TY - JOUR
T1 - Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis
T2 - A Delphi Consensus
AU - Brancaccio, Gabriella
AU - Briatico, Giulia
AU - Apalla, Zoe
AU - Dummer, Reinhard
AU - Eklind, Jan
AU - Seguin, Nicole Basset
AU - Dreno, Brigitte
AU - Fargnoli, Maria Concetta
AU - Guitera, Pascale
AU - Heppt, Markus V
AU - Hoeller, Christoph
AU - Jouary, Thomas
AU - Lallas, Aimilios
AU - Lei, Ulrikke
AU - Leiter, Ulrike
AU - Malvehy, Josep
AU - Ramírez, David Moreno
AU - Paoli, John
AU - Peris, Ketty
AU - Puig, Susanna
AU - Saiag, Philippe
AU - Stockfleth, Eggert
AU - Stolz, Wilhelm
AU - Stratigos, Alexander J
AU - Ulrich, Class
AU - Wennberg, Ann-Marie
AU - Zalaudek, Iris
AU - Argenziano, Giuseppe
PY - 2025/4/1
Y1 - 2025/4/1
N2 - INTRODUCTION: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence.OBJECTIVE: We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.METHODS: Twenty-eight expert dermatologists participated in a 3-round Delphi process. Experts evaluated LSR management strategies, including emollients, antibiotics, steroids, and treatment discontinuation. Agreement levels were measured using a 7-point Likert scale. Consensus was categorized as high if >80% of votes were within the 5-7 rating range and low when >25% were in the 1-3 rating range, with <25% of the votes in the 6-7 rating range. Other combinations of votes were considered as having moderate agreement.RESULTS: High agreement was achieved for the following statements: the approved daily schedule (once daily for 4 weeks) is the most appropriate (92.9%); mild LSR generally do not require intervention and do not impact treatment adherence (96.4%); severe LSR may benefit from temporary treatment interruption and emollient use, ensuring adherence without compromising efficacy (92.9%). The use of emollients (in parallel with the treatment with 5-FU) was considered not needed by most (moderate consensus, 64.3%). Experts emphasized the importance of clear communication about LSR during baseline consultation to enhance patient compliance.CONCLUSION: This consensus provides practical guidance for managing LSR induced by 4% 5-FU, ensuring high adherence and optimizing treatment outcomes. Further research is needed to validate these findings and explore alternative management approaches.
AB - INTRODUCTION: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence.OBJECTIVE: We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.METHODS: Twenty-eight expert dermatologists participated in a 3-round Delphi process. Experts evaluated LSR management strategies, including emollients, antibiotics, steroids, and treatment discontinuation. Agreement levels were measured using a 7-point Likert scale. Consensus was categorized as high if >80% of votes were within the 5-7 rating range and low when >25% were in the 1-3 rating range, with <25% of the votes in the 6-7 rating range. Other combinations of votes were considered as having moderate agreement.RESULTS: High agreement was achieved for the following statements: the approved daily schedule (once daily for 4 weeks) is the most appropriate (92.9%); mild LSR generally do not require intervention and do not impact treatment adherence (96.4%); severe LSR may benefit from temporary treatment interruption and emollient use, ensuring adherence without compromising efficacy (92.9%). The use of emollients (in parallel with the treatment with 5-FU) was considered not needed by most (moderate consensus, 64.3%). Experts emphasized the importance of clear communication about LSR during baseline consultation to enhance patient compliance.CONCLUSION: This consensus provides practical guidance for managing LSR induced by 4% 5-FU, ensuring high adherence and optimizing treatment outcomes. Further research is needed to validate these findings and explore alternative management approaches.
UR - http://www.scopus.com/inward/record.url?scp=105004756710&partnerID=8YFLogxK
U2 - 10.5826/dpc.1502a5787
DO - 10.5826/dpc.1502a5787
M3 - Journal article
C2 - 40401863
SN - 2160-9381
VL - 15
JO - Dermatology practical & conceptual
JF - Dermatology practical & conceptual
IS - 2
M1 - 5787
ER -