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Five Percent 5-Fluorouracil in a Cream or for Superficial Peels in the Treatment of Advanced Photoaging of the Forearms: A Randomized Comparative Study

Guimarães, Carolina Okada Zerbini MD, PhD*; Miot, Hélio A. MD, PhD; Bagatin, Ediléia MD, PhD*

doi: 10.1111/dsu.0000000000000024
Original Article

BACKGROUND The antimetabolite 5-fluorouracil (5-FU) is used for topical treatment of actinic keratosis. Overall improvement in the skin is also observed. Additionally, 5-FU was reported to be used for superficial peels.

OBJECTIVES To evaluate the efficacy and safety of 5% 5-FU cream compared with peels for photodamaged forearms.

METHODS This interventional, randomized, comparative, evaluator-blind study included 32 patients with severe photoaging of forearms. The regimens comprised either application of 5% 5-FU cream everyday for 4 weeks on 1 forearm and 4 weekly peels on the other. Efficacy assessment included: clinical photodamage scores, opinion of patients and investigators, and blind photographic evaluation by independent observers. Skin biopsies were performed for histologic and immunohistochemical analysis. Safety evaluation comprised observation of adverse events.

RESULTS Clinical and histologic findings confirmed the benefits of topical 5% 5-FU, in cream or peels, which improved skin appearance and decreased the dermal elastotic material. Immunohistochemistry showed reduced levels of epidermal p53 and increase in the level of procollagen I. Results were maintained after 6 months. Predictable adverse events occurred, with no differences between treatments. Patients reported better tolerability to peels.

CONCLUSION Five percent 5-FU cream or peels was safe and effective for the treatment of photodamaged forearms. Decreased epidermal p53 levels and new dermal collagen were confirmed.

*Department of Dermatology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil;

Department of Dermatology, State University of São Paulo (UNESP), Botucatu, Brazil

Address correspondence and reprint requests to: Carolina Okada Zerbini Guimarães, MD, PhD, Eulália Silva, St. 138 Sorocaba, Sao Paulo 18030-230, Brazil, or

The authors have indicated no significant interest with commercial supporters.

© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins
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