Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology

Abstract

Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin treatment is effective in hypertrophic scars and warts, but intralesional 5-FU may also be considered since it is cheaper and less painful. Moreover, intralesional 5-FU and bleomycin injection is a viable option for premalignant lesions (i.e., actinic keratosis) and inoperable skin cancers. Both bleomycin and 5-FU have been applied as treatment adjuncts for vitiligo, with 5-FU showing a slightly better outcome. Both agents have a good safety profile, and no serious side effects have been reported following their use in the field of dermatology.

Keywords: 5-fluorouracil; bleomycin; dermatology; injection; topical.

Figure 1

Truncal keloid, (A) before treatment and (B) after 7 sessions of bleomycin injection (every 4 weeks).

Figure 2

Periungual warts, (A) before treatment and (B) after 2 sessions of bleomycin injection (2 weeks apart).

Figure 3

Bowen’s disease, (A) before treatment and (B) after 8 sessions of 5-FU injection (at an interval of 2–3 weeks).

Figure 4

Facial vitiligo, (A) before treatment and (B) after 4 sessions combined treatment with CO₂ fractional laser and bleomycin (each performed every 4–8 weeks).

Figure 5

Venous malformation, (A) before treatment and (B) after 3 sessions of bleomycin injection (spaced 3–4 weeks apart).

Figure 6

Condyloma acuminatum, (A) before treatment and (B) after 2 sessions of bleomycin injection (spaced 2 weeks apart).

Figure 7

Nevus sebaceous, (A) before treatment and (B) following 4 sessions of 5-FU injection after a primary erbium: YAG and Co₂ laser ablation (5-FU injection given every 4–8 weeks).