This work aimed to increase the effectiveness of treatment of patients with seborrheic keratosis by using complex individualized topical therapy with a keratolytic, retinoid, and oxidant, taking into account clinical, instrumental (dermatoscopic, ultrasound), morphological, and immunohistochemical features.
The results of the conducted research are based on data obtained during a comprehensive dermatological evaluation and dynamic observation of 90 patients with seborrheic keratosis. Of these, 60 people/lesions of keratosis in the main group used the following topical regimen as a treatment for the neoplasm: at the first stage, retinoid adapalene gel was applied twice a day for 2 weeks, and 5% salicylic ointment was additionally prescribed twice a week, once in the evening (instead of adapalene gel). Upon completion of this stage, it was recommended to use a 30% solution of hydrogen peroxide once a day for 5-10 days with exposure to the application of the oxidant for 1 minute. The comparison group was represented by 30 patients in whom lesions were removed invasively. The control group consisted of 30 practically healthy people.
The data on the significance of the influence of active insolation lasting more than 2 weeks per year, lack of photoprotection and skin phototype on the development of multiple keratosis have been clarified.
Modern ideas about the role of proliferation disorders and terminal differentiation of keratinocytes in the mechanism of seborrheic keratosis gained further development by determining the expression levels of immunohistochemical markers Ki-67 and caspase-14. Suppression of proliferation and increase in the activity of terminal differentiation was established, which determines the vectors for the selection of drugs for the therapy of neoplasms.
The role of dermatoscopic patterns and ultrasound for different clinical variants and histological types of seborrheic keratosis has been clarified.
The indications and method of complex combined treatment of seborrheic keratosis using topical retinoid adapalene, keratolytic 5% salicylic ointment and oxidizing agent 30% hydrogen peroxide solution have been improved and implemented in practical health care, and its effectiveness is evaluated.
Attention is focused on the trigger factors contributing to the formation of seborrheic keratosis, the mechanisms of its development are supplemented and clarified.
A method of therapy in the form of a topical combined treatment scheme for seborrheic keratosis using a retinoid, keratolytic, and oxidant was developed and implemented in practical health care, which is represented by an algorithm for prescribing drugs with an effective, safe profile and minimal/absent aesthetically unacceptable changes on the skin after its use (patent № 142103 (2020).
The proposed complex scheme of combined topical treatment of seborrheic keratosis is implemented in the Dermatology Center of the University Clinic of the Zaporizhia State Medical University, the outpatient dermatology practice of Zaporizhia City Hospital № 7, the Khmelnytskyi Regional Dermato-Venereological Center, the Dermato-Venereological Department of the Dnipro Regional Center of Socially Significant Diseases, the Dermato-Venereological Department of the Zaporizhia Regional Infectious Diseases Clinical Hospital. The theoretical provisions of the research and practical recommendations have been implemented in the practice of teaching students of the Department of Dermatovenerology and Cosmetology with the Course of Aesthetic Medicine of FPE Zaporizhzhia State Medical University, the Department of Skin and Venereal Diseases of the Dnipro State Medical University, the Department of Dermatovenereology of the Kharkiv Medical Academy of Postgraduate Education, which are confirmed by the acts of implementation.
