5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease.
Adrenal Cortex Hormones
/ therapeutic use
Cicatrix
/ drug therapy
Combined Modality Therapy
Cosmetic Techniques
Dermatitis
/ drug therapy
Dermatologic Agents
/ adverse effects
Fluorouracil
/ adverse effects
Humans
Pigmentation Disorders
/ drug therapy
Skin Diseases
/ drug therapy
Skin Diseases, Infectious
/ drug therapy
Journal
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
ISSN: 1524-4725
Titre abrégé: Dermatol Surg
Pays: United States
ID NLM: 9504371
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
16
2
2021
medline:
18
8
2021
entrez:
15
2
2021
Statut:
ppublish
Résumé
5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
Sections du résumé
BACKGROUND
5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported.
OBJECTIVE
We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease.
METHODS
We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance.
RESULTS
We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas).
CONCLUSION
In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
Identifiants
pubmed: 33587385
doi: 10.1097/DSS.0000000000002879
pii: 00042728-900000000-97626
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Dermatologic Agents
0
Fluorouracil
U3P01618RT
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e66-e70Informations de copyright
Copyright © 2020 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
Références
Parker WB, Cheng YC. Metabolism and mechanism of action of 5-fluorouracil. Pharmacol Ther 1990;48:381–95.
Ren Y, Zhou X, Wei Z, Lin W, et al. Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J 2017;14:480–7.
Prabhu A, Sreekar H, Powar R, Uppin VM. A randomized controlled trial comparing the efficacy of intralesional 5-fluorouracil versus triamcinolone acetonide in the treatment of keloids. J Sci Soc 2012;39:19.
Saha AK, Mukhopadhyay M. A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. Indian J Surg 2012;74:326–9.
Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, et al. Histopathology and immunohistochemical analysis of 5-fluorouracil and triamcinolone treated keloids in double-blinded randomized controlled trial. Wound Repair 2020;28:385–99.
Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, et al. Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections–a randomized controlled trial. J Plast Reconstr Aes 2019;72:4–11.
Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg 2004;30:54–6.
Kabel AM, Sabry HH, Sorour NE, Moharm FM. Comparative study between intralesional injection of bleomycin and 5-fluorouracil in the treatment of keloids and hypertrophic scars. J Dermatol Mohar Surg 2016;20:32–8.
Haurani MJ, Foreman K, Yang JJ, Siddiqui A. 5-Fluorouracil treatment of problematic scars. Plast Reconstr Surg 2009;123:139–51.
Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology 2002;204:130–2.
Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol 2005;52:474–9.
Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc 2014;64:1003–7.
Davison SP, Dayan JH, Clemens MW, Sonni S, et al. Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J 2009;29:40–6.
Khalid FA, Mehrose MY, Saleem M, Yousaf MA, et al. Comparison of efficacy and safety of intralesional triamcinolone and combination of triamcinolone with 5-fluorouracil in the treatment of keloids and hypertrophic scars: randomised control trial. Burns 2019;45:69–75.
Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg 2006;32:907–15.
Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol 2009;34:219–23.
Reinholz M, Guertler A, Schwaiger H, Poetschke J, et al. Treatment of keloids using 5-fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non-invasive objective measures [published online ahead of print, 2020 Mar 14]. J Eur Acad Dermatol Venereol 2020;34:2436–36.
Khare N, Patil SB. A novel approach for management of ear keloids: results of excision combined with 5-fluorouracil injection. J Plast Reconstr Aesthet Surg 2012;65:e315–e317.
Gauthier Y, Anbar T, Lepreux S, Cario-André M, et al. Possible mechanisms by which topical 5-fluorouracil and dermabrasion could induce pigment spread in vitiligo skin: an experimental study. ISRN Dermatol 2013;2013:852497.
Abdelwahab M, Salah M, Samy N, Rabie A, et al. Effect of topical 5-fluorouracil alone versus its combination with erbium: YAG (2940 nm) laser in treatment of vitiligo. Clin Cosmet Investig Dermatol 2020;13:77.
Tsuji T, Hamada T. Topically administered fluorouracil in vitiligo. Arch Dermatol 1983;119:722–7.
Mina M, Elgarhy L, Al-saeid H, Ibrahim Z. Comparison between the efficacy of microneedling combined with 5‐fluorouracil vs microneedling with tacrolimus in the treatment of vitiligo. J Cosmet Dermatol 2018;17:744–51.
Shahmoradi S, Mokhtari F, Faghihi G, Adibi N. Comparing the efficacy of topical clobetasol 0.05% plus 5-fluorouracil 5% cream vs. topical clobetasol 0.05% alone in treatment of vitiligo. J Res Med Sci 2012;17:7–12.
Abd El-Samad Z, Shaaban D. Treatment of localized non-segmental vitiligo with intradermal 5-flurouracil injection combined with narrow-band ultraviolet B: a preliminary study. J Dermatol Treat 2012;23:443–8.
Liebl H, Kloth LC. Skin cell proliferation stimulated by microneedles. JAm Coll Clin Wound Spec 2012;4:2–6.
Attwa EM, Khashaba SA, Ezzat NA. Evaluation of the additional effect of topical 5-fluorouracil to needling in the treatment of localized vitiligo. J Cosmet Dermatol 2019;19:1473–78.
Khater M, Nasr M, Salah S, Khattab F. Clinical evaluation of the efficacy of trichloroacetic acid 70% after micro-needling vs intradermal injection of 5-fluorouracil in the treatment of non-segmental vitiligo; a prospective comparative study. Dermatol Ther 2020;33:e13532.
Ali FR, Al-Niaimi F. Laser-assisted drug delivery in dermatology: from animal models to clinical practice. Lasers Med Sci 2016;31:373–81.
Mokhtari F, Bostakian A, Shahmoradi Z, Jafari-Koshki T, et al. Potential emerging treatment in vitiligo using Er: YAG in combination with 5 FU and clobetasol. J Cosmet Dermatol 2018;17:165–70.
Doghaim NN, El-Tatawy RA, Ismail MA, Abdelaziz Mohammed Ali D, et al. Study the effect of erbium: YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB‐UVB phototherapy. J Cosmet Dermatol 2019;19:122–30.
Garg T, Chander R, Jain A. Combination of microdermabrasion and 5-fluorouracil to induce repigmentation in vitiligo: an observational study. Dermatol Surg 2011;37:1763–6.
Sethi S, Mahajan BB, Gupta RR, Ohri A. Comparative evaluation of the therapeutic efficacy of dermabrasion, dermabrasion combined with topical 5% 5-fluorouracil cream, and dermabrasion combined with topical placentrex gel in localized stable vitiligo. Int J Dermatol 2007;46:875–9.
Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014;171:696–712.
Wallin J. 5-Fluorouracil in the treatment of penile and urethral condyloma acuminata. Br J Vener Dis 1977;53:240–3.
Yazdanfar A, Farshchian M, Fereydoonnejad M, Farshchian M. Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial. Dermatol Surg 2008;34:656–9.
Iscimen A, Aydemir EH, Göksügür N, Engin B. Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study. J Eur Acad Dermatol Venereol 2004;18:455–8.
Salk RS, Grogan KA, Chang TJ. Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study. J Drugs Dermatol 2006;5:418–24.
Bilensoy E, Moroy P, Çırpanlı Y, et al. A double-blind placebo-controlled study of 5-fluorouracil:cyclodextrin complex loaded thermosensitive gel for the treatment of HPV induced condyloma. J Incl Phenom Macrocycl Chem 2011;69:309–13.
Işik S, Koca R, Sarici G, Altinyazar HC. A comparison of a 5% potassium hydroxide solution with a 5-fluorouracil and salicylic acid combination in the treatment of patients with anogenital warts: a randomized, open-label clinical trial. Int J Dermatol 2014;53:1145–50.
Weismann K, Kassis V. Behandlung von Condyloma acuminatum mit 0,5% 5-Fluorouracil-Lösung [Treatment of condyloma acuminatum with 0.5% 5-fluorouracil-solution, A double-blind clinical trial]. Z Hautkr 1982;57:810–6.
Milstein HG. 5-Fluorouracil as an aid in management of acne and melasma. J Am Acad Dermatol 1981;4:97–8.
Guimarães CO, Miot HA, Bagatin E. Five percent 5-fluorouracil in a cream or for superficial peels in the treatment of advanced photoaging of the forearms: a randomized comparative study. Dermatol Surg 2014;40:610–7.
Sachs DL, Kang S, Hammerberg C. Topical fluorouracil for actinic keratoses and photoaging: a clinical and molecular analysis. Arch Dermatol 2009;145:659–66.
Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilm. Facial Plast Surg 2011;27:23–8.
Chiang YZ, Pierone G, Al-Niaimi F. Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol 2017;31:405–13.
Lodha S, Cusack C, Chung C. Hailey–Hailey disease successfully treated with topical 5-fluorouracil: P2007. J Am Acad Dermatol ;64.
Gharavi N, Diehl J, Soriano T. Cutaneous sarcoidosis successfully treated with intralesional 5-fluorouracil. Dermatol Surg 2015;41:1082–5.
Schmidt H, Ochsendorf FR, Wolter M. Topical 5-fluorouracil in Darier disease. Br J Dermatol 2008;158:1393–6.
Morelli Coppola M, Salzillo R, Segreto F, Persichetti P. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol 2018;11:387–96.
Kishi P, Price CJ. Life-threatening reaction with topical 5-fluorouracil. Drug Saf Case Rep 2018;5:4.