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Pathology

(37) Comparison of Topical 5-fluorouracil vs. Photodynamic Therapy in the Management of Lips Actinic Keratosis: Review of the Literature

Thursday, September 21, 2023
1:30 PM – 3:00 PM PDT
Disclosure(s):
Mohammed Amir Rais, DMD: No financial relationships to disclose
Abstract: Background and aim:
Actinic keratosis, also known as solar keratosis, is a cutaneous lesion characterized by proliferation of atypical epidermal keratinocytes following long-term sun exposure. It is a is a precancerous lesion that can undergo malignant transformation leading to squamous cell carcinoma (SCC). Its management options can include approaches such as Topical 5-fluorouracil, Photodynamic Therapy with 5-Aminolevulinic Acid Patch, lasers, cryotherapy and very rarely radiotherapy.
This literature review attempts to answer through investigating previous data whenever better clinical outcomes are provided following Photodynamic Therapy use or Topical 5-fluorouracil appliances in treatment of Actinic Keratosis of the lips

Methods:
A literature search of significant medical databases (pubmed, cochrane, scienedirect, scopus, embase) was performed using keywords for Actinic keratosis, lips, Topical 5-fluorouracil, Photodynamic Therapy, recurrence and malignant transformation. 17 articles including randomized clinical trials, case-controlled studies, case reports, cohort and systematic review studies were retrieved . Data was carefully collected and grouped by approach.

Results:
Short-term results showed total healing in almost three fourth (74.4%) of cases with Photodynamic Therapy application and (83%) while using Topical 5-fluorouracil. Findings report that faster recovery was associated with Photodynamic Therapy compared to Topical 5-fluorouracil. Moreover, toxicity and treatment-related adverse events (AEs) rate was found to be higher following Topical 5-fluorouracil application.

Conclusion:
These data strongly suggests that both Topical 5-fluorouracil and Photodynamic Therapy are effective successful agents to treat lips actinic keratosis. It seems that PDT is a convenient alternative to 5-FU with sufficient effectiveness and more safer outcomes.

References:
1- Patel G, Armstrong AW, Eisen DB. Efficacy of photodynamic therapy vs other interventions in randomized clinical trials for the treatment of actinic keratoses: a systematic review and meta-analysis. JAMA Dermatol. 2014 Dec;150(12):1281-8. doi: 10.1001/jamadermatol.2014.1253. PMID: 25162181.

2-Del Regno L, Catapano S, Di Stefani A, Cappilli S, Peris K. A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions. Am J Clin Dermatol. 2022 May;23(3):339-352. doi: 10.1007/s40257-022-00674-3. Epub 2022 Feb 19. Erratum in: Am J Clin Dermatol. 2022 Apr 22;: PMID: 35182332; PMCID: PMC9142445.