approved drug for the treatment of raised SKs, strikes the perfect balance between efficacy and side effect profile.

Clinical Experience With 40% Hydrogen Peroxide Topical Solution for the Treatment of Seborrheic Keratosis

Despite reassurances about the benign nature of seborrheic keratoses (SKs), patients often request treatment due to cosmetic concerns or for symptomatic relief when SKs become irritated or pruritic. Treatment options include cryotherapy, surgical techniques, and topical therapies. In this study, we present two patients with SKs located on their face and neck who received in-office treatment with 40% Hydrogen Peroxide Topical Solution (Eskata™, HP40), a new FDA-approved topical therapy that has demonstrated efficacy in phase 3 trials. Compared to non-topical, more invasive techniques, HP40 may lead to less pigmentary changes, and may be more efficacious for SKs on the face and neck. Both patients received two treatment courses of HP40, which resulted in positive therapeutic outcomes, including the absence of scarring and pigmentary changes. In addition to the case presentations, we will discuss considerations for appropriate administration of HP40 to maximize clinical outcomes. J Drugs Dermatol. 2019;18(7 Suppl):s173-177.