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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


cedure. It is important to note that in this application process, only one treatment session was administered per patient. The package insert for Eskata suggests that another treatment may be administered after approximately 3 weeks, if the first treatment did not completely clear the lesions. 

In these cases, HP40 produced sufficient and satisfactory results for destruction of SKs while yielding minimal adverse effects. However, HP40 contains a high concentration of hydrogen peroxide, potentially leading to oxidative damage to areas of the skin with increased irritation, pain, and erythema, if treated improperly. To maximize successful clearance of SK and minimize adverse effects, physicians and other practitioners can consider the following techniques. 

The first key to treatment success comes with thorough saturation of the lesion during each application. The provider applying the topical solution must treat the lesion with the recommended number application (four) sessions to achieve the optimal clinical endpoint, which is a thorough whitening of the lesion and surrounding skin (approximately 1 millimeter). The affected area should display no evidence of bleeding, erosion, or blister formation. If one of these adverse effects occurs, the lesion has been saturated with too much topical solution, and the provider should move on to a different lesion. The lesion surface should be uniformly wet without any excessive running or dripping onto the surrounding area of the skin. If any residual solution drips onto the surrounding unaffected skin, the provider should remove the excess solution with a clean absorptive wipe. It is important to use a paper towel or tissue because residual solution may still reside on the unaffected skin, which may increase the risk of adverse effects. For best results, allow the lesion to completely dry before another application. The provider should wait the recommended 1 minute between applications and ensure that the topical solution is applied only to targeted lesions. 


After treatment with HP40, it is important to leave each lesion dry without applying a dressing or ointment for 4 hours so the hydrogen peroxide solution will have maximum effect. After 4 hours, the patient should apply an occlusive dressing to the treated areas. The targeted areas should remain covered with a bandage and lubricated as needed until the SKs slough off naturally. HP40 is a novel FDA approved treatment for seborrheic keratosis. With careful patient selection and attention to best-practice treatment technique, patients can benefit from removal of unsightly lesions with minimized adverse effects. 

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