Patient observations whilst using 5-FU (Efudex)
This patient was kind enough to share his experience by keeping a photo diary and making some notes. This is intended to be used for information purposes only.
"The hints below are what I found to work and not to work for me. They might be useful. Your friendly pharmacist may also be a source of good advice. Firstly, my treatment was for sun damage (actinic keratosis, typical for my light complexion) on my forehead and scalp, the worst at the front."
- Erosion. The treatment consisted of applying the Efudex, twice a day for 4 weeks, or until there was "erosion" or "edema" or scabbing and discharge. If you are a gardener, geologist or engineer, you know what "erosion" means to you. The question is – what does it mean to your dermatologist. In my experience, it was the sort of skin shedding that happened after you got that terrible sun burn when you were young and indestructible, or the kind of skin shedding when you use a pumice stone on dry skin. Scabbing and discharge is easy to imagine. The edema is swelling. I did not get that or perhaps a little, so I cannot comment but it is the erosion interpretation that most patients have difficulty with. Of course, the erosion will not be at all uniform, so what do you do. In my case I continued to apply the cream to those areas but more sparingly and not at all to areas that were scabbing. This worked O.K.. I bought a box of medical latex gloves to apply the Efudex.
- Washing and Re-applying. You should have been told that this is the worse bit. The washing is bad enough and what do you wash with. Having tried the mildest shampoos including baby shampoo, I found that Softsoap hand soap hurt the least. Then you must wait 10 minutes before re-applying the Efudex. This can be excruciating as the skin dries out. The Efudex appears to contain products that sooth and lubricate, so when you re-apply, it is quite a relief. The instructions said that you could apply sun screen two hours after application. I found that this worked if I used sun screen that contained titanium dioxide and was not greater than SPF 30. The SPF 45 and 60 stung badly. I also found that the liquid sun screen Vichy 30 SPF for the face, was the mildest. It seems to have the same medical ingredients as the more creamy variety, so it is probably the non-medical ingredients that sting.
- Recovery Stage. I stopped 1 day short of the full 4 weeks because of the extent of erosion and scabbing. Then came the recovery stage. I read and tried many of the recommendations re what treatment to use during this time.
- I found Polysporin worked well and after trying Vaseline petroleum jelly and Aquaphor as additional moisturizers, I found that the Polysporin acted quite well as a moisturizer itself. Both Vaseline and Aquaphor work well and don’t hurt but are incredibly messy and difficult to clean off without pain. Wet wipes without alcohol work quite well for wiping off the Polysporin and the Vaseline. I let the hydrocortisone dry before adding the Polysporin sparingly. Some people have pointed out that petroleum jelly (Vaseline) does not moisturize. It just prevents loss of moisture. It is however, quite soothing but also keeps air from the skin.
- Some find Aloe Vera gel to be quite good. I tried this on the 5th day of the recovery stage and could not remove it fast enough (with gentle wet wipes) as it stung severely and I returned to the cortisone cream and Polysporin routine.
- Sunscreen. After stopping the Efudex, I could not use sunscreen without it stinging too much, until 6 days after stopping. Then I could use the SPF 30. There had been quite a lot of erosion (skin shedding) and I just looked badly sunburned but I felt that I could re-join humanity. I could also use Lubriderm for dry or sensitive skin after a week into the recovery period. It stung for a few minutes but was tolerable.