Efficacy and irritation in the treatment of actinic keratosis with topical 5-fluorouracil

Journal of Drugs in Dermatology, Sept-Oct, 2004 by Javier Labandeira

We have read with interest the article by Jorizzo about the treatment of actinic keratoses with topical 0.5% 5-fluorouracil in an optimized vehicle (1). With the intermittent use of a standard 5% 5-fluorouracil cream (Efudix) (2), we have recently observed also high efficacy and tolerability, if a longer time-to-healing.

Regarding efficacy, the use of 5% daily (3), 5% intermittent (2) and 0.5% daily (1) topical fluorouracil cream apparently does not show differences. Irritation is lowest with 5% intermittent cream, increases with 0.5% daily cream, to be common with 5% daily cream; therefore, treatment acceptance and fulfillment is considerable only at the first two approaches (1,2). Time-to-healing seems to be similar with the daily use of 5% standard or 0.5% optimized cream (1,3) but it increases with declining application frequency of intermittent 5% cream (2).

From the above, the daily use of 0.5% optimized cream (1) seems to be the best choice because of an acceptable tolerability and a lower time-to-healing than the intermittent use of standard 5% cream. However, the latter can be useful if the former is unavailable, if there is a significant price difference for the patient or the health system or if the caregiver of incapacitated patients cannot apply the treatment daily.

Actinic keratoses are a growing condition, and altered treatment regimens with topical fluorouracil (1,2,4,5) or other drugs (6) are also arising. Given the similar efficacy, tolerability, time-to-healing and cost should be taken into account at choosing a therapy.

References

1. Jorizzo J. Topical treatment of actinic keratosis with fluorouracil is irritation associated with efficacy? J Drugs Dermatol 2004; 3:21-6.

2. Labandeira J. et al. Intermittent topical 5-fluorouracil is effective without significant irritation in the treatment of actinic keratosis but prolongs treatment duration. Dermatol Surg 2004; 30:517-20.

3. Bennett R, et al. Current management using 5-fluorouracil: 1985. Cutis 1985; 36:218-36.

4. Robins P. Pulse therapy with 5-FU in eradicating actinic keratoses with less than recommended dosage. J Drugs Dermatol 2002; 1:25-30.

5. Loven K, et al. Evaluation of the efficacy and tolerability of 0.5% fluorouracil cream and 5% fluorouracil cream applied to each side of the face in patients with actinic keratosis. Clin Ther 2002; 24:990-1000.

6. Tutrone WD, et al. Topical therapy for actinic keratoses, I: 5-Fluorouracil and imiquimod. Cutis 2003; 71:365-70.

Dr. Javier Labandeira

Department of Dermatology, Faculty of Medicine

C/. San Francisco. s/n

15782 Santiago de Compostela

Spain

Phone: 34-981-591996

Fax: 34-981 54 70 94

E-mail: jlabandeirag@meditex.es

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