5-Fluorouracil Field Therapy for Actinic Keratosis

The 4 Seasons AK program
To enhance patient adherence and maintain consistency and convenience, I have modified use of topical 5-fluorouracil (5-FU) as field treatment for actinic keratosis (AK) in the following way.

• Instructions for use
– Apply 5-FU twice daily for 1 week per season for 4 seasons (can reduce to 1 to 2 times yearly thereafter if improved).
– Instruct patients to treat until they see blotchy redness, then 1 additional day or up to 7 days, whichever comes first.
– Provide handouts on proper use/application and duration of use; demonstrate with pictures what patients can expect; and explain post-care management, including barrier repair creams and gentle cleansers.

• Indications
– Patients with extensive AKs beyond the number effectively treated with cryotherapy

– Patients who are mentally capable of undertaking therapy

• Contraindications
– Avoid in patients unlikely to be able to follow instructions for use unless a reliable care provider is available.
– Avoid applying to sites of irritation and inflammation; use caution with seborrheic dermatitis, rosacea, and facial 
involvement with psoriasis or atopic dermatitis.
– Avoid use at areas that can become extremely irritated, such as perinasal regions, nasolabial folds, melolabial regions, periocular regions, and angles of mouth.

• Benefits
– Convenience of being done at home
– Low cost 
– Effectively used as field therapy
– Patient controlled
– Fewer office visits (reassess at 6 months and once yearly thereafter or return care back to primary care provider if well controlled)
– Cryotherapy can still be used for stubborn lesions
– Can be applied to the dorsal forearms, hands, and legs (use of calcipotriene twice daily for 1 week before 5-FU can enhance the effect)
 
Jerry Tan, MD | Windsor, Ontario, Canada
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Make Staff Feel Like Part of Your Team
I am pretty controlling and know that I like to make a lot of decisions on my own. However, I want my staff to feel like they are part of my decision-making team, so I have them help me make some decisions about some of the products we sell in the office. I also want them to try the products, so they can tell our patients about their experience. I have the product representative come to the office, and we all look, feel, try, and decide together. My staff members are more up on what is happening on social media and what some of our patients are asking for than I am, so they are a big help. They now feel like they make the decisions and are much better at marketing their choices. 

Jo Herzog, MD | Vestavia Hills, AL
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Treating Small Skin Tags
Electrodessication is my favorite approach for treating numerous small skin tags of the neck or face. I do this without anesthesia, but consider having patients use lidocaine/prilocaine cream before the procedure to reduce discomfort.

Steven R. Feldman, MD, PhD
Winston-Salem, NC