Efudix / Fluorouracil
"Efudix®" is the brand name of a cream that contains fluorouracil. Fluorouracil (5-FU) is a chemotherapy agent that has been used in the treatment of cancer for many decades. It is prescribed as a topical treatment for the skin conditions solar keratosis and Bowen's disease (also called squamous cell carcinoma in situ or intraepidermal squamous cell carcinoma).
Solar keratoses and Bowen's disease are common precancerous skin conditions that are the result of sun damage. Even if you have been careful about sun exposure in recent years, you may have accumulated sufficient ultraviolet (UV) exposure that you are at risk of continuing to develop these conditions in the future.
Solar keratoses initially start as small tan, brown, or reddish-brown scaly patches on the skin. They commonly occur on sun-exposed areas of skin (face, ears, bald scalps, hands, forearms and legs). Without treatment a small number of solar keratoses can develop into squamous cell cancer (SCC).
Bowen's disease (Squamous Cell Carcinoma in situ)
Bowen's disease appears as a dull red, raised, crusted, scaly patch or plaque. They commonly occur on sun-exposed areas of skin (face, ears, bald scalps, hands, forearms and legs).
How does fluorouracil work?
Fluorouracil interferes with cell reproduction. Because the precancerous cells grow faster than normal cells they are more susceptible to the fluorouracil, so the fluorouracil will clear the solar keratoses and SCC in-situ (Bowen's disease) and leave the normal skin intact.
How do I apply the cream?
There are a variety of regimens described for using fluorouracil cream. Most of these involve applying it once or twice a day, for 3-4 weeks. The cream can be applied with a clean finger, a gloved finger or a non-metal applicator. The cream can be applied to any area of skin (as directed by your doctor), but you should take care to avoid the eyes. Wash your hands thoroughly after each use.
What can I expect?
It is very important to understand that your skin will react during the treatment. Some people have a mild reaction, others have a severe reaction. The reaction involves redness, inflammation, irritation, crusting and peeling. If you are using the fluorouracil cream on your face you may find that the redness and inflammation makes you self conscious and that you do not wish to be seen in public while your face looks like this.
The reaction is a sign that the treatment is working. You may develop redness and inflammation in nearby areas of skin that did not appear to have any abnormalities. This is because there may be abnormal cells in your skin that were not visible. If you have many abnormal cells and lesions you can expect to develop more redness and inflammation than a person who has a single area of abnormality.
If you have a severe reaction, especially if you develop ulceration, it may be appropriate to reduce the frequency with which you are applying the cream. If this is your first time using fluorouracil cream it is a good idea to plan a routine check in with your doctor after 2 weeks of treatment. If you develop significant pain and/or ulceration during the treatment then temporarily stop using the cream and request an urgent review with your doctor. If you stop applying the cream your skin will gradually return to normal. If you have already been using the cream for 3 or 4 weeks your doctor may advise that you can stop using the cream; if you have only been using it for 1 or 2 weeks you may be advised to recommence treatment with a reduced frequency of application.
It usually takes 2-4 weeks for your skin to return to normal after you finish applying the fluorouracil cream. This varies according to the duration of your therapy and the severity of your skin reaction.
Other side effects are rare, but it is possible to develop areas of depigmentation at the site of the original lesions, sun sensitivity and new small blood vessels (telangiectasia). True allergy to the cream is very unusual. Occasionally patients develop systemic symptoms such as mild nausea, loss of appetite and tiredness during treatment.
Do not use fluorouracil cream if you are pregnant or breast feeding.
Other tips for use
Avoid sun exposure throughout and immediately after treatment (mandatory). It is preferable to use this therapy during winter months for this reason.
Take care if applying the cream to the fold between the nose and cheek, as this area is prone to irritation.
Consider treating a single area at a time. For instance, rather than treating both hands simultaneously you may wish to try treating your left hand first, and your right hand after you have finished treatment of the left. If you prefer to sleep on your side you may find it better to treat each side of your face separately. That said, some patient say that it's better to treat the whole face at once and get it over and done with, rather than prolonging the experience.
Where possible, try to avoid starting treatment of your face in the weeks immediately before an important social engagement (like your daughter's wedding).
Sometimes severe inflammation and ulceration can be helped by applying a prescription anti-inflammatory cream (only use this on the advice of your doctor).
Do not use other creams, lotions or cosmetics on the area of skin you are treating with fluorouracil cream.
If you forget to apply the cream one day then simply recommence use the following day. Do not double the dose or apply it more frequently to make up for it.
Only use the cream on the direction of a doctor - do not use left over cream to treat other spots on yourself or others, even if you are sure they are exactly the same thing.
Do not cover the areas of treatment unless your doctor specifically advises you to do so.
Avoid application to the mouth, eyes, vagina and anus as these mucous membranes are prone to inflammation, ulceration and possibly even tissue necrosis (tissue death).
Treatment is very effective, but may need to be repeated in the future if new skin lesions (solar keratoses or SCC in situ) develop.
If a solar keratosis or SCC in situ does not clear with therapy it will definitely require biopsy and usually require surgical excision; until proven otherwise assume that the reason it has not cleared is because it is a skin cancer.
Seek advice from your doctor or pharmacist if you have any queries.
If you are searching for information online please note that Efudix® is called Efudex® in the United States.
Patient blogs on Efudix experiences
Patient story and photos - Lisa, aged 42 (nose)
Patient story and photos - John during July and August 2009 (face)
Patient story and photos - Kirstie, aged 31 (face)
Patient photo - Glenyce after 3 weeks of treatment (face)