Medication Summary
No ongoing medical therapy is needed unless topical therapy has been employed to treat the lesions. A concentrated solution (40%) of hydrogen peroxide was approved by the FDA in 2017 for in office application to patients with raised seborrheic keratoses. Ammonium lactate and alpha-hydroxy acids have been reported to reduce the height of seborrheic keratoses.
Keratolytic agents
Class Summary
Keratolytic agents cause cornified epithelium to swell, soften, macerate, and then desquamate.
Hydrogen peroxide (Eskata)
The exact mechanism is unknown. The 40% topical solution is designed to penetrate into the seborrheic keratosis lesion and cause oxidative damage, which can ultimately result in the sloughing of the seborrheic keratosis cells. It is indicated for in-office topical application by a healthcare professional for patients with raised seborrheic keratosis.
Ammonium lactate lotion (AmLactin, Lac Hydrin)
Ammonium lactate lotion contains lactic acid, an alpha-hydroxy acid that has keratolytic action, thus facilitating release of corneocytes. It is available in 12% and 5% strength; 12% strength may cause irritation on the face. It causes disadhesion of corneocytes. Lactic acid is a racemic mixture of 2-hydroxypropanoic acid and is one of the most effective naturally occurring humectants in the skin.
Trichloroacetic acid (Tri-Chlor)
Trichloroacetic acid cauterizes skin, keratin, and other tissues. Although it is caustic, it causes less local irritation and systemic toxicity than do others in the same class. Treatment of individual seborrheic keratosis with up to 100% trichloroacetic acid can be used to destroy the lesions; however, clinical experience and judgment must be used because scarring may result in inexperienced hands. This treatment must be considered a form of surgery.
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Sharply circumscribed elevated seborrheic keratoses.
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Closer view of multiple seborrheic keratoses in an autosomally dominant mode of inheritance.
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Seborrheic keratoses projecting above the level of the epidermis. Cysts represent sections of hyperkeratotic follicles.
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Seborrheic keratosis showing lackluster surface and appearance of being stuck on the skin surface.
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This is an autosomal dominant form of multiple seborrheic keratoses. This man's daughter is developing a similar distribution and quantity of seborrheic keratoses.
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The back of this same patient as in the image above with multiple seborrheic keratoses. His face had a similar number of seborrheic keratoses.
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Acanthotic type of seborrheic keratosis.
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Higher-power view of the cells in an acanthotic seborrheic keratosis.
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Hyperkeratotic type of seborrheic keratosis.
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Reticulated (or adenoid) type of seborrheic keratosis.
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This is a reticulated (or adenoid) seborrheic keratosis with abundant pigment.
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Seborrheic keratosis with inflammation in the dermis.
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This seborrheic keratosis was a pedunculated lesion in an axillary fold. Clinically, it had some resemblance to a skin tag.