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European Journal of Dermatology

, Volume 27, Issue 6, pp 635–640 | Cite as

5-fluorouracil chemowraps for the treatment of multiple actinic keratoses

  • Lucie Peuvrel
  • Mélanie Saint-Jean
  • Gaëlle Quereux
  • Anabelle Brocard
  • Marie Le Moigne
  • Cécile Frénard
  • Amir Khammari
  • Brigitte DrenoEmail author
Therapy
  • 48 Downloads

Abstract

Background

Few satisfactory treatment options are available for widespread areas affected by multiple actinic keratoses (AKs).

Objectives

Our primary objective was to assess the response rate to weekly 5-fluorouracil (5-FU) chemowraps on widespread AK lesions, and secondarily to assess tolerability, the percentage of patients with recurrence and time to recurrence, the response rate for patients with associated Bowen’s disease (BD), and the percentage of squamous cell carcinomas (SCCs) identified after treatment.

Materials & methods

We conducted an open study which included all the patients who had been treated with weekly 5-FU chemowraps in our department over the course of five years for areas of widespread AKs.

Results

The response rate for AKs was 60%, with 20% complete responses among 25 patients after an average of 9.6 sessions (1 to 64). The treatment had to be discontinued because of toxicity in four patients; one case of contact dermatitis, one case of erosive pustular dermatosis, and two cases of Grade 2 irritations. Invasive SCCs were identified in five patients after treatment cessation. The median recurrence-free survival was five months. A 64% response rate was achieved for associated BD.

Conclusion

The weekly application of 5-FU under occlusion seems to be an interesting, well-tolerated therapeutic option for the treatment of widespread AKs.

Key words

actinic keratosis Bowen’s disease chemowrap fluorouracil occlusion weekly 

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References

  1. 1.
    Gupta AK, Paquet M, Villanueva E, Brintnell W. Interventions for actinic keratoses. Cochrane Database Syst Rev 2012; 12: CD004415.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Nishisgori C. Current concept of photocarcinogenesis. Photochem Photobiol Sci 2015; 14: 1713–21.CrossRefGoogle Scholar
  3. 3.
    Wei J, Kok LF, Byrne SN, Halliday GM. Photodamage: all signs lead to actinic keratosis and early squamous cell carcinoma. Curr Probl Dermatol 2015; 46: 14–9.CrossRefGoogle Scholar
  4. 4.
    Holmes C, Foley P, Freeman M, Chong AH. Solar keratosis: epidemiology, pathogenesis, presentation and treatment. Australas J Dermatol 2007; 48: 67–74, quiz 5–6.CrossRefGoogle Scholar
  5. 5.
    Vatve M, Ortonne JP, Birch-Machin MA, Gupta G. Management of field change in actinic keratosis. Br J Dermatol 2007; 157: 21–4.CrossRefGoogle Scholar
  6. 6.
    Anwar J, Wrone DA, Kimyai-Asadi A, Alam M. The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes. Clin Dermatol 2004; 22: 189–96.CrossRefGoogle Scholar
  7. 7.
    Berner A. Actinic keratosis and development of cutaneous squamous cell carcinoma. Tidsskr Nor Laegeforen 2005; 125: 1653–4.PubMedGoogle Scholar
  8. 8.
    Peris K, Calzavara-Pinton PG, Neri L, et al. Italian expert consensus for the management of actinic keratosis in immunocompetent patients. J Eur Acad Dermatol Venereol 2016; 30: 1077–84.CrossRefGoogle Scholar
  9. 9.
    Glogau RG. The risk of progression to invasive disease. J Am Acad Dermatol 2000; 42: 23–4.CrossRefGoogle Scholar
  10. 10.
    Dreno B, Amici JM, Basset-Seguin N, Cribier B, Claudel JP, Richard MA. Management of actinic keratosis: a practical report and treatment algorithm from AKTeam expert clinicians. J Eur Acad Dermatol Venereol 2014; 28: 1141–9.CrossRefGoogle Scholar
  11. 11.
    Gupta AK, Paquet M. Network meta-analysis of the outcome’ participant complete clearance’ in nonimmunosuppressed participants of eight interventions for actinic keratosis: a follow-up on a Cochrane review. Br J Dermatol 2013; 169: 250–9.CrossRefGoogle Scholar
  12. 12.
    Vegter S, Tolley K. A network meta-analysis of the relative efficacy of treatments for actinic keratosis of the face or scalp in Europe. PLoS One 2014; 9: e96829.CrossRefGoogle Scholar
  13. 13.
    Krawtchenko N, Roewert-Huber J, Ulrich M, Mann I, Sterry W, Stockfleth E. A randomised study of topical 5% imiquimod vs. topical 5-fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including 1-year follow-up. Br J Dermatol 2007; 157: 34–40.CrossRefGoogle Scholar
  14. 14.
    Pomerantz H, Hogan D, Eilers D, et al. Long-term efficacy of topical fluorouracil cream, 5%, for treating actinic keratosis: a randomized clinical trial. JAMA Dermatol 2015; 151: 952–60.CrossRefGoogle Scholar
  15. 15.
    Morton CA, Wulf HC, Szeimies RM, et al. Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus. J Eur Acad Dermatol Venereol 2015; 29: 1718–23.CrossRefGoogle Scholar
  16. 16.
    Anderson L, Jarratt M, Schmieder G, Shumack S, Katsamas J, Welburn P. Tolerability and pharmacokinetics of ingenol mebutate 0.05% gel applied to treatment areas up to 100cm(2) on the forearm(s) of patients with actinic keratosis. J Clin Aesthet Dermatol 2014; 7: 19–29.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Stone N, Burge S. Bowen’s disease of the leg treated with weekly pulses of 5% fluorouracil cream. Br J Dermatol 1999; 140: 987–8.CrossRefGoogle Scholar
  18. 18.
    Epstein E. Fluorouracil paste treatment of thin basal cell carcinomas. Arch Dermatol 1985; 121: 207–13.CrossRefGoogle Scholar
  19. 19.
    Fulton JE Jr, Carter DM, Hurley HJ. Treatment of Bowen’s disease with topical 5-fluorouracil under occlusion. Arch Dermatol 1968; 97: 178–80.CrossRefGoogle Scholar
  20. 20.
    Mann M, Berk DR, Petersen J. Chemowraps as an adjuvant to surgery for patients with diffuse squamous cell carcinoma of the extremities. J Drugs Dermatol 2008; 7: 685–8.PubMedGoogle Scholar
  21. 21.
    Tallon B, Turnbull N. 5% fluorouracil chemowraps in the management of widespread lower leg solar keratoses and squamous cell carcinoma. Australas J Dermatol 2013; 54: 313–6.CrossRefGoogle Scholar
  22. 22.
    Goon PK, Clegg R, Yong AS, et al. 5-fluorouracil “chemowraps” in the treatment of multiple actinic keratoses: a Norwich experience. Dermatol Ther (Heidelb) 2015; 5: 201–5.CrossRefGoogle Scholar
  23. 23.
    Sargen M, Wanat KA, Jambusaria A, Rosenbach M, Sobanko J, Miller CJ. Systemic toxicity from occlusive therapy with topical 5-fluorouracil: a case report and review of the literature. Dermatol Surg 2012; 38: 1756–9.CrossRefGoogle Scholar
  24. 24.
    Han SY, Youker S. Metallic taste as a side effect of topical fluorouracil use. J Drugs Dermatol 2011; 10: 1201–3.PubMedGoogle Scholar

Copyright information

© JLE/Springer 2018

Authors and Affiliations

  • Lucie Peuvrel
    • 1
    • 2
  • Mélanie Saint-Jean
    • 1
    • 2
  • Gaëlle Quereux
    • 1
    • 2
  • Anabelle Brocard
    • 1
    • 2
  • Marie Le Moigne
    • 1
    • 2
  • Cécile Frénard
    • 1
    • 2
  • Amir Khammari
    • 1
    • 2
  • Brigitte Dreno
    • 1
    • 2
    Email author
  1. 1.Department of DermatologyNantes University HospitalNantesFrance
  2. 2.INSERM U1232CIC BiothérapieNantesFrance

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