New treatment can make age spots a thing of the past

Aging can bring unwelcome surprises, like crusty brown spots that gradually appear on your face, neck or trunk.

They’re called unflattering names: age spots, barnacles or, God help us, senile warts, but physicians know them as seborrheic keratosis lesions, or SK lesions, for short. They come in as many varieties as apples at a farmers’ market: waxy, warty, raised or flat. The good news is they’re benign.

Of course, that doesn’t stop many of the 83 million Americans who have them from kvetching. Sometimes the lesions itch, bleed or get irritated by a belt or a bra strap, but for the most part, they’re simply an unwelcome reminder that there’s much in life that’s out of our control.

And there hasn’t been an easy cosmetic treatment, until now.

In December, the Food and Drug Administration approved a first-of-its-kind liquid called Eskata that targets these unsightly spots. Later this month, people who have the means and the patience to sit through at least two visits to their dermatologist’s office can get rid of some raised spots.

“A lot of patients have SKs and want them gone,” said Ellen Marmur, a dermatologist with two Manhattan practices who wasn’t part of the clinical trials conducted by Aclaris Therapeutics, the maker of Eskata. She thinks it has the potential to be a “great tool” in carefully selected patients.

Before Eskata, dermatologists could freeze lesions or use a laser or scalpel to remove them, but the procedures could be painful, and patients didn’t necessarily want to risk potential scarring for a cosmetic annoyance.

Here’s how Eskata works: After a dermatologist has determined a spot is not cancer, a staff person (not necessarily a doctor) delicately applies the highly concentrated hydrogen peroxide liquid to each lesion four times, roughly a minute apart. The idea is to moisten the lesion to dissolve it, while avoiding damaging surrounding skin.

Noelle Galperin, 49, a strategy consultant in Miami who participated in a clinical trial at Leslie Baumann’s office, said she felt a “tingling, almost burning, sensation.” Later, scabs formed on her lesions, and she wore an adhesive bandage for a few weeks to hide the spots from the sun.

Galperin used to be so selfconscious about the lesion on her forehead that she would Photoshop it out of pictures. “Who wants to be seen with brown age spots?” she said. After her Eskata treatments, the spot on her forehead is gone with no scar or sign she had it removed.

“Patients need to know that there’s a chance after two treatments their lesion may be gone and they’ll be happy,” said Robert T. Brodell, the chairman of the department of dermatology at the University of Mississippi Medical Center in Jackson. “Or some may have a lesion that’s 90 percent better, or some might take a third touch-up treatment.”

Still, Brodell called Eskata “something that’s totally different that’s an advance.”

Neal Walker, a dermatologist and the chief executive of Aclaris Therapeutics, estimated that each Eskata applicator will cost the patient $200 to $250. One applicator, he estimated, will be able to treat seven large spots up to 1.5 centimeters wide, or 10 smaller ones.

Some research has found that Eskata has minimal side effects when carefully applied. More than 90 percent of the mostly white patients had no scarring or pigmentation issues. But darker skin tends to have more trouble with pigmentation and scarring after, say, cryotherapy. Ninetyeight percent of patients in the clinical trials were Caucasian.

“It’s a huge gap in the study design,” Marmur said.

The Fitzpatrick phototyping scale classifies complexions from Type 1 (ivory) to 6 (very dark). In one study to measure the effectiveness and safety of Eskata, no patients had the darkest skin tone, and only four of the 450 enrolled participants had Type 5, which resembles Beyoncé’s skin.

“Although the numbers were small, I think the safety profile showed very well,” Walker said when asked why Aclaris research didn’t enroll more patients with darker skin. The FDA label for Eskata allows patients of any skin type to be treated.