ANN ARBOR, Mich.—Efudx, a topical fluorouracil cream that is used to treat the early signs of skin cancer, causes epidermal injury, which stimulates wound healing and dermal remodeling resulting in improved appearance, according to researchers at the University of Michigan, Ann Arbor (Arch Dermatol. 2009;145(6):659-666). In a non-randomized, open-label two-week treatment with fluorouracil cream, 5 percent, followed by clinical and molecular evaluation, 21 healthy volunteers, 56 to 85 years old, with actinic keratoses and photodamage applied a fluorouracil cream for two weeks and biopsies and clinical evaluation at baseline and periodically after treatment.
One day after the final fluorouracil treatment, gene expression of the effectors of epidermal injury (keratin 16), inflammation (interleukin 1 beta) and extracellular matrix degradation (matrix metalloproteinases 1 and 3) was significantly increased. Types I and III procollagen messenger RNA were induced at week four (seven-fold and three-fold, respectively). Type I procollagen protein levels were increased two-fold at week 24. Actinic keratoses and photo-aging were statistically significantly improved. Most patients rated photo-aging as improved and were willing to undergo the therapy again. The mechanism of topical fluorouracil in photo-aged skin follows a predictable wound healing pattern of events reminiscent of that seen with laser treatment of photo-aging.