Evaluation of the Effectiveness of Imiquimod and 5-Fluorouracil for the Treatment of Actinic Keratosis: Critical Review and Meta-analysis of Efficacy Studies

  title={Evaluation of the Effectiveness of Imiquimod and 5-Fluorouracil for the Treatment of Actinic Keratosis: Critical Review and Meta-analysis of Efficacy Studies},
  author={Aditya K. Gupta and Valerie Davey and Heather Mcphail},
  journal={Journal of Cutaneous Medicine and Surgery},
Background:Actinic keratosis lesions occur frequently on sun-exposed skin of Caucasians. They become more prevalent with advancing age and are important in identifying the risk factor of those people possibly predisposed to invasive squamous cell carcinoma. Topical therapies are useful alternatives to cryotherapy for treating diffuse actinic damage and a number of preparations have been developed for treating actinic keratosis.Objectives:A cumulative meta-analysis was performed to determine the… 
Case-based experience in the use of 5-fluorouracil cream 0.5% as monotherapy and in conjunction with glycolic acid peels for the treatment of actinic keratosis
  • D. Goldberg
  • Medicine
    Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology
  • 2010
The cases presented here demonstrate the use of topical 5-fluorouracil cream 0.5% as monotherapy and in conjunction with glycolic acid peels to treat facial actinic keratoses in two patients with extensive histories of prior actic keratosis and skin cancer.
Comparison of topical 5-fluorouracil formulations in actinic keratosis treatment
Clinical trials examining the efficacy of 5-FU cream formulations (0.5% and 5%) in treating multiple AKs of the face and scalp are evaluated to enable dermatologists to appropriately balance the risks and benefits of each respective treatment to provide optimal solutions to patients with multipleAKs.
Imiquimod 3.75% cream (Zyclara) for the treatment of actinic keratoses
Imiquimod 3.75% is an interesting, safe and well-tolerated treatment option for actinic keratoses of the face or balding scalp especially in respect of compliance, as it is indicated for daily use for a shorter time period and approved for use on larger areas compared with imiquIMod 5%.
Topical 5-Fluorouracil for the Treatment of Periocular Actinic Keratosis and Low-Grade Squamous Malignancy
Topical 5-FU may be useful in the treatment of periocular actinic keratoses and squamous cell carcinoma in situ and the authors experience with lesions involving the eyelids, including the eyelid margin is described.
Fluorouracil Formulations for the Treatment of Actinic Keratosis
An overview of the literature focussing on clinical trials and the efficacy of the following fluorouracil formulations currently approved by the US FDA: 0.5% cream, 2% solution, and 5% cream and solution indicates each are effective and safe in the management of actinic keratosis.
Safety, efficacy, and patient acceptability of imiquimod for topical treatment of actinic keratoses
An indepth review of the literature, and clinical evidence for its inclusion in the arsenal of treatment options for patients with actinic keratoses is provided.
A Network Meta-Analysis of the Relative Efficacy of Treatments for Actinic Keratosis of the Face or Scalp in Europe
This network meta-analysis showed that BF-200 ALA, using narrow-band lights, was the most efficacious treatment for mild to moderate AK on the face and scalp.
Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis: A Randomized Clinical Trial.
The results indicate that a single course of fluorouracil cream, 5%, effectively reduces AK counts and the need for spot treatments for longer than 2 years.
Effectiveness of 5‐fluorouracil treatment for actinic keratosis – a systematic review of randomized controlled trials
Despite the widespread use of 5-FU to treat AK, the evidence supporting its use has not been reviewed systematically or appraised critically, unlike that for imiquimod, and to identify areas in which further research is needed.


The management of actinic keratoses in the United States with topical fluorouracil: a pharmacoeconomic evaluation.
This study suggests that once-daily use of 0.5% fluorouracil cream is a cost-effective way of managing a patient with multiple facial AKs.
Clinical effect of imiquimod 5% cream in the treatment of actinic keratosis.
Imiquimod 5% cream may be a promising treatment for AK, and a significant reduction in the average number of lesions per patient was observed for patients treated with imiquIMod.
5-fluorouracil 0.5% cream for multiple actinic or solar keratoses of the face and anterior scalp.
Pooled data from the two pivotal trials indicate that following 4 weeks of therapy the number of subjects with total AK clearance in the Carac and vehicle groups was 52.9% and 1.6% respectively (p<0.001).
A comparison of the effects of intralesional interferon α-2b and topical 5% 5-fluorouracil cream in the treatment of solar keratoses and Bowen's disease
In a comparative study, the efficacy of intralesional α-2b interferon in the treatment of premalignant epidermal lesions was compared with that of topical 5% 5-fluorouracil cream (5-FU). The
Effective treatment of actinic keratosis with 0.5% fluorouracil cream for 1, 2, or 4 weeks.
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.
Further studies with topical 5-fluorouracil.
5% 5-fluorouracil ointment applied twice daily can be used as an effective outpatient treatment in the person with numerous actinic keratoses of the face and neck and is not absorbed in a degree that would produce general toxicity.
A comparison of the efficacy and safety of Jessner's solution and 35% trichloroacetic acid vs 5% fluorouracil in the treatment of widespread facial actinic keratoses.
The medium-depth peel induced by Jessner's solution and 35% trichloroacetic acid is a useful alternative therapeutic option for widespread facial AK, particularly for poorly compliant patients, because it equals fluorouracil in efficacy while being superior in terms of the convenience of a single application with little associated morbidity.