Actinic Keratosis with 5-FU? Is that best?

Actinic keratosis is a pre-malignant condition that, if untreated, can progress to squamous cell carcinoma. In most cases, this is caused by chronic, repeated Sun-exposure.

5-fluorouracil (5-FU or Efudex or Carac) is an old treatment for actinic keratosis that has been used for decades, but is it best? In short, yes if used correctly.

What does that even mean? The original way of using the product was twice a day for 2-4 weeks. This was fairly effective, but resulted in moderate to severe irritation that was unpleasant. This is not the best way of using this medication.

The new way, which is more effective and less irritating, is to use 5-fluorouracil cream WITH calcipotriene cream together. This regimen is shorter, taking only 5-7 days. This is far less irritating and more effective. In fact, more lesions resolve and stay away longer with this newer regimen.

Wait one second. My Dermatologist has recommended blue light. They said that is the best. Who is right?

Blue light is best for the provider–as it is a reimbursable treatment that pays your provider to give it. As far as being more effective, clinical studies suggest otherwise! In healthy patients, the combination of 5 FU and calcipotriene has been proven to be the most effective treatment for actinic keratosis. As far as cost goes, this cream costs about $35 when made by a compound pharmacy. Compare this to Blue light treatment which costs well over $350 between the medication applied and the blue light treatment.

My provider always freezes spots. What is that about?

Cryosurgery is a great treatment for actinic keratosis, especially when one only has a few lesions. Unfortunately, this can result in permament lightening of the skin. When one is in constant need of treatment, it is often best to use a “field” treatment that treats the entire area. For this, 5-FU and calcipotriene is a great option. One single treatment will greatly reduce your need for more and more freezing, save you and your insurance carrier money, and reduce the risk of discoloration from cryosurgery.

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Robert S. Bader, M.D., Dermatologist