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ArticleDermatology practical & conceptual2025

Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus.

Gabriella Brancaccio, Giulia Briatico, Zoe Apalla, Reinhard Dummer, Jan Eklind, Nicole Basset Seguin, Brigitte Dreno, Maria Concetta Fargnoli, Pascale Guitera, Markus V Heppt and 18 more

Abstract read
In one paragraph

Article in Dermatology practical & conceptual, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Gabriella BrancaccioDermatology Unit, University of Campania, Naples Italy.
Giulia BriaticoDermatology Unit, University of Campania, Naples Italy.
Zoe ApallaSecond Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Reinhard DummerUniversity Hospital Zurich and Kantonsspital, Aarau, Switzerland.
Jan EklindDiagnostiskt Centrum Hud, Stockholm, Sweden.
Nicole Basset SeguinDermatology Department, Saint-Louis Hospital, Paris, France.
Brigitte DrenoNantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes, France.
Maria Concetta FargnoliSan Gallicano, Dermatological Institute, IRCCS, Rome, Italy.
Pascale GuiteraSydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Melanoma Institute Australia and Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Markus V HepptDepartment of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and CCC Alliance WERA, Erlangen, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany.
Christoph HoellerDepartment of Dermatology, Medical University of Vienna, Vienna, Austria.
Thomas JouaryDermatology Unit, Hospital Francois Mitterrand, Pau, France.
Aimilios LallasFirst Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Ulrikke LeiDepartment of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Ulrike LeiterCenter for Dermatooncology, Department of Dermatology, University Hospital of Tuebingen, Tuebingen, Germany.
Josep MalvehyDermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.
David Moreno RamírezMedical-&-Surgical Dermatology Service. Hospital Universitario Virgen Macarena, Sevilla, Spain.
John PaoliDepartment of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
Ketty PerisDermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Susanna PuigDermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.
Philippe SaiagDepartment of General and Oncologic Dermatology, Ambroise Paré hospital, APHP, & EA 4340 "Biomarkers in cancerology and haematooncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France.
Eggert StockflethDepartment of Dermatology, Ruhr-University, Bochum, Bochum, Germany.
Wilhelm StolzDepartment of Dermatology, Faculty of Medicine, Ludwig-Maximilians-University, Munich, Germany.
Alexander J Stratigos1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
Class UlrichCharite-Universitiitsmedizin Berlin, Berlin, Germany.
Ann-Marie WennbergDepartment of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Iris ZalaudekDepartment of Dermatology and Venereology of the Hospital Clinics Giuliano Isontino (ASUGI), Maggiore Hospital, Trieste, Italy.
Giuseppe ArgenzianoDermatology Unit, University of Campania, Naples Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTreatments 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.

objectiveWe sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.

methodsTwenty-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.

resultsHigh 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.

conclusionThis 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.

Identifiers

PMID40401863
PMCPMC12090966

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.