PracticeUpdate: Dermatology - Winter 2018

EDITOR’S PICKS 17

Safety and Efficacy of Hydrogen Peroxide Topical Solution in PatientsWith Seborrheic Keratoses Journal of the American Academy of Dermatology Take-home message • These authors report on the results of a pair of randomized controlled studies involving 450 and 487 participants, respectively, that investigated the safety and efficacy of 40% hydrogen peroxide topical solution for the treatment of seborrheic keratoses (SK). Comparedwith 0%of participants achieving complete clearance of four SKs with the vehicle control, 4%and 8%of participants treatedwith hydrogen per- oxide achieved complete clearance of all four SKs in study 1 and 2, respectively. Similarly, as compared with 0% of partic- ipants achieving complete clearance of three out of four SKs with the vehicle control, 13% and 23% of participants treated with hydrogen peroxide achieved complete clearance of three out of four SKs in study 1 and 2, respectively. Themost common side effects reported immediately after treatment included erythema (91%), edema (75%), mild stinging (45%), pruritus (12%), and vesicle formation (10%), which persisted in a small number of participants at day 106. • These data suggest that 40% hydrogen peroxide topical solution for the treatment of SKs is relatively well-toler- ated, but only leads to the clearance of the majority of treated SKs in fewer than 25% of individuals. Jeffrey F. Scott MD Abstract BACKGROUND Approved topical treatments for seborrheic keratoses (SKs) are an unmet need. OBJECTIVE To evaluate the safety/efficacy of 40% hydrogen peroxide topical solution (HP40) versus vehicle (VEH) for the treatment of SKs (A-101-SEBK). METHODS 937 patients with 4 SKs (≥1 lesion each on face and trunk/ extremity) were randomized 1:1 to HP40 or VEH. At each visit, SKs were graded using the Physician's Lesion Assessment (PLA) scale (0:Clear; 1:Near-Clear; 2:≤1mm thick, and 3:>1mm thick). After one treatment, SKs with PLA >0 were re-treated 3 weeks later. RESULTS At day 106, significantly more HP40 patients versus VEH achieved PLA=0 on all 4 SKs (Study 1: 4% vs 0%; Study 2: 8% vs 0%, P<0.01 both) and 3 of 4 SKs (Study 1: 13% vs 0%; Study 2: 23% vs 0%; P<.0001 both). A higher mean per-patient percentage of SKs were Clear (Study 1: 25% vs 2%; Study 2: 34% vs 1%) and Clear/Near-Clear (Study 1: 47% vs 10%; Study 2: 54% vs 5%) with HP40 versus VEH. Local skin reactions were largely mild and resolved by day 106. LIMITATIONS Optimal number of treatment sessions was not evaluated. CONCLUSION Application of HP40 was well-tolerated and was associ- ated with resolution of seborrheic keratosis. Safety and Efficacy of Hydrogen Peroxide Topical Solution, 40% (w/w) in Patients With Seborrheic Keratoses: Results From Two Identical, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Studies (A-101-SEBK-301/302). J Am Acad Dermatol 2018 Jun 01;[EPub Ahead of Print], LS Baumann, A Blauvelt, ZD Draelos, et al. www.practiceupdate.com/c/69431

Abstract BACKGROUND Silver-containing dressings are considered to be safe even though there have been some reports of complications, including argyria and various organ system dysfunctions. Despite the widespread use of silver dressings, little research has been done regarding the absorption and toxicity of silver. OBJECTIVE We aimed to study the systemic absorption of silver in patients with chronic inflammatory wounds and to determine associated factors of systemic silver absorption and evaluated its association with silver toxicity. PATIENTS AND METHOD Prospective, longitudinal, observational, multicen- tre, open-label pilot study. Patients from the Dermatology Departments of Lorraine (France) with the following inclusion criteria: (i) a chronic wound of more than 6 weeks and (ii) an ulcer needing silver-containing dressing were included. Before and after 28 days of treatment, clinical characteris- tics of the wound were recorded; hemogram, hepatic and renal functions, albumin sera and serum silver level were measured. RESULTS Half of the cases displayed raised levels of silver after 1 month of treatment. Predictive factors for systemic silver absorption were wound area, anaemia and malnutrition with anaemia and malnutrition confirmed on multivariate analysis. Wound vascularization may also play a role, as a higher absorption was observed in cases of wound granulation without arterial components. No toxicity was detected. This work has also empha- sized the slow elimination of silver from the body. CONCLUSION Both long-term application and iterative treatments with sil- ver dressings should be discouraged, especially in the elderly, who often suffer frommalnutrition and anaemia to avoid potential cumulative toxicity. Silver Absorption and Toxicity Evaluation of Silver Wound Dressings in 40 Patients With Chronic Wounds. J Eur Acad Dermatol Venereol 2018 May 06;[EPub Ahead of Print], C Brouillard, AC Bursztejn, C Latarche, et al. " …it is important to keep in mind that patients whose nutritional status is poor may be at increased risk for high silver blood levels. "

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VOL. 2 • NO. 3 • 2018