Week 1, 7 day review of 5-FU Efudix 5% Fluourouracil chemotherapy treatment to actinic keratosis on face, scalp and neck. First week was rough. Dermatologist advised ‘it will feel like sandpaper’ but neglected to mention ‘you will look like you have measles/mumps/chickenpox’ combined, plus it will feel like sandpaper!
The 5-FU brings to the surface sub-clinical, formerly invisible AKs which was a big surprise to see just how many there were. I thought I would be treating the tactile Aks i.e. those I could feel and/or see but the cream appears to hunt AKs, above and below the surface. Face was red, tight, rough, itchy and sensitive to sunlight (even in early Spring with max temperature recently a measly 12 degrees centigrade). Pictures taken daily to show progression through stages of application. ‘Rash’ on the back of neck turns out to be mainly eczema (although previously treated with cryotherapy for one lesion) – cream prescribed for that worked well and quickly – ‘Eumovate’ – good stuff – recommend for eczema – better than anything else I have tried over the years.
5-FU applied with fingertips – better feel and ability to control spread or so I thought (I’ve since changed my view on that and last use was with a cotton wool bud). Problems with the AKs around the eyes – the skin needs treated but getting the cream on and stopping it from spreading to the eyes has proven difficult. Initially used moisturiser and/or sun cream but this appears to have made the spread of cream worse, i.e. it acts as as a vehicle to transport the 5-FU from skin down in to eyes – have since stopped using moisturiser and suncream which appears to have helped these last few days. Downside is skin visibly dry, cracked, flaky, scabby and bits fall off periodically.
Due to lack of information from Consultant Dermatologist at time of diagnosis January 2020, I got quite a shock when the cream was first applied. Subsequent research online revealed some interesting points to note; my twice-weekly application for 3-4 months course of 5-FU is significantly less effective than the daily application for 3-4 weeks – the daily course clears Aks quicker, begins the healing process sooner and clears more Aks than the 3 month programme. I tried speaking with the Doctor about this – got as far as the Nurse who checked notes and confirmed Dr thinking twice weekly application until May. When I mentioned the online research, trials and reviews, she was wary of altering the Doctor’s advice but did say, ‘well, if you are going to use it daily only use it for 3 weeks’. I wanted direction not an ‘if’ response. Despite research indicating the 3 is best, I am wary of contradicting the Dr myself – I am not medically trained (but I can find and read clinical trials of Efudix online). If I get the time I may do my own literature review – the most recent one I could find was dated 2016 – this gave a thorough comparison between several types of AK treatments including fluourouracil vs cryotherapy vs light treatment etc. 5% fluourouracil scored well. Cryotherapy is for single lesions whereas 5-FU is for ‘field treatment’ i.e. multiple lesions spread over a wider area.
Read on to week 2 update;