The purpose of this article is to discuss the potential benefit of 5% 5-fluorouracil (5% 5-FU) peels used in conjunction with glycolic acid for the treatment of actinic keratosis (AK) while delivering a cosmetic benefit and to provide a how-to description for clinicians. This article will include a review of published literature, discussion of the author’s technique, and presentation of a case series of patients treated in a clinical setting.
Numerous studies have demonstrated that 5% 5-FU effectively reduces the number of AK lesions and improves the appearance of other markers of photodamage. This efficacy is likely due to the peel action enhanced by 5% 5-FU in patients with moderate to large numbers of AKs, which in turn offers improvement in complexion, skin tone, and skin texture. Moreover, patients’ skin is often smoother and more homogeneous, giving a clearer field in which to continue skin cancer surveillance. The addition of 5% 5-FU to glycolic acid also offers the added benefit of treating subclinical AK lesions, thereby reducing the likelihood of future AKs. Compliance is also improved over use of 5% 5-FU alone, with a decrease in discomfort time from 4 to 8 weeks of 5% 5-FU use to 1 to 2 weeks downtime postpeel. The combination of 5% 5-FU and glycolic acid also improves patient satisfaction, as patients receive an effective treatment for AKs and see an overall cosmetic improvement.
The 5% 5-FU peel has both therapeutic and cosmetic benefits. Cosmetically and therapeutically, the 5% 5-FU peel avoids the side effects of deeper peels and requires less downtime. Therapeutically, the 5% 5-FU peel may also decrease the likelihood of developing skin cancer in the future. The dual mechanisms of the 5% 5-FU peel may, therefore, increase patient compliance with treatment and medical follow-up.