Topical Treatments for Seborrheic Keratosis: A Systematic Review

Abstract

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.

Update of pathophysiology and treatment options of seborrheic keratosis

“…[38][39][40][41] The size and thickness of the lesion, the patient's skin type, and clinical expertise all influence the treatment options. [37][38][39][40][41] Other topical agents used are 5% imiquimode, 28 topical dobisilate, 42 and 3% diclofenac gel, 42 but the response rate is varying.…”

“…Other topical agents used are 5% imiquimode, 28 topical dobisilate, 42 and 3% diclofenac gel, 42 but the response rate is varying. The ablative lasers like Er: Yag has shown good response with minimal side effect profile, but the cost is the limiting factor.…”

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

“…Topical therapy, including tazarotene, imiquimod, alpha-hydroxy acids, 40% hydrogen peroxide, diclofenac, potassium dobesilate, urea and vitamin D analogues, are also reported. 4 Topical calcipotriol induces apoptosis in altered lesional keratinocytes. 5 This is the first clinical study with a follow-up period demonstrating the 100% effectiveness of topical calcipotriol treatment of solitary facial lesions.…”

“…Physical treatment modalities include cryotherapy, shave excision, electrodesiccation, ablative and non‐ablative lasers. Topical therapy, including tazarotene, imiquimod, alpha‐hydroxy acids, 40% hydrogen peroxide, diclofenac, potassium dobesilate, urea and vitamin D analogues, are also reported 4 . Topical calcipotriol induces apoptosis in altered lesional keratinocytes 5 .…”