PracticalDermatology

As a dermatologist with a busy cosmetic practice, I address a variety of different skin conditions during my day. One of the most common conditions I see is patients seeking the removal of seborrheic keratoses, often referred to as SKs. SKs are benign, but patients often ask, “What can I do to get rid of them?”

SKs can be waxy, raised, or shades of brown with a wart-like texture. Over time, they may get bigger, and more may appear. SKs can appear anywhere on the body, except on the palms and soles, but are most common on the face (hairline/temples), neck, chest, and back. I notice that SKs commonly appear in highly visible areas, such as the neck and face, causing a cosmetic concern for both male and female patients alike.

As with any procedure performed in a highly visible area such as the face, the fear of scarring is always a concern, and it's a risk I certainly don't take lightly. As a result, the ability to remove the growth effectively while minimizing the risk of scarring is paramount.

A New Option

Previously, I have used cryotherapy or electrodesiccation and curettage to remove SKs. But now the FDA has approved a topical treatment for raised SKs: Eskata (hydrogen peroxide, Aclarais) topical solution, 40% (w/w). The solution in Eskata is a proprietary, high concentration hydrogen peroxide formula that is released directly onto the skin via a soft tip, pen-like applicator.¹ What I like so much about Eskata is that it is well tolerated, and as a physician, I can offer a new option that is reliable in its ability to treat raised SKs.

Since 83 million Americans have SKs, some of which are flat and some of which are raised, this treatment is beneficial for patients.¹ Although SKs are benign and often increase with age, in my practice, I've seen that patients can still be bothered by them. And it's important for me to be able to address my patients' concerns.

I have had a very positive experience while using Eskata in my practice, and clinical studies have also shown positive results. Two pivotal Phase 3 trials demonstrated Eskata was more effective than vehicle solution in clearing raised SKs. In clinical studies, 18 percent of patients experienced clearance of three out of four of their raised SKs treated with Eskata vs zero percent with vehicle, and six percent of patients experienced clearance of all four raised SKs treated with Eskata vs. zero percent with vehicle. Results were evaluated at Day 106 after initial treatment. Nearly all patients received two treatments. Per the company's Patient Information, most common side effects are itching, stinging, crusting, swelling, redness, and scaling, but individual results may vary.¹

Targeted Treatment

As a targeted treatment, applied directly to the raised SK with a pen-like applicator, Eskata's ease of use and efficacy in the removal of most raised SKs in just a couple of treatments makes it an easy choice for me and an equally easy treatment recommendation to my patients. I'm often asked about downtime following the application and any adjustment needed to daily skin care routines. With Eskata, it's all relatively minor. Due to its purely superficial application, there is no wound care necessary, although the patient could experience some slight itching, scaling, or redness at the application site. Daily skin care routines and the application of makeup can continue as soon as the Eskata topical has dried, but of course a lot of this depends on the patient and their personal recovery and comfort level. I tell all my patients after any treatment not to hesitate to call with any questions or concerns they may have.

1. Aclaris Therapeutics, Inc. (2018, April). Retrieved September 7, 2018, from https://www.eskata.com

Deanne Mraz Robinson, MD, FAAD is a fellowship trained, board-certified dermatologist with award-winning experience in medical, surgical and cosmetic dermatology. She completed dermatology residency at Yale-New Haven Hospital, where she served as Chief Resident and Director for the Yale Resident Cosmetic Clinic. Dr. Mraz Robinson serves as President and Co-Founder of Modern Dermatology and Assistant Clinical Professor of Dermatology, Yale New Haven Hospital.