Open-label study of a-101, a 40% hydrogen peroxide topical solution, in patients with seborrheic keratosis. Hydrogen peroxide is not absorbed systemically by the mother following topical administration, and breastfeeding is not expected to result in exposure of the child to hydrogen peroxide. Jackson JM, Alexis A, Berman B, Berson D, Taylor S, Weiss J. Hydrogen peroxide 40% (Eskata) for seborrheic keratoses. Coyne JD. Hydrogen Peroxide Topical Solution, 40% (w/w) for the Treatment of Seborrheic Keratoses: A Review. Post hoc, the authors also calculated the mean per-patient percentage of clear/nearly clear SKs, which was higher for HP40 than vehicle (47%, 54% versus 10%, 5%, respectively).20, To examine the efficacy of HP40 by location, the percentage of clear/nearly clear SKs at day 106 for each anatomic site was calculated in another study.22 A total of 1,868 SKs were treated in the HP40 group and 1,880 SKs were treated in the vehicle group; 59% of SKs were on the trunk, 30% on the face, and 11% on the extremities. Clipboard, Search History, and several other advanced features are temporarily unavailable. If the tumors are dark, uniform, slow-growing, and have the typical stuck on verrucous appearance, there is a high probability that they are benign, and further workup is not necessary. The therapeutic efficacy was assessed with a 4-point scale, Physicians Lesion Assessment (PLA), developed by the manufacturer where 0 is clear, 1 is nearly clear, 2 is a thin SK with a depth of 1 mm or less, and 3 is a thick SK with a depth greater than 1 mm. 2015; 26(5): 47780. HP40 (Eskata) is a stabilized, topical solution of 40% hydrogen peroxide (H2O2) packaged in an applicator pen that is US FDA-approved to treat seborrheic keratoses (SKs). When choosing a strategy for SK removal, it is important to consider the SKs location as well as the patients skin type and treatment expectations. That provided much more relief from pain and more mobility in my thumb than anything else I had tried. Gulias-Caizo R, Aranda-Rbago J, Rodrguez-Reyes AA. Considerations should include the lesion size and thickness, the patients skin type, clinical suspicion for malignancy, and the physicians clinical experience. Thicker lesions may require multiple freeze/thaw cycles to effectively treat the area. https://www.ncbi.nlm.nih.gov/books/NBK545285/, https://jddonline.com/articles/dermatology/S1545961615P1119X, https://doi.org/10.1016/j.ophtha.2012.09.026, https://pubmed.ncbi.nlm.nih.gov/27477176/, https://eyewiki.org/w/index.php?title=Seborrheic_Keratosis&oldid=86706. Hoffmann J, Twiesselmann C, Kummer MP, Romagnoli P, Herzog V. A possible role for the Alzheimer amyloid precursor protein in the regulation of epidermal basal cell proliferation. 2004 Jun;52(2):154-5. Given this mechanism, HP40 should not be applied to open or infected SKs; without an intact SC to act as a barrier, high concentration H2O2 can cause rapid death of adjacent cells (Figure 1).26 Additionally, HP40 should not be applied within the orbital rim where contact with H2O2 can cause corneal injury.24, In two phase 3 trials with a total of 937 patients, four raised SKs per patient were treated with either HP40 or vehicle using the previously described method (Application and Mechanism).20 Three weeks later, residual SKs were re-treated. Limitations of HP40 are its low efficacy and requirement of multiple treatments, which can result in elevated costs. One of the studies included 6,200 British adults who had not been taking vitamin D (BMJ, Sep. 7, 2022). Seborrheic keratosis of the eyelid has a classic presentation and is therefore simpler to diagnose and treat. Articles written in English between January 2000 and mid-June 2020 discussing phase II and phase III clinical trials were evaluated. Given our current options for the treatment of SKs include only more invasive, non-topical therapies, HP40 fills a void in our therapeutic repertoire as the first FDA-approved topical therapy for SKs. Kirfel G, Borm B, Rigort A, Herzog V. The secretory betaamyloid precursor protein is a motogen for human epidermal keratinocytes. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. Different types of mutations and up-regulation of EGFR have been implicated in SK in addition to other tumors. Inhibition of apoptosis may occur in SKs, contributing to their formation.4Additionally, mutations in the fibroblast growth factor receptor8 and oncogenic phosphoinositide 3-kinase pathway9 may impact their development; however, these changes are not present in all SKs so additional genes are likely involved.8, While SKs do not require treatment, patients often request removal to relieve symptoms of irritated SKs or for cosmetic reasons.10 The most common treatment is cryotherapy with liquid nitrogen; surgical therapies are also used including electrodessication, curettage, shave excision, or laser therapy.7,11, Among other side effects, these invasive methods can cause pain, bleeding, pigmentary changes, and scarring.7,12-15 The risk of pigmentary changes is especially high in patients with skin of color.7 These side effects motivated the pursuit for efficacious topical therapies that minimize long-term adverse effects.
