Topical trichloroacetic acid versus cryotherapy in the treatment of seborrheic keratoses

A prospective comparative study.

Abstract

Background: Seborrheic keratoses (SKs) are benign pigmented epidermal skin tumours which causes considerable cosmetic disfigurement. Common techniques for SK removal include cryosurgery, electrosurgery, curettage, surgical excision or chemical peels. However, there is lack of well-controlled clinical studies evaluating the efficacy and safety of these procedures. Purpose: To compare the efficacy and safety of topical Trichloroacetic acid (TCA) versus cryotherapy in the treatment of SKs. Methods: In this prospective study, 60 clinically diagnosed cases of SK were enrolled. For each participant, SK lesions were treated with cryotherapy and focal topical TCA upto 65%. The procedure was repeated monthly till desired effect or upto maximum of three sessions. Patients were followed up monthly to evaluate clinical outcome on 3-point scale (>75%-excellent;50-75%-good; <50%- poor response) and patient satisfaction rates assessed. Statistical analysis was done by the chi-square test using SPSS software. Results: Out of 60 patients treated, at the end of 6 months, among the lesions treated with TCA, 91.6 %(55) showed excellent response, 8.3%(5) good response. Among lesions treated with cryotherapy 75%(45) showed excellent response, 25%(15) good response. Polling the patients, 43.3%(26) stated that cryotherapy showed better results, 71.6%(43) felt that TCA was the quickest to heal, 73.3%(44) opined cryosurgery to be most painful. Conclusion: Lesions treated with cryotherapy were painful, with longer healing time, whereas TCA is cost effective with higher efficacy and better patient satisfaction rates. Hence we conclude topical TCA is more efficacious and cost effective than cryotherapy in treatment of SKs.