4% 5‐Fluorouracil Cream for Actinic Keratoses: First Report of Efficacy and Tolerability in a Person Living With Human Immunodeficiency Virus Infection

Vollständiger Abstract

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ABSTRACT Actinic keratosis (AK) is a common premalignant skin condition associated with chronic ultraviolet exposure and an increased risk of progression to cutaneous squamous cell carcinoma (cSCC). Its prevalence rises with age and is influenced by multiple factors, including fair skin phototype and immunosuppression. People living with human immunodeficiency virus (HIV) are at increased risk of cSCC due to impaired immune surveillance, highlighting the importance of early diagnosis and effective management of AK in this population. However, data on optimal treatment strategies in individuals with HIV remain limited. Among available therapies, topical 5‐fluorouracil (5‐FU) is considered one of the most effective field‐directed treatments. We describe the case of a 70‐year‐old man with well‐controlled HIV infection who presented with multiple facial actinic keratoses in a field of cancerization. The patient had previously undergone several treatments, including cryotherapy, diclofenac gel, and tirbanibulin, with only temporary improvement. Given the extent of the lesions and prior therapeutic failure, topical 5‐FU 4% cream was initiated once daily for 28 days. During treatment, the patient developed a moderate inflammatory reaction characterized by erythema and pruritus, which was expected and did not require discontinuation. At the 3‐month follow‐up, complete clinical clearance of the lesions was achieved. This case supports the efficacy and acceptable tolerability of topical 5‐FU 4% in the treatment of AK in a patient living with HIV, even after previous treatment failure. The results are consistent with existing evidence supporting the use of 5‐FU as a first‐line field therapy. Given the increased oncologic risk in immunocompromised patients, timely and effective treatment of AK is essential. Nevertheless, the limited evidence available in this specific population underscores the need for further prospective studies to better define management strategies and long‐term outcomes.