You have been prescribed efudex cream to treat a precancerous, sun exposure related skin condition called actinic keratosis. This medication acts mostly on abnormal cells which are growing more rapidly. Normal skin cells are relatively spared in the treatment process. Efudex treats both the visible and “subclinical” lesions meaning those lesions not apparent to the naked eye. The treatment may “bring out” or make apparent many previously unnoticed lesions.
You should apply the cream in a thin film over the entire area that the provider has indicated. Do not apply to just the visible lesions. In a few days the treated area, especially the abnormal tissues will begin to turn red. These areas may become itchy, irritated, and tender to touch. This is expected and is a normal response. The more red areas you have, the more you needed this treatment. Even though this treatment is quite uncomfortable and unsightly it is important to continue for the prescribed time. You MUST stay out of the sun while having this treatment. It is usually uncomfortable to apply sunscreen, so if you do go outdoors, even for brief exposures to the sun, as in walking to the supermarket from the parking lot, you should wear a wide brimmed hat and long sleeves if treating your arms. If you have concerns, please call us for help.
The provider will indicate what schedule you should follow. This medication is prescribed from 2 to 5 weeks, and usually it is applied twice a day for the first 2 weeks. After 2 weeks you will often be instructed to use just once a day, and that should be at bedtime.
Often you will be prescribed a cortisone cream such as desonide or hydrocortisone to be used after the first 2 weeks. It’s purpose is to decrease the inflammation and make you a little more comfortable. It may sting a little when you apply it, but will help the discomfort.
Some suggestions that may be helpful:
Put old pillowcases on your pillow, as you may scratch at the lesions in your sleep causing them to bleed.
If an area seems particularly uncomfortable it is often helpful to apply vaseline or mineral oil to protect and soften the area.
Cool things help with the discomfort. Some patients have had success with ice packs or a fan blowing on the area.
If scabs form do not pick them off. Allow them to loosen and fall off on their own. If they feel tight and crack you may stand in the shower and let the water hit the area, then as soon as possible apply vaseline or mineral oil to prevent dryness and cracking.
Try to keep the efudex away from your eyes and off your lips. If this is difficult, applying vaseline or chapstick to lips may help to keep the medication from migrating on to them. Often the area in the corners between the cheek and nose will react a great deal. If this happens and you get sore in this area do not put it directly into this area. A little will migrate into that area on it’s own. In general avoid treatment of skin crevices or folds.
A little swelling and a small amount of clear drainage can be normal. If there is a lot of swelling or discharge you should contact us, so we can see you to rule out infection.
After you stop the efudex it will take about 2 weeks for your skin to return to normal. It should be smooth with all of the scaly spots gone. Your provider would like to see you back after you are well healed to determine if any abnormal areas persist.
We know this treatment is uncomfortable, but usually the results are worth it. Your provider will help you decide if this is the best treatment for your sun damaged skin. Please try to use the efudex as ordered, but if you find it too difficult please call us to discuss other options. Our number is 448-4745.
Remember to wear protective gear; i.e. Clothing, hat and sunscreen minimum spf 30 if tolerated!
To learn more about Efudex, please visit the website listed here.