Technique key to avoiding pigment change when treating SKs
Technique key to avoiding pigment change when treating SKs
Dr. Jaggi Rao explains his approach to using lasers to treat these non-malignant lesions in dark skin (1,120 words; 5 minutes 30 seconds)
The 7th annual Skin Spectrum Summit, Canada’s conference on Ethnodermatology, is just one month away. Click here for important information.
Treating seborrheic keratosis (SK) in darker skin without causing unacceptable hyper- or hypopigmentation can be a challenge, said Dr. Jaggi Rao at the virtual Colloquium on Black Skin on Saturday, Aug. 21. The Colloquium was presented as part of the Skin Spectrum Summit’s Summer of Dialogue on Black and Brown Skin.
The darker a patient’s skin, the less aggressive a physician should be with treatment because the reactivity of dark skin can easily lead to changes in pigment, he said. “Yet the keratin in seborrheic keratosis is so adherent that you need a little bit of force, a little aggression, to make it come off.”
Dr. Rao said that for SK or the related dermatosis papulosa nigra (DPN) in very dark skin, his common approach is to use a laser device with a wavelength that will generate less incidental heating. He also modifies his technique for using the laser device.
His recommendations include:
Use an Erbium:YAG laser, which is at the peak wavelength for water absorption, so it causes less nonspecific thermal damage.
Another laser option is the 1064 nm Nd:YAG laser, effective for heating parts of the skin with reduced water content, such as the thick stratum corneum of SK lesions.
Hold the handpiece of the 1064 nm laser approximately two inches above the skin when treating the SK lesion.
Treat just the surface of the SK or DPN lesion with either laser, then wipe off the crust that develops.
The patient should adhere to a sun-avoidance plan for one week after treatment.
Bottom line
Strongly keratinized SK lesions can be challenging to treat in reactive dark skin without causing pigment changes, but conservative and careful laser use can treat these lesions relatively safely.
From the literature on seborrheic keratosis
Effectiveness of a cosmetic device containing a combination of alpha- and beta-hydroxy acids, urea, and thuja for the treatment of seborrheic keratoses
This study in 20 patients evaluated the efficacy and tolerability of a topical product with thuja, urea and hydroxy acids as a treatment for seborrheic keratoses. Each participant applied the product to their lesions twice daily for 30 days. After the treatment period, the researchers recorded significant decreases in the thickness and number of patients' lesions. All but one of the participants reported the tolerability of the product was excellent.
Efficacy and safety of cryotherapy, electrodesiccation, CO₂ laser, and Er:YAG laser in the treatment of seborrheic keratosis
In this study, 30 patients who had four similar facial seborrheic keratosis lesions receceived treatment for each lesion with a different modality: electrodesiccation, cryotherapy, CO₂ laser and Er:YAG laser. The investigators found the improvement rate was significantly higher in the CO₂, Er:YAG lasers and electrodesiccation groups compared to the cryotherapy group. There was no significant difference in improvement between the non-cryotherapy groups. Post-treatment pigmentation and texture were similar between all the treatment approaches, though the duration of erythema was longer with the Er:YAG treatment. Overall the patients reported less satisfaction with cryotherapy compared to other treatments.
Combining reflective confocal microscopy and dynamic optical coherence tomography to diagnose melanoacanthoma: Case report
A male patient with Fitzpatrick skin type IV presented with an asymmetric black papule showing clinical and dermoscopic features of both melanoma and seborrheic keratosis (SK). The papule was evaluated using Reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (d-OCT). In the paper, the authors describe the imaging findings which led to a diagnosis of melanoacanthoma, a type of SK. They write that this case highlights the advantages of RCM and d-OCT for noninvasively differentiating melanoma from its clinical mimickers.
Aminolevulinate photodynamic therapy (ALA-PDT) for giant seborrheic keratosis of the head: A case report
This is a case report of a 61-year-old woman who presented with a large, dark-brown, well-demarcated plaque on the top of her head, diagnosed as seborrheic keratosis after dermoscopy, histopathological examination and immunohistochemical examination. She was treated with aminolevulinate photodynamic therapy (ALA-PDT). After the treatment, the lesion was reduced in diameter and thickness. The authors suggest that this successful treatment shows that ALA-PDT is a choice for the treatment of giant seborrheic keratosis. It may be a particularly valuable treatment in body areas where the lesion affects appearance and function.
VIDEO: Dermoscopy Made Simple - Seborrheic Keratoses
At the intersection of skin and society
On Sept. 28, 2021, the Canadian Indigenous broadcasting network APTN announced the first annual 2021 Indigenous Music Accelerator (IMA) winners. The IMA was created to support Indigenous musicians actively working in the music industry who are looking to take their careers further.
The selected artists will participate in five days of intensive, virtual mentorship developed and delivered by Canada’s Music Incubator (CMI), a Toronto-based national not-for-profit organization specializing in professional development, ongoing mentorship and live events for artists, managers, and music companies.
Each IMA-winning artist will also receive a professional photo shoot, a live performance video shoot, and additional one-on-one meetings with some of Canada’s top music industry professionals.
The 2021 IMA artists are
Andrew Joseph Stevens III (aka Drives the Common Man) — A Mi’kmaq self-produced singer-songwriter from London, Ont.
Blue Moon Marquee — A swinging blues band comprised of A.W. Cardinal (vocals/guitar) and Jasmine Colette (vocals/bass/drums).
Cody Coyote — An Ottawa-based Ojibwe/Irish hip hop/electronic artist with ancestry from the Matachewan First Nation.
Jacob Hoskins — An Indigenous electronic artist.
Mimi O’Bonsawin — An award-winning roots singer from Ontario who has Abenaki and French-Canadian roots.
TheRa1 1n — An emerging Plains Cree femcee born and raised in Winnipeg, and has origins in Moosomin First Nation in Treaty Six Territory, Sask.
Robin Cisek — An Indigenous singer-songwriter who creates melodic and moody alternative pop.
This Week
Oct. 4 is World Habitat Day
Oct. 4 is National Child Health Day in the US
Something to think about in the week ahead...
Skin Spectrum Summit, Nov. 4 & 6, 2021
The 7th annual Skin Spectrum Summit conference secretariat has confirmed the support of 14 sponsoring industry partners.
This great circle of new and returning supporters includes:
AbbVie
Amgen Canada Inc.
Arcutis Biotherapeutics
Cipher Pharmaceuticals Inc.
ERFA Canada 2012 Inc.
Leo Pharma Inc.
Molnlycke Health Care
Perfuse Medtec Inc.
Pfizer Canada Inc.
Proctor & Gamble Canada
Sanofi Genzyme Canada Inc.
Sun Pharma Canada Inc.
UCB Canada Inc.
Vivier Therapeutics
The secretariat would also like to express our deep gratitude to our in-kind supporters. These include
Indigenous Medical Students' Association of Canada
McGill University Dermatology Interest Group
Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC)
Obesity Matters
University of Ottawa Dermatology Interest Group
WoundPedia
Wounds Canada.
We are delighted to be working with these vital organizations.
Skin Spectrum Weekly will continue to inform our readers as new partners, and in-kind support are confirmed.
The Summit, Canada’s leading ethnodermatology medical conference for physicians, will be held on Nov. 4 and 6, 2021.
Skin Spectrum Weekly will bring you more news on faculty and topics for this year’s Summit as we get closer to the date.
Skin Spectrum Weekly will receive a discount on registration fees by using the code “SSW”. Register today for the conference, or find more information on the 2021 and prior Summits at SkinSpectrum.ca