Gabriella Brancaccio, Giulia Briatico, Zoe Apalla, Reinhard Dummer, Jan Eklind, Nicole Basset Seguin, Brigitte Dreno, Maria Concetta Fargnoli, Pascale Guitera, Markus V Heppt, Christoph Hoeller, Thomas Jouary, Aimilios Lallas, Ulrikke Lei, Ulrike Leiter, Josep Malvehy, David Moreno Ramírez, John Paoli, Ketty Peris, Susanna Puig, Philippe Saiag, Eggert Stockfleth, Wilhelm Stolz, Alexander J Stratigos, Class Ulrich, Ann-Marie Wennberg, Iris Zalaudek, Giuseppe Argenziano
{"title":"Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus.","authors":"Gabriella Brancaccio, Giulia Briatico, Zoe Apalla, Reinhard Dummer, Jan Eklind, Nicole Basset Seguin, Brigitte Dreno, Maria Concetta Fargnoli, Pascale Guitera, Markus V Heppt, Christoph Hoeller, Thomas Jouary, Aimilios Lallas, Ulrikke Lei, Ulrike Leiter, Josep Malvehy, David Moreno Ramírez, John Paoli, Ketty Peris, Susanna Puig, Philippe Saiag, Eggert Stockfleth, Wilhelm Stolz, Alexander J Stratigos, Class Ulrich, Ann-Marie Wennberg, Iris Zalaudek, Giuseppe Argenziano","doi":"10.5826/dpc.1502a5787","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objective: </strong>We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11168,"journal":{"name":"Dermatology practical & conceptual","volume":"15 2","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090966/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dermatology practical & conceptual","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5826/dpc.1502a5787","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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.