Five percent 5-fluorouracil in a cream or for superficial peels in the treatment of advanced photoaging of the forearms: a randomized comparative study.
BACKGROUND
The antimetabolite 5-fluorouracil (5-FU) is used for topical treatment of actinic keratosis. Overall improvement in the skin is also observed. Additionally, 5-FU was reported to be used for superficial peels.


OBJECTIVE
To evaluate the efficacy and safety of 5% 5-FU cream compared with peels for photodamaged forearms.


METHODS
This interventional, randomized, comparative, evaluator-blind study included 32 patients with severe photoaging of forearms. The regimens comprised either application of 5% 5-FU cream everyday for 4 weeks on 1 forearm and 4 weekly peels on the other. Efficacy assessment included: clinical photodamage scores, opinion of patients and investigators, and blind photographic evaluation by independent observers. Skin biopsies were performed for histologic and immunohistochemical analysis. Safety evaluation comprised observation of adverse events.


RESULTS
Clinical and histologic findings confirmed the benefits of topical 5% 5-FU, in cream or peels, which improved skin appearance and decreased the dermal elastotic material. Immunohistochemistry showed reduced levels of epidermal p53 and increase in the level of procollagen I. Results were maintained after 6 months. Predictable adverse events occurred, with no differences between treatments. Patients reported better tolerability to peels.


CONCLUSIONS
Five percent 5-FU cream or peels was safe and effective for the treatment of photodamaged forearms. Decreased epidermal p53 levels and new dermal collagen were confirmed.
*Department of Dermatology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; †Department of Dermatology, State University of São Paulo (UNESP), Botucatu, Brazil.
Carolina Okada Zerbini
CO
Guimarães
Hélio A
HA
Miot
Ediléia
E
Bagatin
D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D002615:Chemexfoliation / Q000379:methods; D024042:Collagen Type I / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000627:therapeutic use; D005500:Follow-Up Studies; D005542:Forearm / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007641:Keratolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D015595:Skin Aging / Q000187:drug effects; D063465:Skin Cream / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000187:drug effects / Q000378:metabolism
D015415:Biomarkers; D024042:Collagen Type I; D007641:Keratolytic Agents; D016159:Tumor Suppressor Protein p53; D005472:Fluorouracil