{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:20:18Z","timestamp":1777504818771,"version":"3.51.4"},"reference-count":15,"publisher":"Mattioli1885","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence. Objective: We sought to build consensus on management of LSR associated with 4% 5-FU using a Delphi methodology. Methods:\u00a0Twenty-eight expert dermatologists participated in a 3-round Delphi process. Experts evaluated LSR management strategies, including emollients, antibiotics, steroids, and treatment discontinuation. Agreement levels were measured using a 7-point Likert scale. Consensus was categorized as high if &gt;80% of votes were within the 5-7 rating range and low when &gt;25% were in the 1-3 rating range, with &lt;25% of the votes in the 6-7 rating range. Other combinations of votes were considered as having moderate agreement. Results:\u00a0High agreement was achieved for the following statements: the approved daily schedule (once daily for 4 weeks) is the most appropriate (92.9%); mild LSR generally do not require intervention and do not impact treatment adherence (96.4%); severe LSR may benefit from temporary treatment interruption and emollient use, ensuring adherence without compromising efficacy (92.9%). The use of emollients (in parallel with the treatment with 5-FU) was considered not needed by most (moderate consensus, 64.3%). Experts emphasized the importance of clear communication about LSR during baseline consultation to enhance patient compliance. Conclusion:\u00a0This consensus provides practical guidance for managing LSR induced by 4% 5-FU, ensuring high adherence and optimizing treatment outcomes. Further research is needed to validate these findings and explore alternative management approaches.<\/jats:p>","DOI":"10.5826\/dpc.1502a5787","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T01:57:38Z","timestamp":1746496658000},"page":"5787","source":"Crossref","is-referenced-by-count":2,"title":["Management of Local Skin Reactions Caused by 5-FU 4% Cream for the Treatment of Actinic Keratosis: A Delphi Consensus"],"prefix":"10.5826","volume":"15","author":[{"given":"Gabriella","family":"Brancaccio","sequence":"first","affiliation":[{"name":"Dermatology Unit, University of Campania, Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Briatico","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Campania, Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoe","family":"Apalla","sequence":"additional","affiliation":[{"name":"Second Dermatology Department, Aristotle University of Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhard","family":"Dummer","sequence":"additional","affiliation":[{"name":"University Hospital Zurich and Kantonsspital Aarau"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Eklind","sequence":"additional","affiliation":[{"name":"Diagnostiskt Centrum Hud, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Basset Seguin","sequence":"additional","affiliation":[{"name":"Dermatology Department, Saint-Louis Hospital, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigitte","family":"Dreno","sequence":"additional","affiliation":[{"name":"Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Concetta","family":"Fargnoli","sequence":"additional","affiliation":[{"name":"San Gallicano, Dermatological Institute, IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascale","family":"Guitera","sequence":"additional","affiliation":[{"name":"Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Melanoma Institute Australia and Faculty of Medicine and Health, The University of Sydney, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus V.","family":"Heppt","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN) and CCC Alliance WERA, Erlangen, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Hoeller","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical University of Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Jouary","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Hospital Francois Mitterrand, Pau, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aimilios","family":"Lallas","sequence":"additional","affiliation":[{"name":"First Dermatology Department, Aristotle University of Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrikke","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, Copenhagen University Hospital \u2013 Herlev and Gentofte, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Leiter","sequence":"additional","affiliation":[{"name":"Center for Dermatooncology, Department of Dermatology, University Hospital of Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josep","family":"Malvehy","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Cl\u00ednic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Moreno Ramirez","sequence":"additional","affiliation":[{"name":"Medical-&-Surgical Dermatology Service. Hospital Universitario Virgen Macarena, Sevilla, Spain."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Paoli","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketty","family":"Peris","sequence":"additional","affiliation":[{"name":"Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy; UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Puig","sequence":"additional","affiliation":[{"name":"Dermatology Department, Hospital Cl\u00ednic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Saiag","sequence":"additional","affiliation":[{"name":"Department of General and Oncologic Dermatology, Ambroise Par\u00e9 hospital, APHP, & EA 4340 \"Biomarkers in cancerology and haematooncology\", UVSQ, Universit\u00e9 Paris-Saclay, 92104 Boulogne-Billancourt, France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eggert","family":"Stockfleth","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Ruhr-University, Bochum, Bochum, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilhelm","family":"Stolz","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Ludwig-Maximilians-University, Munich"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander J.","family":"Stratigos","sequence":"additional","affiliation":[{"name":"First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Class","family":"Ulrich","sequence":"additional","affiliation":[{"name":"Charite-Universitiitsmedizin Berlin, Berlin, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Marie","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iris","family":"Zalaudek","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology of the Hospital Clinics Giuliano Isontino (ASUGI), Maggiore Hospital, Trieste, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Argenziano","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Campania, Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"27750","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"10.5826\/dpc.1502a5787_ref1","doi-asserted-by":"crossref","unstructured":"Dianzani C, Conforti C, Giuffrida R, et al. 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