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Fluorouracil
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5-Fluorouracil (5-FU) is a medication commonly prescribed for the treatment of cancer. It is classified as a pyrimidine analog and used in a systemic form for treating internal malignancies. In dermatology, the topical form of 5-FU is mainly utilized for actinic keratosis and superficial basal cell carcinoma.

Mechanism: Best known as an antineoplastic agent, 5-FU works by inhibiting thymidylate synthase, a key enzyme responsible for making one of the four DNA building blocks, thymidine. In doing so, the cancerous cells making DNA are deprived of thymidine and therefore undergo cell death. 5-FU works exclusively during the synthesis of DNA and can therefore also cause the destruction of rapidly dividing non-cancerous cells like those found in skin and hair.

Uses: The topical form of 5-FU comes in two different preparations, a solution (2-5%) or cream (0.5-5%). For dermatologic conditions, the cream is most commonly prescribed. A number of brands are available including Carac, Efudex and Fluoroplex. Typical dosage regimes involve application of the cream once or twice daily for 3-4 weeks depending on the lesion and its location. Besides treatment for actinic keratosis and basal cell carcinoma, 5-FU finds utility in treating other conditions such as extra-mammary Paget’s disease confined to the epidermis, Bowen’s disease, porokeratosis, and genital warts.

Side Effects: Since 5-FU inhibits DNA synthesis, all cells are potentially influenced by its use. Common side effects of the topical form include inflammation, erythema (redness), edema, application-site pain and burning. Pregnancy and lactation are contraindicated since 5-FU has shown potential teratogenic effects and should therefore be avoided.

 

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The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician - patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology.

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