Treatment-refractory actinic keratoses successfully treated using simultaneous combination topical 5-fluorouracil cream and imiquimod cream: a case-control study.
BACKGROUND
Most actinic keratoses (AKs) respond to standard treatments, but a subset persist and require further intervention. We report a series of 10 patients with AKs that failed to respond to conventional treatment with cryotherapy and topical monotherapy but responded completely to simultaneous therapy with topical 5-fluorouracil (5-FU) and imiquimod creams.


OBJECTIVE
To report the success of this combination therapy in refractory AKs and to determine whether any clinical or histologic features predict for treatment resistance.


METHODS
Case-control study with two control groups matched to each patient according to lesion location and sex.


RESULTS
Mean lesion diameter (p < .001), lesion diameter greater than 1 cm (p < .001), and the presence of pain (p = .01) were statistically associated with failure of cryotherapy and topical monotherapy. None of the histologic features evaluated were found to be statistically significant, although thicker epidermis was nearly so (p = .054).


CONCLUSIONS
In patients who have failed standard therapy for AKs, combination treatment using topical 5-FU and imiquimod cream may be an effective alternative therapeutic strategy. Larger lesion diameter, specifically greater than 1 cm, and the presence of pain predict conventional treatment resistance.
Department of Dermatology, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. andyondo@yahoo.com
Andrew L
AL
Ondo
R Steven
RS
Padilla
John D
JD
Miedler
Clay J
CJ
Cockerell
James D
JD
Kerner
Robert L
RL
Steiner
Steven M
SM
Mings
Stuart D
SD
Shanler
D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D000704:Analysis of Variance; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003452:Cryosurgery; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure
D000634:Aminoquinolines; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D000077271:Imiquimod; D005472:Fluorouracil