Brancaccio Gabriella, Briatico Giulia, Apalla Zoe, Dummer Reinhard, Eklind Jan, Seguin Nicole Basset, Dreno Brigitte, Fargnoli Maria Concetta, Guitera Pascale, Heppt Markus V, Hoeller Christoph, Jouary Thomas, Lallas Aimilios, Lei Ulrikke, Leiter Ulrike, Malvehy Josep, Ramírez David Moreno, Paoli John, Peris Ketty, Puig Susanna, Saiag Philippe, Stockfleth Eggert, Stolz Wilhelm, Stratigos Alexander J, Ulrich Class, Wennberg Ann-Marie, Zalaudek Iris, Argenziano Giuseppe
Dermatology Unit, University of Campania, Naples Italy.
Second Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Dermatol Pract Concept. 2025 Apr 1;15(2):5787. doi: 10.5826/dpc.1502a5787.
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.
We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.
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.
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.
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.
4% 5-氟尿嘧啶（5-FU）乳膏等治疗方法已在光化性角化病的皮损清除方面显示出强大疗效；然而，治疗期间的局部皮肤反应（LSR）仍然是一项重大挑战，可能会影响患者的依从性。
我们试图采用德尔菲法就与4% 5-FU相关的LSR管理达成共识。
28名皮肤科专家参与了三轮德尔菲过程。专家们评估了LSR管理策略，包括润肤剂、抗生素、类固醇以及治疗中断。使用7点李克特量表衡量一致程度。如果超过80%的投票在5-7评分范围内，则共识为高；如果超过25%的投票在1-3评分范围内，且6-7评分范围内的投票少于25%，则共识为低。其他投票组合被视为具有中等一致性。
对于以下陈述达成了高度一致：批准的每日用药方案（每日一次，持续4周）是最合适的（92.9%）；轻度LSR通常无需干预，也不会影响治疗依从性（96.4%）；严重LSR可能受益于暂时中断治疗并使用润肤剂，确保依从性的同时不影响疗效（92.9%）。大多数人认为无需使用润肤剂（与5-FU治疗同时使用）（中等共识，64.3%）。专家强调在基线咨询期间就LSR进行清晰沟通对于提高患者依从性的重要性。
这一共识为管理4% 5-FU引起的LSR提供了实用指导，确保高依从性并优化治疗效果。需要进一步研究来验证这些发现并探索其他管理方法。
