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October 1973

Multiple Actinic Keratoses of the Forehead

Arch Dermatol. 1973;108(4):581. doi:10.1001/archderm.1973.01620250061026

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To the Editor.—  I believe the following observation may be of interest to your readers.A 50-year-old physician who had multiple actinic keratoses of the forehead was treated with topical applications of 2% fluorouracil. Six full weeks of treatment produced only minimal inflammatory changes and essentially no improvement in his condition. During this period, he had been taking prednisone for dermatomyositis in doses ranging from 35 to 20 mg/day. Presumably the steroid blocked the inflammatory response.It was originally thought that topically applied fluorouracil exerts its selective effect on actinic keratoses through an action analogous to its systemic action, ie, through inhibition of thymidine synthesis and ultimately of DNA synthesis, and that the inflammatory effect is more or less incidental. Apparently, however, the inflammatory reaction is essential for improvement. While the mode of action is not fully understood, most people involved in basic research on the topical application of

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