Article

Seborrheic keratoses: A study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod

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Abstract

Patients with seborrheic keratoses frequently desire an effective topical therapy for seborrheic keratoses. To compare topical calcipotriene, topical tazarotene, and topical imiquimod with standard cryosurgery in the treatment of seborrheic keratoses. Fifteen patients with numerous seborrheic keratoses were enrolled in an open-label study comparing cryosurgery with topical agents. Eight separate seborrheic keratoses were selected to be treated with topical medications. One lesion was treated with cryosurgery. One treatment with cryosurgery led to clinical and histological improvement of all lesions treated. Neither scarring nor recurrence resulted in cryosurgery. In seven of 15 patients, tazarotene 0.1% cream applied BID caused clinical improvement in lesions within 16 weeks. Cryosurgery produces clinical and histological improvement of seborrheic keratoses. The result with cryosurgery was cosmetically acceptable to all patients. Responders to tazarotene cream 0.1% found it cosmetically acceptable.

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... Herron et al. failed to observe clinical improvement following four-month application of 0.005% calcipotriene, compared to 100% clinical improvement with standard cryotherapy (n ¼ 15, self-controlled) (17). Response was assessed monthly for 6 months. ...
... Two studies performed in 2004-2020 evaluated the use of vitamin A-based topical solutions for the treatment of SKs. Herron et al. additionally assessed the efficacy of Tazarotene 0.1% cream, a retinoid derived from vitamin A, on area and clearance of SKs (n ¼ 15, self-controlled) (17). BID application of tazarotene 0.1% for four months resulted in significant clinical and histological improvement in 7/15 patients; however, one treatment with cryosurgery led to histological improvement for all 15 patients. ...
... BID application of tazarotene 0.1% for four months resulted in significant clinical and histological improvement in 7/15 patients; however, one treatment with cryosurgery led to histological improvement for all 15 patients. Furthermore, 10/15 patients reported initial burning, pruritus, and redness subsequent to treatment (17). None of the subjects discontinued treatment due to side effects; however, the authors state the effectiveness of treatment was limited by its irritation. ...
Article
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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.
... In a small study of 15 subjects, it was shown that twice-daily application of 0.1% tazarotene cream caused SKs to be indistinguishable from the normal skin at the end of 6 months of treatment. All patients who responded to this treatment determined the topical treatment to be satisfactory, and wished to continue treatment with tazarotene in the future [10]. Tazarotene cream has also proved to be relatively effective in the treatment of plaque psoriasis in clinical trials, as well as reducing lesions in patients with mild to moderate facial acne. ...
... Vitamin D analogs have also been shown to have some efficacy against SKs [10,11]. Vitamin D is present in the epidermis, and ligand-dependent Vitamin D Receptor (VDR) has been shown to play a role in keratinocyte differentiation and proliferation. ...
... After treatment, 30.2% of patients saw either complete disappearance or at least 80% reduction in the volume of their SKs, and 46.4% saw a reduction in volume between 40 and 80%. In a second study, however, calcipotriol did not result in clinical improvement and thus the results of using these Vitamin D analogs are not clear [10]. ...
Article
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Seborrheic Keratoses (SKs) are one of the most common dermatologic lesions seen by dermatologists. They are biologically benign and do not usually require removal for medical reasons; however, many patients choose removal due to cosmetic preferences. Currently, cryotherapy (liquid nitrogen spray) is the most common mode of removal [1]. Although patients often desire an effective topical treatment, few have been developed that rival the effects of cryotherapy. This article aims to review current available topical treatments, with a particular focus on both the benefits and potential pitfalls of a novel treatment, concentrated Hydrogen Peroxide (H2O2).
... Different modalities have been used to treat seborrheic keratosis. Removing tumors by liquid nitrogen cryosurgery is considered as the standard treatment 3 , but some adverse effects like scarring and hypopigmentation are seen frequently in this modality 4 . During recent years, the tendency toward removing dermatologic tumors by laser surgery has increased and it is considered as an alternative therapeutic option [5][6][7] . ...
... During recent years, the tendency toward removing dermatologic tumors by laser surgery has increased and it is considered as an alternative therapeutic option [5][6][7] . However, due to the patients' enthusiasm in topical treatments, the search is going on to find topical therapies 3 . ...
... Different modalities have been used to treat seborrheic keratosis. Removing tumors by liquid nitrogen cryosurgery is considered as the standard treatment 3 , but some adverse effects like scarring and hypopigmentation are seen frequently in this modality 4 . During recent years, the tendency toward removing dermatologic tumors by laser surgery has increased and it is considered as an alternative therapeutic option [5][6][7] . ...
... During recent years, the tendency toward removing dermatologic tumors by laser surgery has increased and it is considered as an alternative therapeutic option [5][6][7] . However, due to the patients' enthusiasm in topical treatments, the search is going on to find topical therapies 3 . ...
Article
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Eficacy of calcipotriol in the treatment of seborrheic keratosis: a pilot study Background: Seborrheic keratosis is a common benign tumor and many modalities are used to treat it. No convincing data favors the therapeutic effect of calcipotriol on seborrheic keratosis. We aimed to assess the efficacy of calcipotriol in the treatment of this tumor. Method: Eligible patients aged over 40 years with seborrheic keratosis (size: 5-15mm) were instructed to apply 50μg/g calcipotriol ointment twice a day for 12 weeks. The size of the tumor was measured at baseline and after the 12-week period. The size change and improvement were assessed. Result: Thirty out of fifty screened patients were eligible for the study and completed the 12-week course of the study. The mean baseline size of the tumors was 9.30±2.95 mm that decreased to the mean size of 2.02±1.94 mm (P<0.05). The mean percent of improvement was 80.46±17.66% and 6 patients demonstrated 100% improvement. The mean percent of improvement revealed no difference between male and female participants. An intermediate negative correlation existed between the tumor size and the improvement. No serious side effects were reported by patients. Conclusion: Our study concluded that calcipotriol might be effective and safe in the treatment of seborrheic keratosis tumors with slightly better outcomes in smaller tumors. Controlled studies with larger sample sizes should be performed in order to find the effect of calcipotriol on this dermatologic entity.
... Unlike with topical chemotherapy, IMQ is not harmful to normal skin; in fact, during safety studies for the treatment of genital warts, daily use of IMQ was less irritating than Vaseline intensive care lotion. This should provide a comfort level to clinicians in recommending application of IMQ to broad surface areas over a prolonged period of time [18,19]. Exposure to ultraviolet radiation should be avoided or minimized during its use due to increased photosensitivity. ...
... It is a reasonable, but less studied, alternative to corticosteroids for treatment and postoperative prevention of keloids [36][37][38]. Patients with certain syndromes (basal cell nevus syndrome, epidermodysplasia verruciformis, albinism, xeroderma pigmentosum, and Brooke-Spiegler syndrome) showed a diminished response to treatment compared to patients with other types of comorbidities, such as hematologic neoplasia, immunosuppression for renal transplantation, and HIV [7,17,19,20]. Therefore, the use of imiquimod in patients with cutaneous comorbidities needs to be reviewed based on the specific circumstances of each patient [17]. ...
Data
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Imiquimod is an immune response modifier that stimulates the patient's own immune system to release various chemical substances, such as interferon and interleukin-12. Although, approved by the United States Food and Drug Ad-ministration since 1997 as a topical treatment for genital and perianal warts, investigators have found that this product may offer an alternative treatment for a wide variety of medical conditions, such as for actinic keratoses, molluscum con-tagiosum, genital herpes, and various skin tumours. Clinical trials are now demonstrating the beneficial effects that its administration may have in treating other immune-related, dermatologic disorders. Understanding the pharmacology of this kind of drug is another step to fully understanding the power of the human immune system. Local reactions occur most frequently and include itching, burning, pain, soreness, flaking, erosions, and crusting. Since, it is administered lo-cally; only a small amount of drug should reach systemic circulation, if used correctly. However, uncommon systemic side effects have been reported including headache, flu-like symptoms, fatigue, nausea, and myalgia. This article reviews imiquimod use in dermatology including its off-label use, side effects, future developments, new molecules related to dermatology and relevant patents.
... Unlike with topical chemotherapy, IMQ is not harmful to normal skin; in fact, during safety studies for the treatment of genital warts, daily use of IMQ was less irritating than Vaseline intensive care lotion. This should provide a comfort level to clinicians in recommending application of IMQ to broad surface areas over a prolonged period of time [18,19]. Exposure to ultraviolet radiation should be avoided or minimized during its use due to increased photosensitivity. ...
... It is a reasonable, but less studied, alternative to corticosteroids for treatment and postoperative prevention of keloids [36][37][38]. Patients with certain syndromes (basal cell nevus syndrome, epidermodysplasia verruciformis, albinism, xeroderma pigmentosum, and Brooke-Spiegler syndrome) showed a diminished response to treatment compared to patients with other types of comorbidities, such as hematologic neoplasia, immunosuppression for renal transplantation, and HIV [7,17,19,20]. Therefore, the use of imiquimod in patients with cutaneous comorbidities needs to be reviewed based on the specific circumstances of each patient [17]. ...
Article
Full-text available
Imiquimod is an immune response modifier that stimulates the patient's own immune system to release various chemical substances, such as interferon and interleukin-12. Although, approved by the United States Food and Drug Administration since 1997 as a topical treatment for genital and perianal warts, investigators have found that this product may offer an alternative treatment for a wide variety of medical conditions, such as for actinic keratoses, molluscum contagiosum, genital herpes, and various skin tumours. Clinical trials are now demonstrating the beneficial effects that its administration may have in treating other immune-related, dermatologic disorders. Understanding the pharmacology of this kind of drug is another step to fully understanding the power of the human immune system. Local reactions occur most frequently and include itching, burning, pain, soreness, flaking, erosions, and crusting. Since, it is administered locally; only a small amount of drug should reach systemic circulation, if used correctly. However, uncommon systemic side effects have been reported including headache, flu-like symptoms, fatigue, nausea, and myalgia. This article reviews imiquimod use in dermatology including its off-label use, side effects, future developments, new molecules related to dermatology and relevant patents.
... Herron ve ark. (7), standart tedavisi kriyoterapi olan SK'lerde topikal kalsipotrien, tazaroten ve imikuimodun etkinli ini ara tırmı lar ve tazarotenin topikal olarak günde iki defa uygulanmasının 7/15 hastada etkili oldu unu tespit etmi lerdir. Bu etkinli in epidermal diferansiasyonu artırıcı etkisi sonucu oldu u dü ünülmü tür (7). ...
... (7), standart tedavisi kriyoterapi olan SK'lerde topikal kalsipotrien, tazaroten ve imikuimodun etkinli ini ara tırmı lar ve tazarotenin topikal olarak günde iki defa uygulanmasının 7/15 hastada etkili oldu unu tespit etmi lerdir. Bu etkinli in epidermal diferansiasyonu artırıcı etkisi sonucu oldu u dü ünülmü tür (7). Tripsin gibi bazı proteolitik enzimler 1941'li yıllardan beri epidermisi dermisten ayırmak için laboratuvarlarda kullanılmaktadır. ...
... In the pursuit of optimizing immune function through the application of IMQ andconsidering that it is a treatment able to activate innate immunity first and further the adaptive immunity, an effective application scheme could entail a regimen akin to or minor to the treatment conventionally employed against HPV; this should require a dosage equivalent to the IMQ content in a 12.5 mg packet available from various commercial brands. These applications should pertain to areas of the body not exposed to direct sunlight, as recommended by previous studies [206][207][208]. Following this proposed regimen, individuals should apply one packet every three days for a total duration of four weeks, closely adhering to the manufacturer's instructions (Table 1). ...
Article
Full-text available
Through widespread immunization against SARS-CoV-2 prior to or post-infection, a substantial segment of the global population has acquired both humoral and cellular immunity, and there has been a notable reduction in the incidence of severe and fatal cases linked to this virus and accelerated recovery times for those infected. Nonetheless, a significant demographic, comprising around 20% to 30% of the adult population, remains unimmunized due to diverse factors. Furthermore, alongside those recovered from the infection, there is a subset of the population experiencing persistent symptoms referred to as Long COVID. This condition is more prevalent among individuals with underlying health conditions and immune system impairments. Some Long COVID pathologies stem from direct damage inflicted by the viral infection, whereas others arise from inadequate immune system control over the infection or suboptimal immunoregulation. There are differences in the serum cytokines and miRNA profiles between infected individuals who develop severe COVID-19 or Long COVID and those who control adequately the infection. This review delves into the advantages and constraints associated with employing imiquimod in human subjects to enhance the immune response during SARS-CoV-2 immunization. Restoration of the immune system can modify it towards a profile of non-susceptibility to SARS-CoV-2. An adequate immune system has the potential to curb viral propagation, mitigate symptoms, and ameliorate the severe consequences of the infection.
... The use of liquid nitrogen cryotherapy is among the commonly used procedures and previous studies have shown the effectiveness of this modality. [6][7][8] Plasma exeresis is a new minimally invasive technique that has recently gained attention in recent years. The plasma exeresis medical devices generate plasma energy by ionizing atmospheric gas between the device and the skin. ...
Article
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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.
... It is reported that great success has been achieved in the treatment of seborrheic keratosis by using different cryotherapy methods. All seborrheic keratoses treated with cryotherapy improved clinically and histologically [14]. ...
... No assessment was made of lesion recurrence. 50 Artemether (Eleven patients were enrolled in an openlabel, non-randomized, single centre study.) ...
Article
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Seborrheic keratosis (SK) is a common, benign tumor that can occur on every body site and can be conservatively managed. Cosmetic concerns, especially when a lesion involves the facial area, is 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 seborrheic keratosis 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 seborrheic keratosis. Several oncogenic mutations involving FGFR-3 and FOXN1 have been identified. SKs are usually classified clinically and histologically. Dermatoscopy is a non-invasive alternative diagnostic technique widely used in differentiating SK from other benign and malignant tumours. 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. This article is protected by copyright. All rights reserved.
... Після однократного лікування на місці вогнищ виникали явища набряку, утворення пухирів, кірок та ерозій з повною реепітеліалізацією через 1 місяць. Не було виявлено ознак утворення рубців, гіпопігментації або рецидивів при контрольному гістологічному дослідженні через 6 місяців [12]. ...
Article
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Objective of this work is to evaluate the effect of a new topical treatment scheme for seborrheic keratosis on the quality of life in comparison with invasive electrocoagulation technique in terms of secondary changes in the skin (dyschromia, scarring). Materials and methods. 90 patients with seborrheic keratoses (77 females (85.6%), 13 males (14.4%)) were examined at the "University Clinic" and the Department of Dermatovenerology and Cosmetology with the Course of Aesthetic Medicine of FPE of ZSMU. Clinical, dermatoscopic, ultrasound, and pathomorphological examinations were performed for diagnostic purposes. The patients were randomly allocated into 2 groups. Local therapy was recommended as treatment for the first group (n=60). Patients in the second group (n=30) were prescribed electrocoagulation to remove neoplasms. Quality of life was assessed using the standardized DLQI index. The degree of discomfort with the application of a 30% hydrogen peroxide solution was assessed using a visual analog scale. Results. Only 13 patients (21,66%) in Group I had secondary skin changes in the form of hypopigmentation. At the same time 26 (86,66%) patients of Group II had an undesirable result after removal in the form of scar changes. Assessment of quality of life also indicates a significant difference when comparing topical and invasive treatment. According to the questionnaire results, patients in the main group had a score of 5 (4;6), whereas in the case of electrocoagulation removal the score was 7 (6;9) (U=373.5; p=0,000005). Conclusions. The use of topical agents in the treatment of seborrheic keratosis demonstrates effective efficacy in the extent of skin clearing of these neoplasms.
... Focal TCA peels also showed good clinical response in darker-skinned patients (Fitzpatrick IV-V) [156]. Conversely, tazarotene 0.1% cream improved outcomes in less than half of patients, and 12% ammonium lactate lotion (Lac-Hydrin) only affected lesion elevation [157,158]. SK clearance achieved using topical dobesilate [159], 5% imiquimod cream [160], and 3% diclofenac gel has also been reported [161]. A recent meta-analysis found no evidence for the efficacy of topical vitamin D analogues [162]. ...
Article
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.
... Twice a day application of tazarotene was found to be effective in (7/15) 47% patients. 19 Di- ...
Article
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 ≤1mm thick; 3 ≥1mm 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.
... The common operative therapies of seborrheic keratosis include surgical resection, cryosurgery, electrodesiccation, curettage and ablative laser [5,12]. Local or systemic drugs such as vitamin D, tazarotene, calcipotriene, dobesilate, ammonium lactate, and imiquimod are the alternative treatment methods for seborrheic keratosis [5,[12][13][14]. These proposed approaches have shown certain curative effects on seborrheic keratosis, though none are universally effective and some problems or complications such as scarring, hyperpigmentation, and even recurrence may exist [5,12]. ...
Article
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Seborrheic keratosis is a common benign epidermal tumor that occurs mainly in the skin of the face and neck, trunk. The tumors are not, however, seen on the oral mucous membrane. Herein, we describe a case of labial seborrheic keratosis confirmed by histopathology. A healthy 63-year-old man was referred to our hospital for evaluation and treatment of a 2-month history of a labial mass with mild pain. Clinically, the initial impressions were malignant transformation of chronic discoid lupus erythematosus, syphilitic chancre, or keratoacanthoma. Surprisingly, our laboratory results and histopathologic evaluations established a novel diagnosis of a hyperkeratotic type of labial seborrheic keratosis (SK). This reminds us that atypical or varying features of seborrheic keratosis make it difficult to provide an accurate diagnosis. Clinical manifestations of some benign lesions may be misdiagnosed as malignancy. Consequently, dentists should consider this as a differential diagnosis in labial or other oral lesions.
... Lesions are typically removed for cosmetic reasons or, more rarely, if lesions become irritated or inflamed. Removal is most commonly done through cryotherapy, although curettage and cautery has also been used (Herron et al., 2004 Regulatory B cells (Bregs) inhibit inflammatory immune responses (Mizoguchi et al., 2000). In Bregs, phosphoinositide 3-kinase (PI3K) promotes IL-10 production by activating protein kinase B (Akt) (Matsushita et al., 2016). ...
... Acantholytic type of AK can resemble other lesions, associated with acantholysis, such as Grover disease, Darier's disease, as well as seborrheic keratosis with acantholysis [10,16]. Acantholytic type of AK clinically looks like seborrheic keratosis and is manifested by light brown flat lesions with velutinous verruculoses urface [17]. ...
Article
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Objective: Introduction: Actinic keratosis (AK) is precancerous skin lesion that occurs in the sun-exposedskin areas characterized by local intraepidermal dysplasia of different severity (KIN I, KIN II and KIN III). The aim of this research was to study distribution patterns and morphological features of AK histological types. Patients and methods: Materials and Methods: The study included skin biopsy material from 68 patients with different clinical forms of AK. The diagnosis of AK was histologically confirmed in 100% of cases. Results: Results: There were 63.21% of men and 36.8% of women among all patients with AK. The average age of patients was 73.3 ± 8.3.The most common clinico-histological forms of actinic keratosis were typical (41.2%), hypertrophic (16.2%), atrophic (14.7%) and pigmentary (11.7%), bowenoid (8.8%), acantholytic (7.4%). Among the rate of epidermal dysplasia there diagnosed cases of KIN І (50%), KIN ІІ (36.8%) and KIN III (13.2%). Conclusion: Conclusions: It was found a direct correlation between KIN I and typical and pigment forms of AK, KIN II and hypertrophic and bowenoid forms of AK.
... Although 5% imiquimod cream was used in the treatment of seborrheic keratosis in one study, no improvement was observed. [12] CONCLUSION The diagnosis of inverted follicular keratosis is generally established histopathologically as clinical differentiation from other lesions is difficult. Imiquimod cream could offer an effective and successful alternative to surgery. ...
Article
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Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum characterized by exo-endophytic growing. It is thought to be a rare variant of the seborrheic keratosis. The diagnosis of inverted follicular keratosis is generally established histopathologically because clinical differentiation from other lesions is difficult. Herein, we present one such rare case, successfully treated with topical 5% imiquimod cream.
... Common warts Blistering, pain [9] Size of wart and degree of hyperkeratosis [17,34] 75% [7,9] Anogenital warts Pain, hypo-or hyperpigmentation [35] Individual wart area, duration, and anatomic site [36] 67-69% [12] Actinic keratosis Hypopigmentation [37] Duration of freezing [37] 75-79% [15,16] Seborrheic keratosis Hypopigmentation, atrophic scar [7,38] Thickness of the seborrheic keratosis, freeze time, and number of FTCs [39] 96.6% [38] Basal cell carcinoma Poor cosmetic outcome [20] Localization, size, and histological type of the tumor, history of previous recurrence, safety margins and duration of follow-up [7] 99% [21] Squamous cell carcinoma Hypopigmentation [25] Size and risk of the lesion [40] 93% [24] Keloidal scar Hypopigmentation, blistering, delayed healing, and infection [41] Number of cryosurgery sessions and duration of the lesions [1] 61% [29] ...
Article
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Cryosurgery is an alternative treatment for many benign, premalignant, and malignant lesions of the skin. To review the indications of cryosurgery for cutaneous lesions. The retrospective study was based on the assessment of medical records of 1031 dermatology patients who had cryosurgery. One thousand two hundred and forty-four sessions of cryosurgery were applied to the total of 1031 patients. Of the 1031 patients, the most frequent indication for cryosurgery was common warts which were present in 535 (61.59%) patients, followed by anogenital warts in 119 (11.54%) patients, callosity in 81 (7.85%) patients, actinic keratosis in 77 (7.46%) patients, molluscum contagiosum in 35 (3.39%) patients, and other benign or malignant skin lesions. Cryosurgery is still a valuable treatment of choice in various benign, premalignant, and malignant skin diseases but seems to be underused for indications other than viral warts.
... The most common treatment modality is cryotherapy with nitrogen liquid, curettage, laser or surgical shave, and other ablative methods. Some studies show good efficacy of topical administration of vitamin D and tazarotene which result in the induction of keratinocytes apoptosis [8,9]. Patients with multiple lesions have to be examined to exclude malignancy of internal organs, especially in eruptive type of seborrheic keratoses. ...
Article
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IntroductionSeborrheic keratoses are very common benign epidermal tumors. Despite the high frequency, the pathogenesis is still unknown. They are extremely rare in the genital area. The participation of human papilloma viruses (HPVs) in pathogenesis of seborrheic keratoses is being discussed. AimsThe aims of this case report are to inform about extremely rare lesion in genital area in a young man and evaluate the association of HPVs in the development of seborrheic keratoses. Methods We used histopathological examination to establish the correct diagnosis, which revealed signs of seborrheic keratosis. The real-time polymerase chain reaction method confirmed low-risk HPV 6 from the lesions. Main Outcome MeasuresHPVs may play a role in pathogenesis of seborrheic keratoses. ResultsThe patient was successfully treated with shave excision under spinal anesthesia. Six-month follow-up was without any recurrence. We suggest that HPVs can be considered as etiologic factor in creation of seborrheic keratosis. Conclusions Seborrheic keratoses are very common on sun-exposed skin, but they are rare in the genital area, such as on the shaft of penis. This localization may lead to misdiagnosis. Seborrheic keratoses in genital area might negatively influence the sexual life of the patient. Containing HPV 6 low-risk virus, they never lead to malignant transformation. Part M, Svecova D, Brezova D, and Breza J. Giant seborrheic keratoses on penis. J Sex Med 2014;11:3119-3122.
... In an open-label trial involving 15 patients, topical calcipotriol was inferior to standard treatments such as cryotherapy for the treatment of seborrheic keratosis. 104 A later open-label trial of 116 patients with seborrheic keratosis showed that 35 (30.2%) patients had a complete remission or greater than 80% decrease in lesion size after 3 to 12 months of topical tacalcitol. The study further showed that tacalcitol induced apoptosis of explanted lesional tissue in culture, whereas there was no spontaneous apoptosis in control cultures (p , .0001), ...
Article
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Background: Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. Objective: The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. Methods: A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. Results: A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. Conclusion: Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
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D Vitamini Kimyasal Yapısı ve Metabolizması Hülya Cenk D Vitamini Ve Genetik Aydın Rüstemoğlu D Vitamininin Normal Serum Düzeyleri, D Vitamin Düzeylerini Etkileyen Faktörler Ve D Vitamini Yetmezliği Sabiye Akbulut Serum D Vitamininin Ölçümü Andaç Uzdoğan, Çiğdem Yücel D Vitamini Biyoyararlanımı ve Doğal Beslenme Kaynakları Atilla Çifci, Halil İbrahim Yakut Sistemik D Vitamini Tedavi Ajanları, Biyoyararlanımı ve Tedavi Yönetimi Işıl Deniz Oğuz Topikal D Vitamini Tedavisi, Tedavi Yönetimi ve Kullanıldığı Hastalıklar Dursun Türkmen Deride D Vitamini Sentezi Mekanizmaları Abdullah Demirbaş, Ömer Faruk Elmas Güneşten Koruyucu Kullanımı ve D Vitamini Nursel Dilek, Yunus Saral D Vitamininin Deri Yapısı ve Fizyolojisine Etkisi Pelin Hızlı Deri Yaşlanması ve D Vitamini Ülker Gül Psoriasis ve D Vitamini Ülker Gül Psöriatik Artrit ve D Vitamini Mehmet Uçar Atopik Dermatit ve D Vitamini Ayşegül Ertuğrul, İlknur Bostancı Mast Hücresi ve Kutanöz Mastositozda D Vitamini Selçuk Doğan, Tülin Çataklı, İlknur Bostancı Ürtiker ve D Vitamini Kemal Özyurt Kaşıntı ve D Vitamini Kübra Yüce Atamulu Likenoid Dermatozlar ve D Vitamini Nihal Altunışık Vitiligo ve D Vitamini Ayşe Akbaş Melasma ve D Vitamini İbrahim Etem Arıca Rozase ve D Vitamini Nalan Saraç Akne ve D Vitamini Selma Korkmaz Hidradenitis Süpürativa ve D Vitamini Yılmaz Ulaş Seboreik Dermatit ve D Vitamini Dilek Başaran Otoimmün Büllöz Hastalıklar ve D Vitamini Sezgi Sarıkaya Solak Bağ Doku Hastalıkları ve D Vitamini Kevser Gök Behçet Hastalığı ve D Vitamini Şule Ketenci Ertaş, Ragıp Ertaş İdiyopatik Fotodermatozlar ve D Vitamini Bülent Nuri Kalaycı İktiyozis ve D Vitamini Tubanur Çetinarslan Epidermolizis Bülloza ve Vitamin D Eda Haşal Kseroderma Pigmentozum, Epidermodisplasia Verrusiformis ve D Vitamini Derya Yayla Nevüsler ve D Vitamini Serpil Şener, Suat Sezer Aktinik Keratoz ve Seboreik Keratozda D Vitamini Mahmut Sami Metin Deri Maliniteleri ve D Vitamini Sevda Önder Vaskülitler ve Vitamin D Havva Hilal Ayvaz Venöz Trombozis ve D Vitamini Cahit Yavuz Yara İyileşmesi ve D Vitamini Bülent Nuri Kalaycı Diyabetik Ayak Ülseri ve D Vitamini Gözde Ulutaş Demirbaş, Abdullah Demirbaş Granülomatöz Hastalıklar ve D Vitamini Selma Bakar Dertlioğlu Deri Enfeksiyonları ve Vitamin D Atıl Avcı Oral Mukoza Hastalıkları ve D Vitamini Ali İhsan Güleç Tırnak Sağlığı ve Hastalıklarında D Vitamini Hülya Cenk Alopesiler ve D Vitamini Munise Daye Hirsutizm ve D Vitamini Efşan Gürbüz Yontar Sistemik Kortikosteroid Kullanımında D Vitamini Desteği Selma Korkmaz Fototerapi ve D Vitamini Tuğba Özkök Akbulut Covıd-19 Ve Vitamin D Sibel Altunışık Toplu D Vitamini Tedavisinin Yan Etkileri ve D Vitamini Tedavisi Sürecinde Dikkat Edilecek Hususlar Dursun Türkmen, Nihal Altunışık D Vitamini Ve İlaç İlaç Etkileşimleri Şule Gökşin D Vitamini İntoksikasyonu Bedriye Müge SÖNMEZ
Article
Introduction Seborrheic keratosis (SK) are benign lesions with cosmetic concerns. Role of TCA and erbium YAG laser has already been described individually in the literature. However, there is a scarcity of data on the comparative evaluation of these two modalities in SK. Aim The aim of this study was to compare the efficacy and safety profile of Erbium YAG laser ablation with 70% TCA for the treatment of facial SK. Materials and Methods A total of 50 cases of facial SK were included in the study. Group A included SK lesions on the right side of face treated with Erbium YAG laser ablation while Group B included SK lesions on the left side of face treated with topical 70% trichloroacetic acid. Repeated sessions of laser and TCA application were given at 2-week intervals till cure was achieved or up to a maximum of three sessions. Grading of response to treatment was assessed as complete response (100% clearance), partial response (>50 to 99% improvement), and inadequate or no response (<50% improvement). Results Complete clearance was observed in 40 (80%) and 29 (58%) cases in Groups A and B, respectively. There was a statistically significant difference in clearance rates between the two groups ( P = 0.019). Number of sessions was significantly lesser in laser group (mean ± SD = 1.24 ± 0.43) than in the 70% TCA group (mean ± SD = 1.88 ± 0.79) ( P = 0.001). Statistically significant lesser downtime was observed in group A ( P = 0.001). Patient satisfaction rate was much higher in group A. Hyperpigmentation was more common in group B (TCA). Conclusion Although both the treatment modalities achieved good results, erbium YAG laser ablation showed superior results than 70% TCA with better patient satisfaction rates but more downtime. Also, no major adverse effects were observed in the two groups.
Article
Zusammenfassung Die seborrhoische Keratose (SK) ist der häufigste gutartige epidermale Tumor in der klinisch‐dermatologischen Praxis. Diese Übersicht fasst den Kenntnisstand zu Klinik, Histologie, Epidemiologie, Pathogenese und Therapie von SK zusammen. Anhand des klinischen und histologischen Bildes unterscheidet man verschiedene Typen der SK. Es wird vermutet, dass mehrere Faktoren, darunter das Alter, eine genetische Prädisposition und möglicherweise auch die Exposition gegenüber ultravioletter Strahlung mit der Entstehung der Tumoren in Verbindung stehen. Die Läsionen können an allen Körperregionen auftreten, mit Ausnahme der Handflächen und Fußsohlen, die häufigsten Stellen sind jedoch das Gesicht und der obere Rumpf. Die Diagnose erfolgt meistens klinisch, in manchen Fällen unter Zuhilfenahme eines Dermatoskops oder durch Biopsie. Viele Patienten bevorzugen es, SK aus kosmetischen Gründen zu entfernen, obwohl keine medizinische Indikation hierzu vorliegt. Bei den Behandlungsmöglichkeiten wird zwischen chirurgischen, chirurgisch‐destruierenden (Laser, Elektrodesikkation/‐kaustik, Kryotherapie) und topisch‐medikamentösen Verfahren unterschieden. Letztere sind aktuell in klinischer Entwicklung. Die Behandlung wird abhängig vom klinischen Bild und der Präferenz des Patienten individuell angepasst.
Article
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.
Article
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.
Article
Background. Seborrheic keratosis is a benign skin tumor removed through electrodessication, cryotherapy, or surgery. Alternative options may be beneficial to patients with contraindications to standard treatment, or those who prefer a non-invasive approach. Objectives. To determine the effectiveness and safety of topical medications on seborrheic keratosis in the clearance of lesions, compared to placebo or standard therapy. Methods. Studies involving seborrheic keratosis treated with any topical medication, compared to cryotherapy, electrodessication or placebo were obtained from MEDLINE, HERDIN, and Cochrane electronic databases from 1990 to June 2018. Results. The search strategy yielded sixty articles. Nine publications (two randomized controlled trials, two non randomized controlled trials, three cohort studies, two case reports) covering twelve medications (hydrogen peroxide, tacalcitol, calcipotriol, maxacalcitol, ammonium lactate, tazarotene, imiquimod, trichloroacetic acid, urea, nitric-zinc oxide, potassium dobesilate, 5-fluorouracil) were identified. The analysis showed that hydrogen peroxide 40% presented the highest level of evidence and was significantly more effective in the clearance of lesions compared to placebo. Conclusion. Most of the treatments reviewed resulted in good to excellent lesion clearance, with a few well tolerated minor adverse events. Topical therapy is a viable option; however, the level of evidence is low. Standard invasive therapy remains to be the more acceptable modality.
Chapter
KernpuntenDe verruca seborrhoica of verruca senilis (ouderdomswrat) is een benigne huidafwijking die op volwassen leeftijd optreedt.Bijna alle ouderen hebben een of meer ouderdomswratten.Behandeling is in de regel niet nodig, maar kan eenvoudig worden uitgevoerd met cryotherapie, curettage of diathermie.Een recente ontwikkeling is behandeling met waterstofperoxide 40 %. De verruca seborrhoica of verruca senilis (ouderdomswrat) is een benigne huidafwijking die op volwassen leeftijd optreedt. Bijna alle ouderen hebben een of meer ouderdomswratten. Behandeling is in de regel niet nodig, maar kan eenvoudig worden uitgevoerd met cryotherapie, curettage of diathermie. Een recente ontwikkeling is behandeling met waterstofperoxide 40 %.
Article
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Seborrheic Keratosis (SK) is a common, benign epidermal tumor as observed by dermatologists. Removal is rarely indicated, and usually requested by patients for cosmetic preference. The most common method of removal is cryotherapy, but other topical treatments exist. Topical Hydrogen Peroxide has been recognized as an effective topical treatment. Safety concerns and maximum efficiency of peroxides have been a topic of study in a variety of dermatological conditions. This article aims to review the chemical composition of hydrogen peroxide (H 2 0 2 ) in treating SK, methods to increase its effectiveness as a topical dermatological product, and explore the promising new FDA approved treatment.
Article
Seborrheic keratosis (SK) is a benign, common disease affecting mostly the middle aged and elderly population. SK lesions are characterized by pigmented skin growth, a warty surface, and sharp margins. Current therapies (curettage or cryotherapy) are invasive and painful. A non-invasive treatment is evaluated in this clinical study. Objectives: To assess the efficacy, safety, and tolerability of Nitrizinc Complex® topical solution (NZCS) for treatment of SK, after one to two topical applications. Thirty-two SK patients with a total of 59 lesions were treated with NZCS. Outcomes were determined by the dermatologist at clinical visits at one, three, six, and 12 months post-procedure and by subjective evaluation of patients through questionnaires. Six months after treatment, complete elimination was observed in 80% of the lesions (72% of the patients), while 93.3% of the lesions showed at least 50% reduction. Treatment ended with 100% cosmetic benefit as no scars or dyschromia were observed in the treated areas. Subjective treatment and cosmetic satisfaction were evaluated and corresponded to 8.66/10 and 8.07/10, respectively. The product was preferred over all other options previously used by all patients. Treatment was highly tolerable as discomfort, such as pain and itching/burning sensations, was minimal. No relapse cases have been observed at 12 months after treatment. This study demonstrates that NZCS is an efficient, easy-to-apply, safe and well tolerated treatment for SK lesions, and may therefore be considered as a potential topical non-invasive alternative for SK treatment.
Article
Background: Seborrheic keratosis (SK) is a common benign skin tumor, yet no topical treatments are approved in the United States. Objective: To evaluate the proprietary, stabilized, high-concentration hydrogen peroxide-based topical solution A-101 (32.5% and 40% concentrations) for treatment of facial SK lesions. Materials and methods: In this multicenter, double-blind, vehicle-controlled study, eligible subjects were randomly assigned to receive up to 2 treatments of A-101 40%, A-101 32.5%, or vehicle solution applied to a single facial SK lesion. The primary efficacy assessment was the Physician's Lesion Assessment (PLA), a validated 4-ordinal scale. Results: The primary end point, the mean reduction in PLA grade from baseline to Day 106 was 1.7 for A-101 40%, 1.4 for A-101 32.5%, and 0.1 for vehicle (p < .001, both concentrations vs vehicle). Lesions for 68%, 62%, and 5% of subjects, respectively, were judged to be clear or near clear (p < .001, both concentrations vs vehicle). Local skin reactions were predominantly mild and transient. No subjects discontinued because of treatment-related adverse events. Conclusion: A-101 solution demonstrated efficacy in treating SKs on the face. Greater magnitude of effect was seen with the 40% concentration than the 32.5% concentration. A-101 solution had a favorable safety and tolerability profile at both concentrations.
Chapter
Benign lesions are the most commonly treated lesions by those who perform cryosurgery; most of treated lesions include seborrheic keratosis, lentigo simplex molluscum, and warts. The versatility of this technique has extended its use to other conditions that range from keloids and leishmaniasis to anecdotal uses as in alopecia areata and granuloma annular.
Chapter
A 39-year-old female with a changing skin lesion visited the Primary Care clinic. Due to its changing appearance, the lesion was biopsied and found to be a seborrheic keratosis. Seborrheic keratoses (SK) are benign epidermal tumors that become increasingly common as people age. The lesions tend to be elevated, with well-demarcated borders, and have a waxy or verrucous appearance. SKs are usually asymptomatic; however, they may become pruritic and occasionally bleed due to trauma caused by friction. SKs do not require treatment; however, they may be removed by cryosurgery or electrodesiccation if they become symptomatic or cosmetically bothersome.
Chapter
Seborrheic keratosis is a benign keratinocytic proliferation of unknown etiology, acquiring a papillomatous morphology and varying degrees of pigmentation. Dermatologists easily diagnose them visually. Although usually asymptomatic and not treated for reasons other than cosmesis, they may become irritated or infected; in such circumstances removal by a variety of methods including cryosurgery is medically justifiable.
Article
Aims: Pigmented lesions such as of seborrheic keratosis and senile lentigo, which are commonly seen on skin of people>50years of age, are considered unattractive and disfiguring because of their negative psychological impact. Drug therapy using all-trans retinoic acid (ATRA) is an attractive option for self-treatment at home. We have developed an ATRA-loaded microneedle patch (ATRA-MN) and confirmed the pharmacological effects of ATRA-MN application in mice. Here, we describe a clinical study to evaluate the safety and efficacy of ATRA-MN in subjects with seborrheic keratosis or senile lentigo. Main methods: ATRA-MN was applied to the lesion site of each subject for 6h once per week for 4weeks. The skin irritation reaction was scored to assess adverse reactions and blood tests were performed to evaluate the presence of systemic adverse reactions. To assess the treatment effect using ATRA-MN, the desquamation and whitening ability of the investigational skin was observed. Key findings: Desquamation of the stratum corneum was observed following four ATRA-MN applications at 1-week intervals, but ATRA-MN applications did not induce severe local or systemic adverse effects. Significance: These results showed that ATRA-MN treatment is promising as a safe and effective therapy for seborrheic keratosis and senile lentigo.
Article
This month sees the introduction of a three-part article on benign skin 'lumps and bumps' that may be encountered in general practice.
Article
Seborrheic keratoses (SK) are benign cutaneous lesions frequently seen in old age. The aim of the study is to compare the efficiency of Er:YAG lasers with cryotherapy in the treatment of SK. The study was carried out on 42 patients with SK sized 0.5-3 cm, located on the back, chest, face and neck. Lesions with a similar size and location on the same patient were matched. In the same session, half of the lesions were treated with cryotherapy, while the other half were treated with Er:YAG lasers. All of the patients were clinically evaluated in two recalls with a one-month interval between appointments. The efficiency of the treatments was clinically evaluated. Following the first treatment, complete healing was detected in all of the lesions (100%) treated with Er:YAG lasers, while the healing rate was 68% in the cryotherapy group (p < 0.01). In the Er:YAG laser-treated group, hyperpigmentation was significantly lower and more erythema developed than in the cryotherapy group. Er:YAG lasers offer a one-step procedure which is a very simple and economic treatment and provides an alternative treatment method with better cosmetic results compared to cryotherapy.
Article
Seborrheic keratosis (SK) is a common benign lesion that develops from the proliferation of epidermal cells. Since SK usually occurs on the face, extremities, and upper trunk of the elderly, the finding of this lesion on the auricle is rare. Given the rarity of SK lesions of the auricle and the lack of familiarity with its presentation, otolaryngologists have difficulty diagnosing SK. Authors experienced a case of solitary SK that originated from the auricle in a 65-year-old man. We present this case with a review of the literature.
Article
Seborrheic Keratosis (SK) is one of the most common non-cancerous skin lesions of adults. The lesions are generally asymptomatic but may occur with itching, pain and bleeding. Current treatments are painful, often result in local bleeding and infection and are not suitable for the removal of many lesions in a patient. In the current study, topical treatment with BL-5010, a novel aqueous formulation, was investigated for its safety and efficacy in SK patients. In a Phase I/II, open-label, single-arm study, 60 patients were treated by single application of BL-5010 with 6 month- follow-up. Primary endpoint was safety and tolerability parameters assessed by physical examinations, adverse events, vital signs and dermal irritation. Secondary endpoints included dermal irritation and efficacy that was evaluated by lesion removal response, by patients' and investigators'-assessed cosmetic outcomes, as well as the proportion of lesions that were adequate for histopathological analysis. Lesions detached from the skin in >96% of patients by day 30. The cosmetic outcomes were good or excellent by investigators (94.6%) and patients (84%) by day 180. BL-5010 demonstrated a good safety profile and detached lesions were suitable for subsequent histopathological diagnosis. A single application of BL-5010 was safe and resulted in detachment of the SK lesion from the skin with no serious accompanying complications, thus may be considered as an alternative treatment to painful, invasive and expensive treatment options. These encouraging results, support further development of BL-5010 topical treatment for SK with a therapeutic potential for other skin lesions such as actinic keratosis, skin tags and warts. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Article
Seborrheic keratosis is one of the most common skin benign tumors in humans with a high occurrence rate of 80%-100% in people of >50 years of age; however, its pathogenesis is still unclear. The standard treatment includes cryotherapy and laser surgery for physically removing lesions. Drug therapy for this condition has not been well established. We aimed to evaluate the use of all-trans retinoic acid (ATRA)-loaded microneedle (MN) patches as a simple, alternative therapeutic option to traditional surgical treatments. This therapeutic strategy was designed to induce the proliferation of basal keratinocytes and accelerate stratum corneum turnover, leading to the lesion falling off the surface of the skin. The MN patch induced epidermal hyperplasia and marked expression of heparin-binding epidermal growth factor-like growth factor mRNA and protein corresponding to ATRA activity in the skin of HR-1 hairless mice. The acceleration of stratum corneum turnover was also observed by the dansyl chloride method. The skin irritation study in mice and safety study in humans support the safety findings of our study. Overall, MN patches can offer an effective and safe means of ATRA delivery into the skin, and the ATRA-loaded MN patch appears to be an effective pharmaceutical product providing a novel therapeutic option for seborrheic keratosis.
Article
Due to the ability of imiquimod (Aldara, 3M Pharmaceuticals) to rapidly and potently stimulate both innate and adaptive arms of the immune system, imiquimod has rapidly been recognized as a potential candidate for off-label use in over 60 conditions as presented in numerous case reports, letters, and small trials. It is our goal to examine and consolidate this impressive body of literature in order to provide the practicing dermatologist with a quick reference of the conditions that have been successfully treated with imiquimod, the dosages used, and the success rates of treatments.
Article
background . Unintended thermal damage occurring during surgery with the CO 2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness. objective . Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO 2 laser and a superpulsed CO 2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients. methods . Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser. conclusion . The superpulsed mode was found to convey only a slight advantage. The use of a 50‐millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.
Article
Background. Depending upon the patient's age at transplant, skin type, sun exposure, and the need for immunosuppressive therapy to prevent rejection, there is escalation in the development of cutaneous malignancies in organ transplant patients a number of years after transplantation. Thus, with the expansion in these procedures over the past decades, and the ever-lengthening survival of these patients, we are seeing an increase in cutaneous malignancies in this patient population.Objective. To determine if combined therapy with 5% 5-fluorouracil and 5% imiquimod may be useful in the treatment of squamous cell carcinoma in situ.Methods. We present five renal transplant patients, all more than 10 years posttransplantation, three with insulin-dependent diabetes, who developed multiple areas of squamous cell carcinoma (SCC) in situ. All these patients were on chronic immunosuppressive chemotherapy to prevent rejection, but were otherwise doing well. All the patients had biopsy-proven SCC in situ on their lower extremities that even in normal patients may be a challenge to treat.Results. We treated these five patients with a combination of a local immune therapy, imiquimod cream, and a topical chemotherapeutic agent, 5% 5-fluorouracil (5-FU), with clearing of the areas of SCC in situ.Conclusion. Although immunotherapy must be used with caution in organ transplant patients to avoid graft rejection, topical imiquimod is a local immune modulator that potentiates local innate and possible adaptive immunity without measurable effects on systemic immunity. In addition, there is evidence that cytokines induced by imiquimod may improve the therapeutic efficacy of topical 5% 5-FU in the treatment of SCC in situ.
Article
Topical vitamin D analogues offer a new, effective, more convenient and generally well-tolerated option for the treatment of psoriasis. Only psoriasis vulgaris has been intensively studied, but other forms of the disease may also respond. Both calcitriol and calcipotriol have been shown to be effective in numerous clinical trials, and the latter has compared well with betamethasone valerate and short-contact dithranol in controlled studies. Their mechanism of action is not yet fully understood and may prove complex. The most important effect may be a direct regulation of keratinocyte proliferation and differentiation. However, these compounds also have potent immunological properties, and may act by inhibition of cytokine production by keratinocytes or lymphocytes. Topical application of vitamin D analogues appears generally to be remarkably safe, but hypercalcaemia and hypercalciuria may develop if large quantities are used.
Article
This study on the use of liquid nitrogen as a cryotherapeutic agent was, in a large measure, prompted by the questions of residents and interns: "With how much pressure, for how long, and what lesions should we treat?" An attempt to develop an exact measurement time and pressure system was found to be beset with many variables. Therefore such a system would probably not replace the art involved in using cryotherapy. A knowledge of the histopathology, vascularity, and preconceived depth of each lesion treated is necessary for the successful therapeutic use of cryoagents.
Article
Unintended thermal damage occurring during surgery with the CO2 laser limits its usefulness because of slow healing and increased scarring. The superpulsed mode was developed to address this problem, but little clinical data exist to evaluate its effectiveness. Patients having warts of the hands and feet, seborrheic keratoses, lentigines, and actinic cheilitis were treated by three experienced laser surgeons using both the conventional continuous mode CO2 laser and a superpulsed CO2 laser. Effectiveness of therapy, healing time, and rates of scarring were compared for the two groups of patients. Charts of patients treated in 1988 and 1989 were reviewed and data recorded regarding surgical parameters, healing time, scarring, and effectiveness of therapy. Patients were placed in a diagnosis category with each laser only if there was a corresponding patient treated by the same physician using the other laser. The superpulsed mode was found to convey only a slight advantage. The use of a 50-millisecond pulse was even more advantageous. The superpulse parameters are analyzed and ideal parameters to prevent unwanted thermal damage are suggested.
Article
Sixty-five patients having a total of 492 lesions were treated with the Candela pigmented lesion dye laser (510 nm, 300 ns). Lesions treated included café-au-lait macules, lentigines, seborrheic keratoses, and postinflammatory hyperpigmentation. Fluences varied from 2.0 J/cm2 to 3.5 J/cm2, but averaged 2.25 J/cm2. Response was good to excellent after one treatment with 40-50% completely clearing and an additional 33% clearing by 75% or more. Repeated treatments were capable of clearing residual lesions. Histologic examination revealed vacuolization of melanin-containing cells and suprabasilar vesicles. The only adverse sequelae were transient hypopigmentation and hyperpigmentation, which resolved in 4 to 6 months.
Article
The biologically active form of vitamin D3, calcitriol, is effective in the treatment of psoriasis but can alter calcium metabolism. Calcipotriene is an analog of calcitriol that has low calcemic activity and aids in clearing psoriasis. The purpose of this study was to determine the safety of topical therapy with calcipotriene particularly in relation to calcium and bone metabolism. In a double-blind, randomized, parallel, vehicle-controlled trial, 78 adults with plaque psoriasis were treated twice daily with topical calcipotriene ointment (50 microgram/gm, maximum usage, 120 gm per week) or vehicle for 8 weeks. After a screening visit, patients were admitted to the hospital at weeks 0 (baseline), 1,2,4, and 8. Blood and urine chemistry analysis included parathyroid hormone, serum calcium, bone-specific alkaline phosphatase, urinary hydroxyproline, and 24 hour urinary calcium excretion. Bone densitometry measures were performed at baseline and week 8. No incidences of calcipotriene treatment-related hypercalcemia, calcium mobilization from bone, or clinically significant changes in bone density wer noted during this study. Topical application of up to 120 gm per week of calcipotriene ointment for 8 weeks is safe and effective for plaque psoriasis. There were no adverse effects on calcium and bone metabolism during this 8 week study.
Article
Vitamin D3 analogs have been found to be effective in treating psoriasis. We attempted to identify the targets and actions of vitamin D3 in the skin and to explore the availability of synthetic vitamin D3 analogs with selective actions on particular cell types or cell functions. A review of the literature focused on the cellular targets of vitamin D3 in the skin and within the immune system. Furthermore, the use of novel vitamin D3 analogs in skin diseases other than psoriasis was reviewed. The vitamin D receptor has been detected in most skin cells, which means that keratinization, hair growth, melanogenesis, fibrogenesis, angiogenesis, and immune-mediated processes are potential targets for vitamin D3. Vitamin D3 analogs have been synthesized with a higher therapeutic index or a higher degree of selectivity than the natural form of vitamin D3. Vitamin D3 analogs with wide-ranging clinical applications may become available for dermatology.
Article
Most biologically active forms of vitamin D3 (1,25(OH)2D3) and its analogs have functions and therapeutic potential that extend beyond those of regulating bone mineralization and intestinal calcium transport. We attempt to provide the rationale for the effectiveness of 1,25(OH)2D3 and its analogs in dermatology. The recent literature on the mechanisms of action of 1,25(OH)2D3 were reviewed. 1,25(OH)2D3 affects keratinocyte differentiation partly through its regulation of epidermal responsiveness to calcium. Calcium and 1,25(OH)2D3 interact in transcription of the genes required for differentiation and in the stability of the mRNAs produced from such genes. An understanding of these mechanisms provides a rationale for treatment of various skin diseases with 1,25(OH)2D3 and its analogs and directs development of more effective therapy.
Article
1,25-dihydroxyvitamin D3 (1,25(OH)2D3) is a drug with potent antiproliferative action on keratinocytes that have nuclear receptors for 1,25(OH)2D3. We investigated the effects of 1,25(OH)2D3 on widespread seborrheic keratoses in 51 patients with these tumors. The data indicated that resolution of these tumors was dependent on both tumor size and dose of 1,25(OH)2D3. Among 15 patients treated with a high dose (0.5 microgram/d) of oral 1,25(OH)2D3, the lesions of widespread seborrheic keratoses changed from brown-black papules to brownish papules with erythema and/or crust as early as 2 wk after the start of treatment. The tumors finally developed into an atrophic scar or brownish pigmented macule. Histologically, vacuolation of the spinous cells, vesicle formation, and liquefaction degeneration of the basaloid cells were observed. Numerous lymphocytes had infiltrated in the papillary dermis. Among 36 patients treated with a low dose (0.25 microgram/d) of 1,25(OH)2D3, brownish papules became pale to normal in color and reduced in size, without erythematous change. Histologically, acanthosis of the epidermis was reduced, but degenerative change of the tumor cells was not observed. These data suggest that oral therapy of 1,25(OH)2D3 is an acceptable method well suited to the removal of seborrheic keratoses, especially those that are predominantly small tumors.
Article
Calcipotriol (Daivonex R; Leo Pharmaceuticals, Zurich, Switzerland) may cause irritation of the skin, whereas allergic reactions are less common. In the present study we describe two patients with different types of reaction patterns, one presenting as an allergic, the other as an irritant contact dermatitis. Irritative skin reactions were observed only at higher testings doses, in contrast to the allergic type of reaction, which occurred at a lower testing dose. The present observation suggests, that a batch of different testing doses, including lower testing doses may help to differentiate between an allergic type of contact dermatitis and an irritant type of reaction after treatment with calcipotriol.
Article
The pharmacokinetic profile of tazarotene helps to ensure that systemic exposure to the drug and its metabolites is minimal. First, percutaneous penetration is limited, with less than 6% of the applied drug being absorbed into the bloodstream. Second, tazarotene is rapidly metabolized into tazarotenic acid and other metabolites that are not lipophilic. Third, tazarotene and its metabolites are rapidly eliminated from the blood in the urine and feces. These three pharmacokinetic features help to ensure that post-treatment plasma levels of tazarotene and its metabolites are comparable to those of endogenous retinoids, which suggests that the risk of teratogenic effects is minimal. Limited systemic exposure to the drug also ensures that any adverse effects are local effects rather than systemic effects. Overall, tazarotene has a good safety profile and is not associated with contact sensitization, phototoxicity, photoallergic reactions, mutagenicity, or carcinogenicity.
Article
Spiny keratoderma is a descriptive term used to encompass a variety of unusual, disparate keratodermas. Spiny keratoderma has been associated with lipid abnormalities and has been limited to the palms and soles in some individuals. We describe an acquired case of spiny keratoderma in which an adult woman developed filiform lesions predominating on the trunk and proximal extremities. Treatment with topical emollients and keratolytic agents was unsuccessful, but topical tazarotene led to long periods of resolution. She has had no other associated abnormalities. The clinical features and differential diagnosis of spiny keratoderma are reviewed.
Article
Despite numerous therapeutic options the treatment of common warts and molluscum contagiosum remains unsatisfactory for both patients and physicians. Imiquimod, a novel topical immune response modifier, has been successfully used for the treatment of external anogenital warts. We aimed to evaluate the safety, tolerance and efficacy of imiquimod for the treatment of common cutaneous warts and mollusca that were resistant to previous therapeutic interventions. Imiquimod 5% cream was self-applied by the patients to the warts or mollusca once daily for 5 days per week and left in place overnight. Assessment for response and the occurrence of side-effects was performed every 4 weeks until clinical cure or up to a maximum of 16 weeks. Twenty-eight of 50 (56%) patients with warts achieved a total clearance (n = 15; 30%) or a > 50% reduction in wart size (n = 13; 26%) after a mean treatment period of 9.2 weeks. Twelve of 15 (80%) patients with mollusca achieved a total clearance (n = 8; 53%) or a > 50% reduction in molluscum size (n = 4; 27%). There was no difference in response with regard to gender, human immunodeficiency virus serostatus or atopic predisposition. Patient-applied 5% imiquimod cream holds promise as an effective treatment of common warts and mollusca in a difficult-to-treat patient population.
Article
Overall results from a multicenter study involving more than 1000 patients with plaque psoriasis treated with tazarotene 0.1% gel plus a topical corticosteroid are soon to be published. This report considers a subgroup of 246 patients from that study who were switched from calcipotriene plus corticosteroid treatment (at baseline) to tazarotene plus corticosteroid for up to 12 weeks. Moderate (> or = 50%) global improvement was achieved in 75% of patients between the baseline visit (when on calcipotriene therapy) and the final visit (when on tazarotene therapy). Considerable additional reductions (38%-50%) in overall severity of plaque psoriasis, plaque elevation, scaling, pruritus, and overall discomfort were achieved over and above improvements already achieved with calcipotriene therapy. Furthermore, 74% of patients were satisfied with their treatment regimen at the final visit (when on tazarotene therapy), compared with 17% at baseline (when on calcipotriene therapy).
Article
Superficial basal cell carcinoma (sBCC) is an increasingly common tumor in fair-skinned populations throughout the world. Imiquimod, an immune response modifier that induces cytokines including interferons, has been shown in preliminary studies to have an effect when applied topically to BCC. We conducted a multicenter, randomized, open-label dose-response trial of imiquimod 5% cream in the treatment of primary sBCC assessing efficacy and safety of different dose regimens. Ninety-nine patients were randomized to 6 weeks' application of imiquimod in 1 of 4 treatment regimens: twice every day, once every day, twice daily 3 times/week, once daily 3 times/week. The treatment site was excised and examined histologically 6 weeks after cessation of imiquimod. Intention-to-treat analysis revealed 100% (3/3) histologic clearance in the twice-daily regimen, 87.9% (29/33) clearance in the once every day regimen, 73.3% (22/30) clearance in the twice-daily 3 times/week regimen, and 69.7% (23/33) clearance in the once-daily 3 times/week regimen. Dose-related inflammatory skin reactions at the site of application were common. The majority were well tolerated and only 1 patient withdrew from the trial as a result of a medication-related skin reaction. Imiquimod 5% cream appears to have potential as a patient-administered treatment option in sBCC.
Article
Actinic keratoses (AK) are premalignant lesions, which are routinely treated by destructive procedures such as cryotherapy, electrodessication or topical 5-fluorouracil. The aim of this study is to report six cases of AK treated with a potential new topical therapy, imiquimod. Subjects included in this study had suffered with recurrent AK for between 5 and 16 years. All six men were treated with imiquimod 5% cream three times a week for 6-8 weeks. In the event of a local skin reaction treatment was modified to two times per week. All the AK lesions were successfully cleared after treatment with imiquimod cream 5% for 6-8 weeks. Histologically, no apparent signs of persisting AK could be detected, and no recurrences were reported during follow up. This study suggests that imiquimod may be useful as a new therapy for the treatment of actinic keratoses.
Article
To assess the clinical and molecular response of patients with recurrent high-grade vulvar, vaginal, or cervical intraepithelial neoplasia treated with topical 1-2(2-methylpropyl)-1H-imidazo [4,5-c] quinolin-4-amine (imiquimod) cream 5%, an immune response modifier with known efficacy in the treatment of external genital warts. This is the first case series in the peer-reviewed literature reporting the use of imiquimod in high-grade intraepithelial neoplasia of the lower genital tract. Eight patients with high-grade intraepithelial neoplasia were treated with imiquimod in the gynecological oncology clinic and the HIV gynecology clinic at The University of Texas Medical Branch at Galveston. Frozen biopsies were available for RNA extraction on four patients before and after therapy. Using semiquantitative reverse transcription-PCR, we measured RNA levels of IFNs alpha and gamma, 2',5'-oligoadenylate synthetase, as well as CD4 and CD8 lymphocyte markers. Of the patients treated, four had complete responses, two had partial responses, one progressed, and one did not tolerate the therapy. Of the four complete responders, two remained disease-free (mean follow-up, 33 months). 2',5'-Oligoadenylate synthetase RNA expression showed an increased trend after therapy. These results obtained in this small and heterogeneous group merit further study in the use of topical 5% imiquimod use in the treatment of intraepithelial neoplasia. An important mechanism of action of imiquimod may involve 2',5'-oligoadenylate synthetase antiviral activity.
Article
Background: Seborrheic karatoses are benign lesions that are easily irritated and often cosmetically objectionable. Liquid nitrogen cryotherapy and other surgical methods are useful in treating these lesions, but are difficult to tolerate in patients who have large numbers of lesions requiring treatment. The alexandrite laser was used in one patient to quickly and efficiently destroy hundreds of seborrheic keratoses. The treatment was tolerable and excellent cosmetic results were achieved.