A clinical comparison and long‐term follow‐up of topical 5‐fluorouracil versus laser resurfacing in the treatment of widespread actinic keratoses

Abstract

Compared to treatment with topical 5-FU, Er:YAG laser resurfacing is more effective regarding recurrence rates. Although significantly more side effects occur, laser resurfacing is a useful therapeutic option especially in patients with widespread AK.

Effectiveness of 5‐fluorouracil treatment for actinic keratosis – a systematic review of randomized controlled trials

“…Treatment with 5% 5‐FU resulted in an average reduction of 79.5% (range, 59.2%–100%) in the mean number of lesions, from an average of 24.0 at baseline (range, 10.3–61.8) to 4.0 (range, 0–8.8) at follow‐up 5,11,16,18,19 . In comparison, treatment with 0.5% 5‐FU resulted in an average reduction of 86.1% (range, 77.9%–91.7%) in the mean number of lesions, from an average of 13.9 lesions at baseline to 3.9 lesions at follow‐up 20,21 .…”

“…Eight studies compared 5% 5‐FU with other treatments – imiquimod, 13,14 cryotherapy, 14 diclofenac sodium 3% gel (DFS), 15 facial resurfacing, 11,16 photodynamic therapy (PDT), 17 5% 5‐FU augmented with tretinoin, 18 and 0.5% 5‐FU 5 . One study compared different dosing regimens of 5% 5‐FU (twice daily for 3 weeks vs. twice daily for 1 day per week for 12 weeks) 19 .…”

“…In comparison, treatment with 0.5% 5‐FU resulted in an average reduction of 86.1% (range, 77.9%–91.7%) in the mean number of lesions, from an average of 13.9 lesions at baseline to 3.9 lesions at follow‐up 20,21 . The average number of lesions was reduced by 94.5% (range, 92.9–96.6%) when treated by laser resurfacing, 11,16 and 28.0% (range, 21.6–34.4%) when treated with placebo 12,20,21 (Table 1).…”

Comparison of topical 5-fluorouracil formulations in actinic keratosis treatment

“…Concurrent application of 0.5% triamcinolone with 1% 5-FU suppresses inflammation, resulting in fewer 5-FU-related side effects without a compromise in efficacy (25). Better comparative studies, not only between 5-FU formulations but also between 5-FU and other treatments, will assist in the development of a treatment algorithm for first-, second-, and third-line therapies for AKs (26). Taken together, the dose-response relationship recorded here provides inadequate information to permit a rational conclusionother than stating that the relationship remains sub judice.…”

Ingenol Mebutate 0.06% Gel for Field Treatment of Actinic Keratosis on 250 cm2 of Skin on Trunk and Extremities: A Randomized Dose-Finding Trial

“…The use of non-standardized reporting of endpoints hinders cross-trial comparison with other currently available fielddirected therapies, including 5-fluorouracil, imiquimod, diclofenac and photodynamic therapy. 5 Studies have generally focused on the face and scalp [14][15][16][17] rather than the extremities, where AK lesions are more difficult to treat and have shorter remission times. 10 Partial, but not complete, clearance results from the current trial, investigating treatment in the trunk and extremities, compare well with two previous studies with imiquimod 2.5% and 3.75% that investigated a scalp/facial treatment area > 25 cm 2 .…”