Aging Skin Regains Some of Its Youth When Rubbed
with Chemotherapy Drug in Recent Study
Application of fluorouracil appears to improve sun
damage, precancerous skin patches
June 15, 2009 Want to improve the looks of your
sun-damaged skin that is beginning to show precancerous skin patches? A
newly released study suggests the answer may be found in rubbing a
little of the chemotherapy medication fluorouracil on your aging skin.
The report by University of Michigan associate
professor of dermatology Dana L. Sachs, M.D., appears in the June issue
of Archives of Dermatology, one of the Journal of the American
Medical Association/Archives journals.
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Fluorouracil stops the body from synthesizing
thymine, a building block of DNA. This drug is currently used to treat
cancers of the colon, head and neck, pancreas and other organs.
In early studies of patients with cancer undergoing
treatment with fluorouracil, clinicians noticed changes in skin
appearance, which led to the development of a topical therapy for the
treatment of actinic keratoses (skin lesions that may develop into skin
cancer).
Sachs and colleagues evaluated molecular and
clinical changes in the skin of 21 healthy volunteers with skin lesions
and sun-damaged skin.
Participants applied 5 percent fluorouracil cream
to the face twice daily for two weeks. Skin biopsies and clinical
evaluations were performed at the beginning of the study and
periodically throughout treatment.
Photographs were also taken at the beginning of the
study and after one, two, four, six, 10 and 24 weeks, and were evaluated
by three dermatologists who were not involved in examining the patients
during the study.
Nineteen patients completed all aspects of the
study, and 20 responded to a questionnaire at week 10.
The number of actinic keratoses was significantly
reduced following treatment, from an average of 11.6 lesions to an
average of 1.5. Clinical evaluations also identified overall
improvements in aging-related damage, including decreases in fine
(small) and course (large) wrinkling, lentigines (dark skin spots),
hyperpigmentation (skin that has become darker) and sallowness (a yellow
skin tone).
One day after the final fluorouracil treatment,
testing of the skin biopsies revealed an increase in the levels of
compounds related to skin injury, inflammation and degradation of the
extracellular matrix (the non-living tissue that supports skin), in
addition to the precursor of collagen, which rebuilds damaged skin.
"Topical fluorouracil causes epidermal [outer skin
layer] injury, which stimulates wound healing and dermal remodeling
resulting in improved appearance," the authors write.
"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."
The treatment was generally well tolerated. On the
10-week questionnaire, 95 percent of patients rated their skin as
improved and 89 percent were willing to undergo the therapy again.
"For patients in whom a course of topical
fluorouracil is indicated for the treatment of actinic keratoses, there
will likely be the additional benefit of a restorative effect from sun
damage; this may provide further motivation for these patients to
undergo the rigorous treatment," the authors conclude.
"It is possible that for some patients topical
fluorouracil may have an important role against photo-aging. For others,
however, it may not be cosmetically acceptable given that a standard
course of therapy may last two to three weeks and the ensuing reaction
can persist for several more weeks.
Undoubtedly, there will be patients who desire a
therapy such as topical fluorouracil for cosmetic purposes given the
relatively low cost of this therapy compared with ablative laser
resurfacing."
Editor's Note: This study was supported by Valeant
Pharmaceuticals International.
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Dana L. Sachs, M.D.
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UMHS Department of Dermatology
