Efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis

Seborrheic keratosis (SK) is a common benign skin epidermal lesion. Different treatment modalities have been proposed for this lesion. This study aimed to compare the efficacy and safety of electrodesiccation, cryotherapy, CO2 laser, and Er:YAG laser in the treatment of SK. The study was carried out on 30 patients each with four similar facial SKs. Each lesion was assigned to be treated with cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in a random fashion. Therapeutic results were evaluated 8 weeks after the interventions through clinical and dermatoscopic assessment. Treatment improvement criteria for each lesion included the texture of the lesion, severity of the pigmentation, and an overall assessment of the healing. The severity of burning, pain, erythema, and the duration of the erythema after the procedures were documented. A survey of the patients' satisfaction with the treatments was also performed. In the assessment of overall lesion healing by two dermatologists, the improvement rate was significantly higher in the CO2, Er:YAG lasers and electrodesiccation group compared to the cryotherapy (p < 0.001). However, the CO2 and Er:YAG laser and the electrodesiccation groups showed no significant difference (p > 0.05). Moreover, no significant difference was observed in posttreatment pigmentation and texture between the groups (p > 0.05). The pain and burning severity after the interventions were negligible in all four groups. Prolonged erythema was not observed in any of the cases; however, the duration of erythema in the Er:YAG laser group was significantly longer (p < 0.001). Patient satisfaction in the cryotherapy group was significantly lower than the other three groups (p < 0.001). The efficacy of treatment and patient satisfaction rate is highly comparable between electrodesiccation, CO2 laser, and Er:YAG laser but significantly higher than cryotherapy.