Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus

Brancaccio G, Briatico G, Apalla Z, Dummer R, Eklind J, Seguin NB, Dreno B, Fargnoli MC, Guitera P, Heppt M, Hoeller C, Jouary T, Lallas A, Lei U, Leiter U, Malvehy J, Ramírez DM, Paoli J, Peris K, Puig S, Saiag P, Stockfleth E, Stolz W, Stratigos AJ, Ulrich C, Wennberg AM, Zalaudek I, Argenziano G (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 15

Article Number: 5787

Journal Issue: 2

DOI: 10.5826/dpc.1502a5787

Abstract

Introduction: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence. Objective: We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology. Methods: Twenty-eight expert dermatologists participated in a 3-round Delphi process. Experts evaluated LSR management strategies, including emollients, antibiotics, steroids, and treatment discontinuation. Agreement levels were measured using a 7-point Likert scale. Consensus was categorized as high if >80% of votes were within the 5–7 rating range and low when >25% were in the 1–3 rating range, with <25% of the votes in the 6–7 rating range. Other combinations of votes were considered as having moderate agreement. Results: High agreement was achieved for the following statements: the approved daily schedule (once daily for 4 weeks) is the most appropriate (92.9%); mild LSR generally do not require intervention and do not impact treatment adherence (96.4%); severe LSR may benefit from temporary treatment interruption and emollient use, ensuring adherence without compromising efficacy (92.9%). The use of emollients (in parallel with the treatment with 5-FU) was considered not needed by most (moderate consensus, 64.3%). Experts emphasized the importance of clear communication about LSR during baseline consultation to enhance patient compliance. Conclusion: This consensus provides practical guidance for managing LSR induced by 4% 5-FU, ensuring high adherence and optimizing treatment outcomes. Further research is needed to validate these findings and explore alternative management approaches.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Tübingen Germany (DE) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset Sweden (SE) Catholic University of the Sacred Heart / Università Cattolica del Sacro Cuore Italy (IT) Universitat de Barcelona (UB) / University of Barcelona Spain (ES) Centre hospitalier universitaire (CHU) de Dijon Bourgogne France (FR) Aristotle University of Thessaloniki Greece (GR) Gentofte Hospital Denmark (DK) Università degli studi della Campania Luigi Vanvitelli Italy (IT) Universitätsspital Zürich (USZ) Switzerland (CH) Ruhr-Universität Bochum (RUB) Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) National and Kapodistrian University of Athens Greece (GR) Charité - Universitätsmedizin Berlin Germany (DE) Hospitales Universitarios Virgen Macarena y Virgen del Rocío Spain (ES) Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal France (FR) Université de Nantes France (FR) Medizinische Universität Wien Austria (AT)

How to cite

APA:

Brancaccio, G., Briatico, G., Apalla, Z., Dummer, R., Eklind, J., Seguin, N.B.,... Argenziano, G. (2025). Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus. Dermatology Practical & Conceptual, 15(2). https://doi.org/10.5826/dpc.1502a5787

MLA:

Brancaccio, Gabriella, et al. "Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus." Dermatology Practical & Conceptual 15.2 (2025).

BibTeX: Download