Dermatology practical & conceptual · 2025
Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus.
СтатьяНазвание и аннотация: Перевод в очереди
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Brancaccio Gabriella, Briatico Giulia, Apalla Zoe, Dummer Reinhard, Eklind Jan, Seguin Nicole Basset, Dreno Brigitte, Fargnoli Maria Concetta, Guitera Pascale, Heppt Markus V, Hoeller Christoph, Jouary Thomas, Lallas Aimilios, Lei Ulrikke, Leiter Ulrike, Malvehy Josep, Ramírez David Moreno, Paoli John, Peris Ketty, Puig Susanna, Saiag Philippe, Stockfleth Eggert, Stolz Wilhelm, Stratigos Alexander J, Ulrich Class, Wennberg Ann-Marie, Zalaudek Iris, Argenziano Giuseppe
Аннотация
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.
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.