Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus.

IF 2.3 4区 医学 Q2 DERMATOLOGY
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
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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.

Abstract Image

Abstract Image

5-FU 4%乳膏治疗光化性角化病引起的局部皮肤反应的处理:德尔菲共识。
导语:4% 5-氟尿嘧啶(5-FU)乳膏对光化性角化病的病变清除有很强的疗效;然而,治疗期间的局部皮肤反应(LSR)仍然是一个重大挑战,可能影响患者的依从性。目的:我们试图利用德尔菲方法就4% 5-FU相关LSR的管理达成共识。方法:28名皮肤科专家参与了3轮德尔菲法。专家评估了LSR的管理策略,包括润肤剂、抗生素、类固醇和停药。协议水平采用7分李克特量表进行测量。如果>80%的投票在5-7评级范围内,共识被分类为高,当>25%的投票在1-3评级范围内,共识被分类为低,结果:对以下陈述达成了高度一致:批准的每日时间表(每天一次,为期4周)是最合适的(92.9%);轻度LSR一般不需要干预,也不影响治疗依从性(96.4%);严重LSR可能受益于暂时中断治疗和使用润湿剂,确保坚持治疗而不影响疗效(92.9%)。大多数人认为不需要使用润肤剂(与5-FU治疗同时使用)(中度共识,64.3%)。专家们强调了在基线会诊期间明确沟通LSR的重要性,以提高患者的依从性。结论:该共识为4% 5-FU诱导LSR的管理提供了实用指导,确保了高依从性和优化治疗效果。需要进一步的研究来验证这些发现并探索替代的管理方法。
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CiteScore
1.40
自引率
0.00%
发文量
217
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