Enhancing Outcomes in Seborrheic Keratosis: Using a Novel Treatment Solution

July 2019 | Volume 18 | Issue 7 | Supplement Individual Articles | 178 | Copyright © July 2019

Todd E. Schlesinger MD FAAD, Clint Favre

Dermatology and Laser Center of Charleston; Clinical Research Center of the Carolinas, Charleston, SC

treatments. The patient indicated that she had no trouble caring for the areas treated and that she believes that the HP40 was effective in the removal of her SKs. She observed that a majority of the treated SKs completely disappeared, and the ones that did remain after treatment had a reduction in size. The patient expressed that she was delighted with the outcome and that the treatment has improved her lifestyle. The patient proclaimed that she expresses more confidence and rejuvenation as her skin appears “more youthful and feels younger” since the treatment.

Patient two, a 75-year-old male with Fitzpatrick skin type III, expressed that he had an extensive history of sun exposure throughout his youth and adulthood. Patient two reported that he first noticed his SKs approximately 7 to 10 years previously on his back and chest region. The patient stated that he had never been embarrassed by the appearance of SKs; however, he did express that they were “aesthetically, very unpleasant” and made him feel much “older.” The patient stated that he had never previously tried any treatments for the cosmetic removal of his SKs but became very interested in the treatment of HP40 after hearing about the potential of this non-invasive treatment. Specifically, the patient expressed that the reduction of potential adverse effects of HP40 compared to other traditional therapies was appealing. He stated that he never tried any conventional treatment due to his concerns with potential scarring and post-treatment pigmentation changes. The patient stated that he tolerated the initial treatment of HP40 well with no sign of discomfort or irritation, and that he does not recall any pain of adverse side effects after the procedure. The patient stated that within approximately 3 days, two of the treated lesions were completely gone. Altogether, the patient indicated that two of the target lesions were clear, two were partially destroyed, and two were left unaffected. Even with this result, the patient stated that he was thrilled with the outcome, and that the targeted treatment sites appear more youthful and appealing to the eye.

The two patients, both adults over the age of 60, presented with multiple (ranging from 5-6) benign, clinically typical SKs on the neck and chest region as seen in Figure 1.

Lesions ranged from 1 to 1.5 mm in thickness and 5-15 mm in length and width. The SKs were free from any hair that could interfere with the application and diminish the effect of the topical solution. Prior to the application of the topical solution, each targeted SK was disinfected and degreased with alcohol. The treatment was applied by a physician using the single-use, disposable applicator provided with Eskata. Topical solution was applied onto the targeted SKs, and each SK was rubbed, using the angled soft tip of the disposable applicator, with moderate pressure in a circular motion for approximately 20 seconds. The application process was designed to saturate the lesion with the HP40 solution including under any lesion edges using the tapered applicator tip. Treatment cycles were repeated up to 4 times per targeted SK and, according to the instructions for use for Eskata, each targeted lesion requires 60 seconds between each application. Only one treatment session was given for each patient. In some cases, two or more may be required for best results.


Seborrheic keratosis can impose a substantial burden on individuals due to their unappealing appearance, potentially accompanied by medical or cosmetic concerns as well. Many individuals express dissatisfaction with the presence of SKs and seek removal of these benign lesions. From a survey of 406 patients who sought treatment for their SKs, 53% stated they did not like how SKs looked, 33% reported that they were embarrassed by the appearance of SKs, and 31% indicated they believed the presence of SKs resulted in an older appearance.6 Furthermore, 61% of surveyed female patients stated they have actively tried to disguise the presence of SKs with clothing, make-up, and jewelry.6

Similarly, both participants described here indicated they were bothered with the appearance of their skin and uncomfortable with how people perceived them. The patients stated that the presence of SKs hindered their confidence and negatively affected the quality of their life. The individuals became interested in HP40 treatment after learning about the potential benefits and reduced risks compared to traditional therapies for SKs including pigmentary changes, erythema, edema, crusting, and blister formation.19,21,22 While one individual stated that he had no side effects during and after treatment, the other said that she felt no pain during the initial treatment and after, only mild erythema, tenderness, and minor pain that lasted approximately 1 week. Each expressed no evidence of post-treatment permanent pigment alterations, and many of the targeted lesions were clear or partially clear within 1 to 2 weeks after treatment (Figure 2). Ultimately, both individuals expressed satisfaction with the pro-