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Fluorouracil vs imiquimod for the treatment of actinic keratosis

The most widely used topical agents for the field-based treatment of multiple actinic keratoses are 5-fluorouracil and imiquimod. Their comparative effectiveness was assessed in a real-world community-based cohort study published in the Journal of the American Academy of Dermatology.

The study compared the effectiveness of 5-fluorouracil and imiquimod in reducing risk for subsequent actinic keratoses. It identified 5,700 adults in the US who had an actinic keratosis diagnosed in 2007 and who subsequently filled a prescription for 5-fluorouracil or imiquimod. Researchers followed subjects for subsequent actinic keratoses and estimated the two-year (short-term) and five-year (long-term) differences in cumulative risk.

The study found that 5-fluorouracil reduced the short-term incidence of subsequent actinic keratoses, but there was no statistically significant evidence of a long-term decreased risk compared with imiquimod.

It concluded that 5-fluorouracil appeared to be significantly more effective than imiquimod in the short-term, but not long-term, prevention of subsequent actinic keratoses.

Read more research on actinic keratosis.


Romain Neugebauer, Katherine A. Levandoski, Zheng Zhu, Monica Sokil, Mary-Margaret Chren, Gary D. Friedman, Maryam M. Asgari, MD, Maryam M. Asgari. A real-world, community-based cohort study comparing the effectiveness of topical fluorouracil versus topical imiquimod for the treatment of actinic keratosis. Journal of the American Academy of Dermatology. April 2018. Volume 78, Issue 4, Pages 710–716. DOI: https://doi.org/10.1016/j.jaad.2017.12.042

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