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Background and objective <p>Seborrheic keratosis (SK) is a&#xa0;common benign epidermal tumor for which the optimal noninvasive treatment has not yet been definitely clarified. Hydrogen peroxide 40% (H<sub>2</sub>O<sub>2</sub>) is the only U.S. Food and Drug Administration (FDA)-approved topical agent for raised SK, whereas trichloroacetic acid (TCA) is widely used for chemical ablation. This study compared the clinical efficacy, dermoscopic improvement, safety, and patient satisfaction of H<sub>2</sub>O<sub>2</sub> 40% versus TCA 70% in SK treatment.</p> Methods <p>In this randomized controlled study, 64&#xa0;patients were assigned to H<sub>2</sub>O<sub>2</sub> 40% (<i>n</i> = 32) or TCA 70% (<i>n</i> = 32) applied over two to four sessions at 2‑week intervals. Outcomes included physician lesion assessment (PLA), lesion dimensions, subjective self-assessment (SSA), dermoscopic features, adverse events, and patient satisfaction.</p> Results <p>Trichloroacetic acid 70% demonstrated significantly greater efficacy, with complete lesion clearance in 43.8% versus 0% in the H<sub>2</sub>O<sub>2</sub> group (<i>p</i> &lt; 0.001). Dermoscopic clearance was achieved in 56.3% versus 6.3% (<i>p</i> &lt; 0.001), respectively. Patient satisfaction was significantly higher with TCA (<i>p</i> = 0.001). Mild scarring occurred in 25% of TCA-treated patients, while no scarring or pigmentary complications were observed with H<sub>2</sub>O<sub>2</sub>.</p> Conclusion <p>Trichloroacetic acid 70% provides superior clinical and dermoscopic clearance compared with H<sub>2</sub>O<sub>2</sub> 40%, albeit with a&#xa0;higher risk of mild scarring; H<sub>2</sub>O<sub>2</sub> is safer but less effective. Limitations include the lack of prospective trial registration, the single-center design, the small sample size with short follow-up, potential performance bias, and limited generalizability. This study was not prospectively registered.</p> Graphic abstract <p></p>

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Hydrogen peroxide 40% versus trichloroacetic acid 70% in the treatment of seborrheic keratosis

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Hanaa Samy Mohamed Othman,
  • Osama A. Hashem,
  • Osama Elshabory,
  • Mohamed L. Elsaie

摘要

Background and objective

Seborrheic keratosis (SK) is a common benign epidermal tumor for which the optimal noninvasive treatment has not yet been definitely clarified. Hydrogen peroxide 40% (H2O2) is the only U.S. Food and Drug Administration (FDA)-approved topical agent for raised SK, whereas trichloroacetic acid (TCA) is widely used for chemical ablation. This study compared the clinical efficacy, dermoscopic improvement, safety, and patient satisfaction of H2O2 40% versus TCA 70% in SK treatment.

Methods

In this randomized controlled study, 64 patients were assigned to H2O2 40% (n = 32) or TCA 70% (n = 32) applied over two to four sessions at 2‑week intervals. Outcomes included physician lesion assessment (PLA), lesion dimensions, subjective self-assessment (SSA), dermoscopic features, adverse events, and patient satisfaction.

Results

Trichloroacetic acid 70% demonstrated significantly greater efficacy, with complete lesion clearance in 43.8% versus 0% in the H2O2 group (p < 0.001). Dermoscopic clearance was achieved in 56.3% versus 6.3% (p < 0.001), respectively. Patient satisfaction was significantly higher with TCA (p = 0.001). Mild scarring occurred in 25% of TCA-treated patients, while no scarring or pigmentary complications were observed with H2O2.

Conclusion

Trichloroacetic acid 70% provides superior clinical and dermoscopic clearance compared with H2O2 40%, albeit with a higher risk of mild scarring; H2O2 is safer but less effective. Limitations include the lack of prospective trial registration, the single-center design, the small sample size with short follow-up, potential performance bias, and limited generalizability. This study was not prospectively registered.

Graphic abstract