Does intermittent "pulse" topical 5-fluorouracil therapy allow destruction of actinic keratoses without significant inflammation?
BACKGROUND
Topical 5-fluorouracil (5-FU) is effective in removing actinic keratoses but causes unsightly and painful erosions. Intermittent "pulse" 5-FU therapy has been described as being an effective and comfortable technique for destroying actinic keratoses.


OBJECTIVE
The purpose of this study was to determine the efficacy and cutaneous side effects of intermittent 5-FU therapy.


METHODS
Efficacy of treatment was evaluated by three experienced dermatologists separately comparing randomly arranged before and after photographs. Degree of skin reaction was graded from photographs taken during treatment.


RESULTS
Of 13 patients treated with intermittent 5-FU, two had an excellent result, three a good result, but eight failed to show discernible improvement. Efficacy was linked to the degree of skin irritation.


CONCLUSIONS
Pulse 5-FU failed to clear actinic keratoses in most patients. Intermittent 5-FU treatment does not dissociate its therapeutic efficacy from its undesirable erosive effects. Pulse therapy is a less intensive way of employing 5-FU and may be of value in patients unwilling to accept the erosions and discomfort that accompany the traditional course of daily 5-FU applications.
Epstein
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Department of Dermatology, University of California, San Francisco, USA.
D000279:Administration, Cutaneous; D000963:Antimetabolites / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003872:Dermatitis / Q000517:prevention & control*; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000209:etiology; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007642:Keratosis / Q000188:drug therapy*; D010781:Photography; D012074:Remission Induction; D016037:Single-Blind Method; D012867:Skin / Q000187:drug effects
D000963:Antimetabolites; D005472:Fluorouracil