Treatment of Seborrheic Keratosis by High Frequency Focused Ultrasound - An Early Experience with 11 Consecutive Cases

Jacek Calik, Monika Migdal, Tomasz Zawada, Torsten Bove, Jacek Calik, Monika Migdal, Tomasz Zawada, Torsten Bove

Abstract

Purpose: High intensity focused ultrasound operating at 20 MHz has been demonstrated as a safe and efficient treatment modality for a range of dermatological indications. The method is potentially also applicable to removal of seborrheic keratosis.

Patients and methods: A total of 54 seborrheic keratoses in 11 volunteer subjects (8 women and 3 men, average age 51.5 ± 13.2 years) were treated in a single session with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. Handpieces with nominal focal depths of 0.8 mm below the skin surface were used to administer acoustic energy of 0.99-1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real-time. Treatment efficacy and side-effects were assessed directly after treatment and at follow-up 4-15 weeks after treatment.

Results: The treatment showed positive results in 96.3% of the cases. About 68.5% of the cases were classified as complete response and 27.8% of the cases as partial response. Two cases (3.7%) did not respond to treatment and were classified as stable condition. No subjects experienced worsening of their condition, and no treatment received the classification of progressive condition. Side effects were primarily redness in the treatment area due to superficial telangiectasia, mild scarring, and persisting and slow-healing lichen planus-like keratosis. No adverse events were observed.

Conclusion: HIFU is concluded to be a safe and efficient skin treatment for seborrheic keratoses. It has advantages over conventional treatments that can lead to pain during treatment and scarring after healing.

Keywords: HIFU; dermatology; dermoscopy; seborrheic warts; skin tumor; solar lentigo.

Conflict of interest statement

The HIFU device was provided by TOOsonix to the Old Town Clinic for clinical work. Dr Jacek Calik reports non-financial support from Toosonix, during the conduct of the study. Dr Tomasz Zawada and Mr Torsten Bove report a patent EP3589367B1 issued to TOOsonix A/S. The authors report no other conflicts of interest in this work.

© 2022 Calik et al.

Figures

Figure 1
Figure 1
High-frequency HIFU applied to the human skin. At 20 MHz, the focal zone is sufficiently small to prevent damages to the deeper part of the dermis and subcutaneous layer below.
Figure 2
Figure 2
Dynamics in removal of seborrheic keratosis by high-frequency HIFU. (A) An epidermal seborrheic keratosis (SK) is located in the skin. (B) Shoulder-by-shoulder HIFU doses are placed to cover the SK-field including a small margin. (C) A necrotic volume containing SK cells is formed directly after treatment. (D) The wound crust is spontaneously released after 1–2 weeks after damaged cells have been replaced.
Figure 3
Figure 3
TOOsonix HIFU system operating at 20 MHz. The handpieces have an integrated real-time video camera allowing accurate control and monitoring of the treatment.
Figure 4
Figure 4
(A) Overview of anatomical location of lesions selected for HIFU treatment. (B) Anatomical location for each subject in the study.
Figure 5
Figure 5
Typical dermoscope appearance of seborrheic keratosis. (A) Before HIFU treatment. (B) Directly after treatment. Whitening of the epidermis and denaturation of the superficial skin structure as a reaction to the thermal and mechanical effects of HIFU can be observed.
Figure 6
Figure 6
Summary chart of dermoscopic features detected at follow-up.
Figure 7
Figure 7
Case 1. (A and B) Macro-photo and dermoscope pictures of a large and thick seborrheic keratosis before HIFU. (C and D) Macro-photo and dermoscope pictures 6 weeks after initial HIFU treatment. The seborrheic keratosis has clearly reduced in thickness and the majority of brown clods and coiled vessels have been removed. The lesion is however still clearly visible, in particular in the periphery of the original lesion. A second repeat treatment was administered. (E and F) Macro-photo and dermoscope picture at follow-up visit 10 weeks after first treatment (4 weeks after second treatment). The visual appearance is significantly improved, but seborrheic keratosis is still visible, and a third treatment will be needed to fully remove the lesion.
Figure 8
Figure 8
Case 2. (A and B) Macro-photo and dermoscope picture of large seborrheic keratosis on left breast before HIFU. (C and D) Macro-photo and dermoscope picture of treated area at control visit 4 weeks after HIFU treatment.
Figure 9
Figure 9
Case 3. (A) Macro-photo of 5 selected seborrheic keratoses lesions for HIFU treatment. (B) Dermoscope picture of lesion number 4 before HIFU. (C) Dermoscope picture of lesion number 4 at the control visit 5 weeks after treatment.

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Source: PubMed

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