Abstract

Background: Seborrheic keratosis is a benign epidermal tumor commonly seen in the sun-exposed skin of adults. Current treatment modalities are invasive, which include electrodessication, cryotherapy, or surgery. Alternative options such as topical therapy may be beneficial to patients who have contraindications to standard treatment, or to those who prefer a non-invasive approach. However, evidence supporting the use of topical agents is lacking.

Objective: To determine the effectiveness and safety of topical medications on seborrheic keratosis in the clearance of lesions, compared to placebo or standard therapy.

Methods: Human studies involving adults with seborrheic keratosis treated with any topical medication and compared to cryotherapy, electrodessication or placebo were obtained from MEDLINE, HERDIN, and Cochrane electronic databases. Articles published from 1990 to June 2018 were included in this review.

Results: The search strategy yielded sixty articles. Nine publications (2 randomized controlled trials, 2 non-randomized controlled trials, 3 cohort studies, 2 case reports) covering twelve topical medications (hydrogen peroxide, tacalcitol, calcipotriol, maxacalcitol, ammonium lactate, tazarotene, imiquimod, trichloroacetic acid, urea, nitric-zinc oxide, potassium dobesilate, 5-fluorouracil) were identified. Among these, qualitative analysis showed that hydrogen peroxide presented the highest level of evidence and was shown to be significantly more effective in lesion clearance compared to placebo.

Conclusion: Most of the topical medications reviewed were more effective compared to placebo, with a few well-tolerated minor adverse events.  Hence, topical treatment may be considered as a viable option; however, the level of current evidence is low and standard invasive therapy remains to be the mainstay of management.

Citation

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Keywords

seborrheic keratosis, topical, systematic review