Topical 5-fluorouracil Research Articles

Topical 5-fluorouracil 1% as first-line therapy for giant ocular surface squamous neoplasia

To evaluate the clinical outcomes of topical 5-fluorouracil (5-FU) 1% as first-line therapy for giant ocular surface squamous neoplasia (OSSN). This was a non-comparative cohort study. We included patients with biopsy-proven giant OSSN in a tertiary-care setting. Giant OSSN was defined as a single lesion≥15mm in the largest basal dimension or an extent of≥6 clock hours of limbal involvement. Topical 5-FU 1% was administered QID for one week, followed by a three-week drug holiday. This treatment cycle was repeated until resolution. Resolution rate was the primary outcome measure, where complete resolution was defined clinically and by tomography. Secondary outcomes were time to resolution and frequency of recurrence and side effects. Twenty-seven eyes (27 patients) were included; the majority (19, 70%) were men, with a mean age of 69.2±15.7 years. Corneal/conjunctival intraepithelial neoplasia was diagnosed in 88%, and squamous cell carcinoma (SCC) in the remaining 12% of cases. The rate of complete resolution was 77.8% (21/27) after a mean of 5.1±2.1 cycles. The median time to complete resolution was 5 months (CI95% 4-6 months). During a mean follow-up of 10.2±2.9 months, recurrence was observed in one patient (4.8%) and four (14.8%) reported side effects. Patients with partial resolution were older and had a higher frequency of SCC diagnosis than those with complete resolution. Topical 5-FU 1% appears to be useful as first-line therapy for giant OSSN, with good tolerance and a low frequency of recurrence. More studies with larger sample sizes and longer follow-up are needed.

Combined Cryotherapy and Topical Imiquimod, 5-Fluorouracil, and Tazarotene Effectively Treats Locally Advanced Basal Cell Carcinoma and is Associated with Nearby Nodular Basal Carcinoma Regression

Combined Cryotherapy and Topical Imiquimod, 5-Fluorouracil, and Tazarotene Effectively Treats Locally Advanced Basal Cell Carcinoma and is Associated with Nearby Nodular Basal Carcinoma Regression

The efficacy of fractional CO2 laser with or without triamcinolone acetonide or 5-fluorouracil in the treatment of early postburn hypertrophic scars

Hypertrophic scars (HTSs) are the result of an abnormal healing process resulting from burns and other severe traumas. The symptoms of that condition include skin irritation, discomfort, and itching. This study aimed to assess the efficacy of fractional carbon dioxide (CO2) laser therapy alone or with triamcinolone or 5-fluorouracil (FU) in the treatment of early post-burn hypertrophic scars (HTSs) that develop during the first 6 months after the injury. A prospective, randomized, single-blind comparative study was conducted on 30 patients aged 16–65 with hypertrophic scars (HTS) resulting from burns. Patients had no prior treatment for their scars. We randomly assigned participants to one of three groups: Group A received fractional CO2 laser therapy alone, Group B received fractional CO2 laser therapy with topical 5-fluorouracil, and Group C received fractional CO2 laser therapy with topical triamcinolone acetonide. All treatment groups showed significant improvements (p < 0.05) in overall scar severity and height. Patients in Group C (fractional CO2 laser + triamcinolone) demonstrated significant improvements in scar pliability, height, and pigmentation (p < 0.05). In contrast, patients in Group B (fractional CO2 laser + 5-FU) showed significant reductions in scar vascularity, pliability, and height following treatment (p < 0.05). While all groups reported minor changes in pain and itching, there were no significant differences in these symptoms between Group B and Group C. HTSs of this trial revealed reductions in overall scar surface area and thickness and improvement of pliability and pigmentation; however, there was not statistically significant difference between the effect of 5-fluorouracil and triamcinolone acetonide (TAC), suggesting that neither drug offers better efficacy over the other. Level I, singleblinded randomized control study.

Association Between Local Skin Reactions and Efficacy with 5-Fluorouracil 4% Cream in Actinic Keratosis: A Post-Hoc Analysis of Two Randomised Clinical Trials.

Topical 5-fluorouracil (5-FU), 5% or 4% cream, is recommended among first-line treatments for actinic keratosis (AK). Local skin reactions (LSRs) are an expected and transient response to treatment with 5-FU but can lead to treatment discontinuation when severe. This analysis aimed to investigate whether the severity of LSRs during the treatment was associated with lesion clearance assessed 4 weeks after completing treatment. This post hoc analysis pooled data from two randomised clinical trials (HD-FUP3B-048 and HD-FUP3B-049). Only patients treated with once-daily 5-FU 4% for 4 weeks were considered. Analyses included LSR severity at week 2 and 4 and clearance 4 weeks after completing treatment (week 8). Analysed LSRs were erythema, scaling, oedema, crusting, erosions, stinging and pruritus, which were each categorised as mild, moderate, severe or none. Response was categorised as complete clearance (CC; clearance of all lesions), partial clearance (PC; ≥ 75% clearance) or no clearance (NC; < 75% or for subgroup analyses NC < 100%). Data from 397 patients were included. The median number of AK was 11 (lower quartile Q1 = 7 and upper quartile Q3 = 18) and grades were mild to moderate (86.4% of patients) and severe. At week 8, 321 patients (80.9%) had CC/PC and 76 (19.1%) had NC. Patients who achieved CC/PC had, at baseline, more lesions, a more severe disease and lesions preferentially on the ears/face than patients with NC. In adjusted logistic regression analyses and across all LSR grades, CC/PC at week 8 was associated with occurrence of erythema, oedema, crusting and stinging at week 2 and all LSRs at week 4. Severe erythema observed at week 2 was significantly associated with lesion clearance compared with mild erythema. At week 4, both severe and moderate erythema, moderate scaling and moderate pruritus were significantly associated with lesion clearance at week 8 compared with mild LSRs. Results according to the LSR severity for patients who had 100% clearance are quite similar. Our analysis showed that the severity of LSRs during 5-FU 4% treatment for AK was associated with a higher clearance rate. It appears that severe LSRs did not compromise treatment efficacy. Because LSRs can still be unpleasant, strategies must be developed to relieve patients to allow continued 5-FU 4% application.

Is the benefit of sequential 5-fluorouracil and daylight photodynamic therapy versus daylight photodynamic therapy alone sustained over time? - 12-month follow-up of a randomized controlled trial.

Since recurrences and new AKs commonly are observed after treatment long-term effects of field-directed therapies for AKs are crucial. Thus, we evaluated the 6- and 12-month efficacy and satisfaction of sequential topical 5-fluorouracil (5-FU) and daylight PDT (dPDT) with dPDT alone. In a randomized intra-individual study patients with multiple AKs in the face and scalp were treated with 4% 5-fluorouracil cream twice daily for 7 days on one side of the scalp/face, followed by dPDT on both sides. Lesion clearance rate, lesion recurrence rate and number of new lesions were evaluated at 6- and 12-month after treatment. 58/60 completed 6-month and 55/60 completed 12-month follow-up. Pre-treatment with topical 5-FU improved the long-term efficacy of dPDT, especially for moderately thick AKs, with a lesion clearance of 72% at 12-month compared to 48% after dPDT alone (p=0.017). The recurrence rate at 12-month was 15% for combination treatment and 20% for dPDT alone (0.042). Most patients were highly satisfied with both treatments. Sequential treatment with short-term topical 5-FU followed by dPDT maintained a higher complete lesion clearance than dPDT alone at both 6- and 12-month follow-ups, with fewer new AKs developing after combination therapy.

Topical 5-fluorouracil as monotherapy for ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) comprises a gamut of diseases, which encompass conjunctival intraepithelial neoplasia, conjunctival carcinoma in situ, and squamous cell conjunctival neoplasia. Gold standard treatment for OSSN entails excision with cryotherapy. A lot of progress has been made recently that shows that chemotherapeutic drugs, such as mitomycin C, 5-fluorouracil (5-FU), and interferon alfa2b, can be just as effective. This is a case report that includes two cases: An 81-year-old Filipino female and a 65-year-old Filipino male who presented with a pinkish lesion on the bulbar conjunctiva. Documentation was done through clinical observation, slit-lamp examination, and the use of anterior segment optical coherence tomography (OCT). 1% topical 5-FU was given as chemotherapy administered at 1 drop 4×/day for 1 week with a 3-week drug holiday. During the course of treatment, we noted clinical resolution of the lesions grossly on slit-lamp examination. On anterior segment OCT, a decrease in diameter and thickness was noted, but with remaining areas of hyperreflectivity and thickened epithelium at the site of the lesion. No decrease in visual acuity was noted during the course of treatment, as well as any adverse effects such as eye pain or inflammation. Considering its safety and efficacy profile, 5-FU has great potential to be considered as a first-line therapy in the topical treatment of OSSN. Topical chemotherapy can target microscopic diseases that may be missed surgically and decrease adverse effects. As seen in this case report, 5-FU shows much promise as a possible alternative in the treatment of OSSN.

Combined topical 5-fluorouracil and calcipotriene effectively treats superficial keratinocyte carcinomas: A retrospective cohort study from 2 academic centers

Combined topical 5-fluorouracil and calcipotriene effectively treats superficial keratinocyte carcinomas: A retrospective cohort study from 2 academic centers

Chemoimmunotherapy-Resistant Ocular Surface Squamous Neoplasia Managed With I-125 Brachytherapy.

The purpose of this study was to report the management of chemoimmunotherapy-resistant ocular surface squamous neoplasia (OSSN) with iodine-125 (I-125) brachytherapy. A 36-year-old man presented to the clinic with biopsy-proven OSSN that covered ∼70% of the corneal surface and extended to the 6 o'clock position of the inferior limbus of the OS. The visual acuity was 20/20 in the OD and 20/40 in the affected OS. He was treated with topical interferon alpha-2b 1 MIU/mL (4 times daily [QID] for 6 weeks) and then 4 cycles of topical 5-fluorouracil 1% (QID, 1 week on, 3 weeks off) with an incomplete response. He switched to topical mitomycin C 0.04% (QID, 1 week on, 2 weeks off) for 2 cycles and received a subconjunctival injection 25 mg (0.5 mL of a 50-mg/mL solution) of 5-fluorouracil. The tumor persisted. The patient was ultimately cured with placement of an 18-mm I-125 brachytherapy plaque for 97 hours (50 Gy). Because of extensive corneal involvement and risks associated with surgery, an 18-mm I-125 brachytherapy plaque was placed over the cornea and limbus. The treatment led to full resolution of the tumor within 1 month of treatment and recovery of 20/20 vision in the affected eye. Thirty-two months after treatment, the patient developed a visually significant posterior subcapsular cataract OS and underwent successful phacoemulsification surgery, returning to 20/20 vision. He has remained tumor-free for over 55 months. This case highlights the efficacy and safety of I-125 brachytherapy as an alternative for intraepithelial OSSN unresponsive to conventional chemoimmunotherapy, particularly when extensive surgical excision poses significant risks.

Excision combined with ocular surface reconstruction followed by topical chemotherapy for ocular surface squamous neoplasia

PurposeTo investigate the visual prognosis of ocular surface squamous neoplasia (OSSN) after tumor resection and ocular surface reconstruction, and clarify factors that influence recurrence.Study designRetrospective cohort study.MethodsMedical records of all patients who underwent surgical treatment for OSSN at our hospital between January 1996 and December 2019 were reviewed. Tumor size/location, histological classification, surgical procedure, intraoperative mitomycin-C use, and postoperative topical 5-fluorouracil (5-FU) administration were examined, and pre and postoperative visual acuity (VA) were compared to elucidate factors that influence disease recurrence.ResultsTumor excision was performed in 70 eyes of 70 cases (43 men, 27 women; average age: 71.6 ± 12.6 years) with dysplasia (8 eyes), carcinoma in situ (26 eyes), and invasive squamous cell carcinoma (36 eyes). Tumors were found in the limbus (N = 59 eyes), palpebral conjunctiva (N = 8 eyes), and from the bulbar to palpebral conjunctiva (N = 3 eyes). Surgical procedures performed were limbal transplantation/keratoepithelioplasty (N = 29 eyes), cultivated oral mucosal epithelial transplantation (N = 3 eyes), and auto-conjunctival epithelium transplantation (N = 2 eyes). Ocular surface was reconstructed using amniotic membrane, donor cornea, or cultivated epithelial sheet. The mean follow-up was 38.6 ± 38.6 months (range, 2 months to 13.8 years). VA postoperatively improved in 25 (61.0%) cases. Recurrence occurred in 19 (27.1%) cases at from 2 to 50 months (median: 12.5 months) postoperative. Uni- and multivariate analyses revealed that presurgical tumor size and postoperative administration of 5-FU were significantly related to recurrence.ConclusionCombined surgical excision and postoperative topical 5-FU administration effectively prevented OSSN recurrence, and ocular surface reconstruction contributed to improvement of VA.

Triple therapy approach for treating chromoblastomycosis in a Lebanese patient.

Chromoblastomycosis, though rare in non-endemic regions like Lebanon, should be considered in patients presenting with chronic, verrucous skin lesions unresponsive to conventional therapies. Multimodal treatment combining oral antifungals, cryotherapy, and adjunctive topical 5-Fluorouracil demonstrates efficacy in managing refractory cases. Follow-up visits three and 6 months after treatment cessation showed sustained lesion clearance and no recurrence.

Combination topical 5-fluorouracil 5%/calcipotriene 0.005% cream for the treatment of cutaneous in situ squamous cell carcinoma: A pilot study

Combination topical 5-fluorouracil 5%/calcipotriene 0.005% cream for the treatment of cutaneous in situ squamous cell carcinoma: A pilot study

Cure rate of low-risk superficial basal cell carcinoma treated with topical 5-fluorouracil

Background: Basal cell carcinoma (BCC) is the most common cancer in the world making this condition a public health issue. Superficial BCC (sBCC) is a subtype with indolent behavior. The gold standard treatment is the surgical resection, however, sBCC can be treated with more cost-effective noninvasive therapies such as 5% 5-Fluorouracil (5-FU). The objective of this study was to evaluate the clinical cure rate, tolerability and satisfaction levels on patients featured intermediate pigmented skin in the treatment of low-risk superficial basal cell carcinoma with topical 5% 5-FU. Methods: A prospective case series study was conducted between June 2014 and August 2018 at the dermatology service of Hospital de San José in Bogotá, Colombia with histologically-proven superficial BCC lesions. Lesions were treated with topical 5% 5-FU twice daily for up to 8 weeks. A follow-up evaluation was conducted at weeks four and eight during treatment. Follow-up was planned to be conducted every three months. Results: The study included 19 patients with 23 biopsy-proven sBCC lesions. Twenty-two lesions completed treatment with 5% 5-FU cream. The follow-up period ranged between 7 and 48 months and the median follow-up time was 38 months (IQR 21-48). All study patients featured intermediate or higher pigmented skin. Clinical cure was achieved in 95.45% of treated lesions. Conclusions: The efficacy rate of 5% 5-FU for 8 weeks treatment for sBCC located in intermediate and low-risk areas was 95% offering high levels of patient satisfaction with an outstanding tolerability profile.

Application of topical 5-Fluorouracil to reduce the recurrence of odontogenic keratocyst: A prospective study with 2-year follow-up

ObjectivesThe purpose of this prospective study was to evaluate the effect of topical 5-Fluorouracil as an adjunct therapy in reducing the recurrence of odontogenic keratocyst. MethodsForty-eight patients with proven incisional biopsy as odontogenic keratocyst were included in this clinical study. The patients were divided into two equal groups, the test group patients were treated with 5-Fluorouracil cream after cyst enucleation. However, the control group patients were treated with cyst enucleation only. Recurrence (yes/no) was the primary outcome variable evaluated by clinical signs of inflammation, swelling, or pain within a 2-year follow-up. The pain was measured on a visual analogue scale, and swelling was measured pre-surgically using vertical and horizontal references, 1 week, 1 month, 3 months, 6 months, 12 months, and 24 months. Computed tomography was performed pre-surgically and 24 hours post-surgically, at 12-month, and 24-month intervals to evaluate local bone density. The T-test was used to compare between two studied groups. ResultsPost-surgical follow-up showed uneventful wound healing in both groups with no clinical signs of recurrence or swelling, pain results demonstrated that patients have decreased records throughout the observation periods with no significant difference between both groups. Normal sensation was encountered in all patients except for one patient in the control group who showed no sensation (score 2). Post-surgical radiographic findings revealed a considerable shift in bone density in all patients of both groups at the site of excised lesions during the follow-up periods compared with immediate post-surgical radiographs. However, the test group patients demonstrated a significant increase of bone density between different evaluation periods (P = 0.001) than the control group. ConclusionConservative enucleation of odontogenic keratocyst combined with topical application of 5-Fluorouracil is an effective treatment with lower recurrence rates, less morbidity, and normal bone healing.

Keratoacanthoma

ABSTRACTKeratoacanthomas (KAs) are a type of skin tumor that rapidly grow (Bosch-Amate et al., 2022). A form of KAs was first identified in 1889 (Jeon et al., 2011). These types of lesions can be challenging to differentiate from cutaneous squamous cell skin carcinoma both through histopathology and clinically (Higgins et al., 2015; Ko et al., 2012; Mei et al., 2022). Adding to the complexity, there are no current evidence-based guidelines for treatment of KAs. Although KAs can be self-resolving, the persistence and growth of the KA is unpredictable (Bettoli et al., 2023; Ko et al., 2012). Treatment of KAs with surgical excision or Mohs are typically considered first line due to the possibility of misdiagnosis and invasion into local tissue (Ambur et al., 2022). Dependent upon the location and size of the KA, comorbidities, patient preference, and other considerations, surgical treatment may not be the most ideal treatment (Kiss et al., 2019). There are many nonsurgical options including intralesional injections of methotrexate, fluorouracil, corticosteroid, bleomycin, or interferon alpha (Kiss et al., 2019). Ionizing radiation, systemic agents, destructive therapy, topical imiquimod, and topical fluorouracil are also possibilities for treatment of KAs (Ambur et al., 2022). Even though conditions of KAs were first identified over 100 years ago, more research is needed to be able to accurately diagnose and appropriately treat KAs (Tisack et al., 2021).

Efficacy of topical 5-Fluorouracil in the management of ocular surface squamous neoplasia: a study of 101 eyes.

To study the efficacy and side-effect profile of topical 5-Fluorouracil (5-FU) in the treatment of ocular surface squamous neoplasia (OSSN). Retrospective study of 101 eyes of 100 patients treated with 5-FU with one week on and 3weeks off regimen. Of the 100 patients (101 eyes), the mean age at diagnosis of OSSN was 49 (median, 52years; range, 11-87years). History of prior intervention was noted in 6 (6%) eyes. Tumor epicenter included bulbar conjunctiva (n = 54; 53%), limbus (n = 27; 27%), and cornea (n = 20;20%). Mean number of cycles of topical 5-FU administered was 3 (median, 3; range, 1-8). Complete tumor regression was achieved with topical 5-FU in 89 (88%) eyes with a mean number of 2 cycles (median, 2; range, 1-6) of 5-FU. The remaining 12 (12%) lesions underwent additional treatment including excisional biopsy (n = 7), extended enucleation (n = 3), and topical Interferon alpha 2b (n = 2) for complete tumor control. Over a mean follow-up period of 6months (median, 5months; range, 1-36months) following treatment, tumor recurrence was noted in 2 (2%) patients, and side-effects were noted in 7 (7%) eyes including conjunctival hyperemia (n = 1), punctal stenosis (n = 1), sterile keratitis (n = 4), and limbal stem cell deficiency (n = 1). Topical 5-FU is an effective non-invasive therapy for OSSN with a minimal side-effect profile.

Assessing outcomes of topical 5-fluorouracil as primary and adjuvant therapy for squamous cell carcinoma in-situ.

Cutaneous squamous cell carcinoma in-situ (SCCis) is an intraepithelial tumor with a good prognosis. Standard treatment includes both surgical and non-surgical interventions. We determined the clearance rate for SCCis and residual SCCis identified on frozen section during Mohs micrographic surgery (MMS) after treatment with topical fluorouracil 5% cream (5-FU). All MMS cases were initiated for biopsy-proven invasive squamous cell carcinoma (SCC). A retrospective chart review was conducted from January 2017-February 2024 at Columbia University Irving Medical Center (CUIMC) to identify patients with SCCis who were treated with topical 5-FU as primary therapy or adjuvant therapy(AT) for residual SCCis post-MMS for invasive SCC. 41 patients were included (80% males, 70.1 ± 11.8 years). The average follow-up time for the primary therapy group was 25.4 ± 12.8 months, and for the post-MMS AT group 22.5 ± 11.1 months. In the group treated with topical 5-FU as primary therapy (n = 28), 27 patients (96.43%, 95% confidence interval: 81.65-99.91%) achieved complete clearance. One patient had recurrence at 8 months post-treatment. Of the patients in the post-MMS adjuvant treatment group (n = 13), 12 (92.3% clearance, 95% confidence interval 63.97-99.81%) achieved complete clearance. One patient had recurrence at 8 months post-treatment. This study found that topical 5-FU cream is effective as both primary therapy for SCCis and as adjuvant therapy for residual SCCis following MMS of invasive SCC.

Topical 5-Fluorouracil 0.5% as primary treatment for Ocular Surface Squamous Neoplasia.

To evaluate the efficacy of topical treatment with 5-Fluorouracil (5-FU) 0.5% in cases of Ocular Surface Squamous Neoplasia (OSSN), and to assess the tolerance of patients undergoing treatment. Patients with clinical diagnosis of OSSN referred to the Ocular Oncology division from the Federal University of Sao Paulo, Brazil, were recruited for the current study. Patients were treated with topical 5-FU 0.5% using a regimen of 4 times daily for 10 days, followed by a 3-week drug holiday, continued up to 3 cycles before an alternative treatment. Lesions were evaluated at baseline and throughout treatment. Treatment adherence was assessed using the Morisky Medication Adherence scale. Any adverse events along the treatment were noted. A total of 30 eyes of 30 patients adherent to the treatment were included in the study. Among the total cases treated with 5-FU 0.5%, 24 patients achieved therapeutic success after a mean treatment duration of 21.71 ± 7.77 days, representing a success rate of 80.00% (95% CI: 60.75-91.18%). For each 1 mm2 increase in the lesion area, the odds of treatment success decrease by 6% (OR: 0.94; 95%CI: 0.88-0.99; p = 0.033). Only mild adverse events such as ocular discomfort, ocular burning and tearing were observed along the treatment in 8 patients. Topical 5-FU 0.5% is an effective therapeutic option in the treatment of OSSN, with an 80% therapeutic success rate, showing good tolerability. The size of the lesion was identified as a factor influencing treatment success, therefore it should be taken into consideration when defining treatment approaches.

Ocular Surface Squamous Neoplasia with Coexistent Pterygia: A Study of 14 Cases and Review of Literature

ABSTRACT Purpose To report the clinical presentation, anterior segment optical coherence tomography features, treatment, and outcomes of ocular surface squamous neoplasia (OSSN) associated with pterygium. Methods Retrospective interventional series of 14 cases in a 28-month study period. Results OSSN was coexistent with pterygium (n = 14) in < 1% of all pterygia (n = 7384). The mean age at the presentation of OSSN with pterygium was 49 years (median, 49 years; range, 36 to 71 years). Referral diagnosis included pterygium sans OSSN (n = 7, 50%), granuloma (n = 1, 7%), actinic keratosis (n = 1, 7%), and conjunctivitis (n = 1, 7%). All OSSNs were unilateral, and six patients (43%) had bilateral pterygia. Tumors arose from the nasal (n = 8, 57%), or temporal (n = 6, 43%) quadrants. The mean tumor diameter was 4 mm (median, 4 mm; range, 2 to 6 mm), and the mean thickness was 2 mm (median, 1 mm; range, 1 to 3 mm). The delineation between OSSN and pterygium could be identified on anterior segment optical coherence tomography (AS-OCT) in all (100%) cases. All patients received 1% topical 5-fluorouracil (5-FU), and complete tumor regression was achieved in 13 (93%) cases with a mean number of 2 cycles (median, two cycles; range, 1 to 4 cycles). There were no significant adverse effects. No tumor recurrence was noted over a mean follow-up period of 11 months (median 12 months; range, 1 to 4 months) Conclusion AS-OCT allows accurate detection and mapping of tumor extent in OSSN with coexistent pterygium, and topical 5-FU yields excellent tumor control.

Pre-treatment with topical 5-fluorouracil increases the efficacy of daylight photodynamic therapy for actinic keratoses – A randomized controlled trial

BackgroundDaylight photodynamic therapy (dPDT) and topical 5-fluorouracil (5-FU) are each effective treatments for thin grade I actinic keratosis (AKs), but less so for thicker grade II-III AKs. Prolonged topical treatment regimens can be associated with severe skin reactions and low compliance.This study compares the efficacy of sequential 4 % 5-FU and dPDT with dPDT monotherapy for multiple actinic keratoses. MethodsSixty patients with a total of 1547 AKs (grade I: 1278; grade II: 246; grade III: 23) were treated in two symmetrical areas (mean size 75 cm2) of the face or scalp, which were randomized to (i) 4% 5-FU creme twice daily for 7 days before a single dPDT procedure and (ii) dPDT monotherapy. Daylight exposure was either outdoor or indoor daylight. ResultsTwelve weeks after treatment 87 % of all AKs cleared after 5-FU+dPDT compared to 74 % after dPDT alone (p<0.0001). For grade II AKs, the lesion response rate increased from 55 % with dPDT monotherapy to 79 % after 5-FU+dPDT (p<0.0056). Moderate/severe erythema was seen in 88 % 5-FU+dPDT areas compared to 41 % of dPDT areas two days after dPDT. Twelve weeks after treatment 75 % of the patients were very satisfied with both treatments. ConclusionsSequential 5-FU and dPDT was more effective than dPDT monotherapy in the treatment of AKs, especially for grade II AKs. Local skin reactions were more pronounced after combination treatment, but no patients discontinued the treatment. The combination of 5-FU and dPDT is an effective treatment of large treatment areas with high compliance and satisfaction.

Punctal and Canalicular Stenosis Following Topical 1% 5-Fluorouracil Eye Drop Therapy for Ocular Surface Squamous Neoplasia.

To present the first known cases of punctal and canalicular stenosis following topical 5-fluorouracil (5-FU) eye drops for ocular surface squamous neoplasia (OSSN). A retrospective chart review of patients with OSSN receiving topical 1% 5-FU eye drops as a primary or adjuvant treatment between 2013 and 2021 was performed. Individuals diagnosed with punctal or canalicular stenosis during or after topical 5-FU use were included in this study. Four individuals met these criteria; we report clinical findings and treatment course for each patient. We reviewed 303 patients (316 eyes) with OSSN. All patients were treated with topical 1% 5-FU eye drops in cycles, given 4 times daily for 1 week with 3 weeks off. Four patients (5 eyes) developed punctal stenosis, for a frequency of 1.3%. The mean age at 5-FU initiation in the 4 individuals was 61 years (range 53-69). Most individuals were male (75%), White (75%), and non-Hispanic (100%). The most common presenting symptom of stenosis was epiphora, noted 4.6 ± 3 months after initiating topical 5-FU (after 4.9 ± 2.0 cycles). This occurred in 4 eyes while on therapy (3, 2, 4, and 4 months since 5-FU initiation) and in 1 eye after stopping therapy (10.3 months since 5-FU initiation). In 1 eye, punctal stenosis and epiphora resolved spontaneously after stopping 5-FU. Punctal dilation led to symptom resolution in 2 eyes. Surgical intervention (punctoplasty and external dacryocystorhinostomy) was needed in 2 eyes for punctal and canalicular stenosis, respectively. Punctal or canalicular stenosis is a rare and previously unreported adverse effect of topical 5-FU that may require surgical treatment.