Comparing the efficacy of plasma exeresis and cryotherapy for the treatment of seborrheic keratosis: A randomized controlled trial.

BACKGROUND: Seborrheic keratoses (SK) is a benign epithelial skin tumor and plasma exeresis is a new technique. AIMS: To compare the efficacy and safety of plasma exeresis and cryotherapy for treating SK. METHODS: This study is a randomized controlled trial (RCT). One side of each patient was randomly treated with plasma exeresis (peak-to-peak voltage of 3.44 kV and a frequency of 62.5 kHz) and the other side with cryotherapy. RESULTS: Thirty-five males were enrolled. At week 3, 37.1 % (N = 13) of lesions treated by plasma exeresis were clear, which was higher than those treated by cryotherapy 17.1% (N = 6). However, this difference was not significant (p-value: 0.06). At week 6, 16 (57.1 %) out of 28 remaining lesions, treated by plasma exeresis were clear, which was significantly higher (p-value: 0.005) than those completely cleared by cryotherapy in 6 out of 29 remaining lesions (20.7%). The mean physician assessment scale score was significantly reduced in both groups in the second follow-up (plasma group first follow-up 0.91 ± 0.89 vs. second follow-up 0.5 ± 0.64 and p-value: 0.0031; cryo group first follow-up 1.4 ± 0.84 vs. second follow-up 1.1 ± 0.72 and p-value: 0.0002). Regarding side effects, no significant difference was seen (p = 0.438). The most common complications in the plasma and cryotherapy groups were erythema (10/19, 52.63%) and hypo pigmentation (5/13, 38.46%). CONCLUSIONS: Both cryotherapy and plasma exeresis are effective. We observed a significantly higher cleared lesions treated with plasma exeresis in 6 weeks and after two sessions.

Seborrheic keratosis.

Seborrheic keratosis (SK) is the most common benign epidermal tumor in clinical dermatological practice. This review summarizes current knowledge about the clinical and histological appearance, epidemiology, pathogenesis, and treatment of SK. There are different subtypes of SK based on clinical presentation and histologic findings. Several factors, including age, genetic predisposition, and possibly also exposure to ultraviolet radiation, are thought to contribute to the development of SK. The lesions can occur on all areas of the body except for the palms and soles, but the most common sites are the face and upper trunk. The diagnosis is usually made clinically, and in some cases by dermatoscopy or histology. Many patients prefer to have the lesions removed for cosmetic reasons although there is no medical indication. Treatment options include surgical therapy, laser therapy, electrocautery, cryotherapy, and topical drug therapy, which is currently in development. Treatment should be individualized depending on the clinical picture and patient preference.

Update of pathophysiology and treatment options of seborrheic keratosis.

Seborrheic keratosis (SK) is a common, benign tumor that can occur on everybody site and can be conservatively managed. Cosmetic concerns, especially when a lesion involves the facial area, are the most common reason for excision. SK shows male gender preponderance and increasing age is an independent association with the condition. Even though more prevalent in the elderly, it has also been reported in younger age groups like adolescents and young adults. Precise pathogenesis is still obscure, but ultra-violet exposure represents a predisposing factor to SK by altering the biochemical concentration and expression of factors like Glutamine deaminases, endothelin, and stem cell factor. Moreover, the accumulation of amyloid-associated protein has also been postulated. Involvement of genitalia has been associated with human papillomavirus infection. Recently, Merkel cell polyomavirus nucleic acid was also detected in SK. Several oncogenic mutations involving FGFR-3 and FOXN1 have been identified. SKs are usually classified clinically and histologically. Dermatoscopy is a noninvasive alternative diagnostic technique widely used in differentiating SK from other benign and malignant tumors. In terms of treatment, topical agents, shave dissection, cryosurgery, electrodesiccation, laser application and curettage under local anesthesia are safe methods for eradication of SKs, mostly for cosmetic purposes. Though generally safe, the latter techniques may occasionally cause post-procedure depigmentation, scarring, and recurrence. Nanosecond-pulsed electric field technology is a promising new technique with fewer side-effects.

Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses.

Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.

Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Seborrheic Keratoses.

BACKGROUND: Nanosecond pulsed electric field technology (also known as Nano-Pulse Stimulation or NPS) is a nonthermal, drug-free, energy-based technology that has demonstrated effects on cellular structures of the dermis and epidermis in previous clinical studies. OBJECTIVE: To evaluate the safety and efficacy of a single NPS treatment for clearing seborrheic keratoses (SKs). MATERIALS AND METHODS: This study was a prospective, randomized, open-label, multisite, nonsignificant risk trial in which each subject served as their own control. Fifty-eight subjects had 3 of 4 confirmed SK lesions treated, resulting in 174 total treated lesions. Subjects returned for 5 to 6 follow-up evaluations and photographs. RESULTS: At 106 days after NPS treatment, 82% of treated seborrheic keratoses were rated clear or mostly clear by the assessing physician. Seventy-one percent of lesions were rated clear or mostly clear by the 3 independent reviewers based on the 106-day photographs. All treated subjects returned for all study visits, and 78% of the subjects were satisfied or mostly satisfied with the outcome of the treatment. No adverse events were reported. CONCLUSION: The NPS procedure was well tolerated and effective in the removal of SKs.

Recent advances in managing and understanding seborrheic keratosis.

Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser-Trélat sign. New targeted cancer treatments can cause a pseudo-Leser-Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric-zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.

Global Perspectives of the Patient of Color

Many cultures associate beauty with an even complexion. It has been shown in many reported references, the major cosmetic concern in patients of color is discoloration. This issue addresses discoloration of individuals of color and the use of a multitude of preparations that can blend the complexion. Authors in Asia, Sweden, France, and Brazil discuss the use of injectable deoxycholic acid in nonsubmental regions and hyaluronic acid for skin boosting, an off-label usage or procedures in the United States. Skin boosting improves hydration and the smoothness of the skin. Additionally, international methods of treating cosmetic patients with multiple modalities are discussed.

The color of skin: brown diseases of the skin, nails, and mucosa.

Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.

Managing Seborrheic Keratosis: Evolving Strategies and Optimal Therapeutic Outcomes.

Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided. J Drugs Dermatol. 2018;17(9):933-940.

Managing Seborrheic Keratoses: Evolving Strategies for Optimizing Patient Outcomes.

The seborrheic keratosis is the most common benign skin tumor of middle-aged and elderly adults, affecting nearly 83 million individuals in the US alone. Although these are benign lesions, many patients still undergo some form of treatment. Clinicians are frequently presented with a challenge when determining whether to remove a seborrheic keratosis, and which treatment modality to use when doing so. The most commonly used method of removal is cryotherapy, however there are numerous other options that can be employed with varying degrees of efficacy. In this article, we highlight the use of topical keratolytics, vitamin D analogues, and lasers, to name a few. We also address potential side effects associated with these treatment options, as well as discuss patients' preferences and concerns. We conclude with the most recent advances in topical treatments currently under clinical investigation, and offer treatment strategies aimed at maximizing patient satisfaction.

J Drugs Dermatol. 2017;16(11):1064-1068.

Treatment of seborrheic keratosis in bilateral external auditory canal using fiber CO2 laser.

In this article, we report a 33-year-old female patient with lesions of bilateral external auditory canals who was treated using fiber CO2 laser without canaloplasty. Histopathological examination confirmed the diagnosis of irritated type seborrheic keratosis, which is rare in external auditory canal. Twelve months after the treatment, the patient showed no signs of recurrence.

Proceso de atención a las personas con lesiones quísticas y tumorales benignas. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología Médico-Quirúrgica y Venereología / Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV)

Las lesiones cutáneas benignas representan un motivo de consulta frecuente, tanto en atención primaria como en las consultas de dermatología. Sin embargo, existe una amplia variabilidad en el acceso de los usuarios al diagnóstico y tratamiento de las lesiones cutáneas benignas, debido principalmente a que no se establecieron criterios explícitos y homogéneos para el abordaje de los pacientes con lesiones benignas. Con el objetivo principal de reducir la variabilidad en la atención a las personas con lesiones quísticas o tumorales benignas la Sección Territorial Andaluza de la AEDV ha desarrollado un proceso de atención en el que se describen el recorrido del paciente, las características de calidad de las actuaciones y las recomendaciones para la toma de decisiones en este tipo de lesiones

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type

Estudio Piloto del Efecto de la Calendula Officinalis en Preparación Homeopática sobre las Lesiones de la Queratosis Seborreica / Pilot Study of the Effect of Calendula officinalis in Preparation Homeopathic on Injury Seborrheic Keratosis

El presente trabajo tiene el objetivo de mostrar los efectos de la Calendula officinalis en preparación homeopática sobre las lesiones características de la queratosis seborreica, en una muestra piloto, de tipo clínico, conformada por ocho pacientes del sexo femenino, cuyo rango de edad se encuentra entre los 52 y 76 años. Las voluntarias fueron captadas en la Unidad Médica de la Escuela Nacional de Medicina y Homeopatía del Instituto Politécnico Nacional. La elección de la calendula officinalis como tratamiento fue sustentada por antecedentes de estudios realizados sobre la misma, los cuales demostraron una acción antitumoral. (AU)

This paper aims to show the effects of Calendula officinalis in homeopathic preparation on the characteristic lesions of seborrheic keratosis, a pilot sample, clinical, composed of eight female patients whose age range is between 52 and 76 years. The volunteers were captured in the Medical Unit of the National School of Medicine and Homeopathy , National Polytechnic Institute . The choice of calendula officinalis and treatment was supported by a history of studies of the same , which showed an antitumor action. (AU)

Estudio piloto del efecto de la calendula officinalis en preparación homeopática sobre las lesiones de la queratosis Seborreica / Pilot study of the effect of calendula officinalis in preparation homeopathic on Injury seborrheic keratosis

El presente trabajo tiene el objetivo de mostrar los efectos de la Calendula officinalis en preparación homeopática sobre las lesiones características de la queratosis seborreica, en una muestra piloto, de tipo clínico, conformada por ocho pacientes del sexo femenino, cuyo rango de edad se encuentra entre los 52 y 76 años. Las voluntarias fueron captadas en la Unidad Médica de la Escuela Nacional de Medicina y Homeopatía del Instituto Politécnico Nacional. La elección de la calendula officinalis como tratamiento fue sustentada por antecedentes de estudios realizados sobre la misma, los cuales demostraron una acción antitumoral.

This paper aims to show the effects of Calendula officinalis in homeopathic preparation on the characteristic lesions of seborrheic keratosis, a pilot sample, clinical, composed of eight female patients whose age range is between 52 and 76 years. The volunteers were captured in the Medical Unit of the National School of Medicine and Homeopathy , National Polytechnic Institute . The choice of calendula officinalis and treatment was supported by a history of studies of the same , which showed an antitumor action.

Sign and pseudo-sign of Leser-Trélat: case reports and a review of the literature.

BACKGROUND: Leser-Trélat is distinguished by a rare paraneoplastic sign that is characterized by the sudden eruption of multiple seborrheic keratoses (SKs), associated with underlying internal malignancies. Similar non-malignancy-associated SK eruptions are referred to as the "pseudo-sign of Leser-Trélat" (PLT). OBJECTIVE: Two cases of rapid SK eruptions, one the sign of Leser-Trélat (SLT) and one PLT, are presented, and the literature on SLT and PLT is reviewed. METHODS: A literature review of SLT/PLT was performed by searching the PubMed database for all related English published cases. RESULTS: We identified 109 cases of SLT and 12 cases of PLT, with a mean patient age of 61.8 years. SK eruptions were observed before (68.3%), after (22.1%), and at the time of (9.6%) malignancy diagnosis. The malignancy most frequently associated with SLT was gastric adenocarcinoma. The most common anatomical location of SK eruptions was the trunk (18.9%). Frequently reported associated signs and symptoms included pruritus (52%) and acanthosis nigricans (38.7%). The most common treatment included surgery (35.8%), chemotherapy (26.9%), and radiation therapy (26.9%). Treatment resulted in clinical improvement (45%), no change (30%), exacerbation (15%), or initial improvement followed by exacerbation of SKs. Patient outcomes included disease stability/ improvement (48.4%), recurrence (9.7%), exacerbation/metastasis/new malignancy (4.8%), and death (37.1%). LIMITATIONS: This was a retrospective study and excluded non-English published cases. CONCLUSION: This review updates the existing SLT literature and emphasizes the presence of PLT. Clinicians should be aware that SK eruptions may be early manifestations of an internal malignancy or other pathology. To our knowledge, this is the first review examining both SLT and PLT.