Effectiveness of 5‐fluorouracil treatment for actinic keratosis – a systematic review of randomized controlled trials

@article{Askew2009EffectivenessO5,
  title={Effectiveness of 5‐fluorouracil treatment for actinic keratosis – a systematic review of randomized controlled trials},
  author={Deborah A. Askew and Sharon Mickan and H. Peter Soyer and David Wilkinson},
  journal={International Journal of Dermatology},
  year={2009},
  volume={48}
}
Actinic keratosis (AK) lesions present as dry, rough, yellow– brown, scaly plaques which may become thickened and horny. Most AKs are caused by chronic exposure to ultraviolet (UV) radiation and are therefore most common in middle-aged and elderly fair-skinned individuals. Regions with a higher UV exposure show a higher prevalence, and the incidence rate increases with age. 1 Around 15–25% of lesions resolve spontaneously over a 12-month period, and the risk of a single lesion progressing to an… 
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TLDR
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TLDR
Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice.
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TLDR
An overview of the different ways of measuring the efficacy of AK treatments, such as using recurrence rates or sustained clearance rates, and the importance of evidence from post-marketing surveillance trials for the detection of efficacy values and safety signals is provided.
Conventional treatment of actinic keratosis: an overview.
TLDR
There is still a need for long-term follow-up studies to better determine the recurrence rate and for comparative studies to develop a truly patient-tailored therapy for actinic keratosis.
Interventions for actinic keratoses.
TLDR
The primary outcome 'participant complete clearance' significantly favoured four field-directed treatments compared to vehicle or placebo, and the possible reduction of squamous cell carcinoma was found.
Prevalence, Discontinuation Rate, and Risk Factors for Severe Local Site Reactions with Topical Field Treatment Options for Actinic Keratosis of the Face and Scalp
TLDR
Prevalence of severe LSRs among various topical treatments for AK is reviewed and discontinuation rates due to LSOs are summarized and possible therapy-unrelated risk factors for the development of L SRs with increased severity are summarized.
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References

SHOWING 1-10 OF 27 REFERENCES
Effective treatment of actinic keratosis with 0.5% fluorouracil cream for 1, 2, or 4 weeks.
TLDR
Once-daily administration of 0.5% fluorouracil cream for 1, 2, or 4 weeks is safe and effective for the treatment of AKs, although efficacy increased with increasing treatment duration.
Pathology and pathobiology of actinic (solar) keratosis – an update
TLDR
Actinic keratosis is a UV light‐induced lesion and develops mostly in fair‐skinned patients being susceptible to solar damage and is considered as an early in situ squamous cell carcinoma 1,2 and are categorized in several classifications with subdivisions into three grades depending on the amount of atypical keratinocytes in the epidermis.
Evaluation of the Effectiveness of Imiquimod and 5-Fluorouracil for the Treatment of Actinic Keratosis: Critical Review and Meta-analysis of Efficacy Studies
TLDR
It is suggested that imiquimod may have higher efficacy than 5-fluorouracil for actinic keratosis lesions located on the face and scalp and therefore provides another option to dermatologists.
Topical chemotherapy of actinic keratoses of the upper extremity with tretinoin and 5‐fluorouracil: a double‐blind controlled study
TLDR
It was concluded that daily application of 0.05% tretinoin cream appeared to enhance the efficacy of topical 5‐FU in destruction of AK of the arms and may represent a useful treatment modality.
Imiquimod for actinic keratosis: systematic review and meta-analysis.
TLDR
Imiquimod 5% cream was effective in the treatment of AK, preventing potential development of squamous cell carcinoma and future investigation might be aimed at elucidating optimal dosing to minimize adverse events without detriment to efficacy.
Facial resurfacing for nonmelanoma skin cancer prophylaxis.
TLDR
All 3 modalities demonstrated benefit for AK reduction and skin cancer prophylaxis compared with controls and warrant further study in a larger trial.
A randomised study of topical 5% imiquimod vs. topical 5‐fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including 1‐year follow‐up
Background  Actinic keratoses (AK) frequently occur on sun‐exposed skin and are considered as in situ squamous cell carcinoma. To date, no treatment algorithm exists for first or second line
Short incubation PDT versus 5-FU in treating actinic keratoses.
TLDR
Broad area PDT treatment with ALA plus activation with blue light appears to be as effective as 5-FU in the treatment of actinic keratoses, although ALAplus laser light is somewhat less effective than the above therapies.
Bilateral comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% 5-fluorouracil cream in the treatment of actinic keratoses of the face and scalp.
TLDR
A bilateral comparison study of the efficacy and tolerability of diclofenac 3% gel used for 90 days and 5% fluorouracil cream used for 28 days in thirty patients with AK of the face and scalp demonstrated substantial efficacy in the number of lesions cleared and the proportion of patients with significant lesion clearing.
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