title: Practice trends in the treatment of actinic keratosis in the United States: 0.5% fluorouracil and combination cryotherapy plus fluorouracil are underused despite evidence of benefit.
abstract: BACKGROUND
  Topical fluorouracil and cryotherapy are among the most commonly used treatments for actinic keratosis. Evidence shows that 0.5% fluorouracil has similar efficacy and is better tolerated than 5% fluorouracil. Evidence also shows that combination therapy with cryosurgery and fluorouracil is beneficial.
  
  
  OBJECTIVE
  To examine fluorouracil and cryotherapy use in the treatment of actinic keratosis.
  
  
  METHODS
  The National Ambulatory Medical Care Survey database was queried for visits for actinic keratosis. Visits were analyzed for patient demographics, provider specialty, and treatment regimens. Fluorouracil and cryotherapy use was analyzed over time.
  
  
  RESULTS
  Cryotherapy was the most commonly used treatment for actinic keratosis. Fluorouracil products were prescribed to 1.1 million patients (6.6%) between 2001 and 2008; of these, dermatologists prescribed 0.5% fluorouracil in 51.8% of cases and 5% fluorouracil in 38.9% of cases. Combination fluorouracil and cryotherapy was used for only 1.1% of actinic keratosis visits between 1993 and 2008 and was never used by nondermatologists.
  
  
  CONCLUSIONS
  Despite evidence suggesting comparable efficacy, greater tolerability, and lower cost of 0.5% fluorouracil relative to 5% fluorouracil, 5% fluorouracil is used by dermatologists almost as often as 0.5% fluorouracil. Among nondermatologists, 5% fluorouracil is used exclusively. Combination therapy of fluorouracil and cryotherapy is underused despite evidence of its benefit.
authors.affiliation: Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hagele
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Levender
authors.forename: Scott A
authors.initials: SA
authors.lastname: Davis
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Williford
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D055623:Keratosis, Actinic / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000963:Antimetabolites; D005472:Fluorouracil