Week 2 on Efudix 5% fluourouracil treatment of Actinic Keratoses.
This was a difficult week. Following my initial shock at the reaction to the first application of the EFUDIX to face (I thought it had to be an allergic reaction), I went online to educate myself. I had little forewarning from my Consultant dermatologist other than it ‘will feel like sandpaper’. No mention of the other normal reactions to the Efudix cream and no mention that it was a form of chemotherapy.
Several hours on Google and Youtube uncovered a number of research papers, clinical trials and literature reviews. In summary, after 50 years of real-world usage with the 5% fluourouracil, the most effective treatment course is once or twice daily for three to four weeks, as opposed to my treatment plan i.e. twice weekly for 3-4 months. The daily application is better at clearing existing AKs, clears more of them and gets the patient into recovery earlier. The obvious downside is a significantly more extreme reaction with subsequent ‘suffering’ for the patient. The upside is that this option works better and gets it over with in a shorter time period. The weekly dosage I am on will clear Aks, yes but not as quickly and extends the course across a 3 to 4 month period – and that’s before the healing begins which will take another few months.
I tried asking the Doctor for advice but got as far as a nurse who checked notes and confirmed twice weekly. In response to my online research I was advised ‘well, if you are going to do that, only do it for three weeks’. Not a definitive answer and I was wary of contradicting the Dr. even though I was incorrectly treated for several years with a diagnosis of eczema and as a result am doubtful as to the average GPs competence in these matters. Second-guessing the Dr. I am thinking the less severe 3 month dosage will be easier on me and make it more likely I will persevere? The Doctor may also not have been aware of how many Aks there are on my face and scalp. These become evident as soon as the cream is applied – the Efudix is an AK hunter killer and as such brings to the surface and makes visible, Aks initially invisible and/or just below the surface. However, surely a dermatologist would have had some experience in this field?
NB – previous treatment for Ak on back of neck plus eczema diagnosis. Different GP prescribed EUMOVATE cream to treat that and I was impressed at how quickly it worked – an almost overnight reduction in roughness, itching and redness to neck. Highly recommend that. Unable to find an exact match for purchase online – presume requires prescription from Doctor. Active ingredient is 0.5 mg clobetasone butyrate, for info.
As for face – skin is very tight, rough and uncomfortable, skin breaking, scabs forming, red and inflamed.
Important lesson learned this week – avoid moisturiser and sun cream anywhere near the eyes – it will work its way down into the eyes by the end of the day and cause havoc! Terrible problems with that this week with itching, aggravation and friction sores to eyelids from rubbing them. AVOID!
In an attempt to apply the scientific method to this programme, I have noted, counted and mapped the number of tactile, visible and sub-clinical lesions across my face and scalp. As can be seen from the photos and simple imagery, the number appears to have increased from week 1 through week 2 with the Efudix digging deeper below the surface to do its thing. I will monitor the number of Aks through the next few months with the hope that 5-FU will works its magic and leave me with a significantly reduced number of AKs by end of treatment course.
I had 30+ left side of face and 40+ right side of face. I believe right side dominance due to physical environment and lifestyle – back of house faces East – I would be outside often therefore more sun on right side and right side is driver’s side to sun.
This treatment is a ‘field treatment’ as opposed to previous treatment of multiple individual lesions with the liquid nitrogen (which was ineffective). An interesting piece of information found online regarding cryotherapy – experiments/comparisons made for length of application – 5 seconds up to 20 seconds. Clear winner 20 seconds application i.e. the tip of the liquid nitrogen applicator held close to the AK for 20s. Painful yes but much more effective. I was given a short, several second burst when treated three times over the last year – perhaps that is why I am now suffering this treatment? Should bear that in mind next time I speak with Doctor.
Anyways, that’s week 2 over with – onwards and upwards. Stay tuned for next thrilling installment either by subscribing to the newsletter or go on to Youtube to subscribe and keep up with next video as treatment progresses over the next few months.
I trust this will be of some use to you guys out there about to start this treatment or part way through and wondering what the hell is going on! If you have any useful advice re this treatment please add your comment. Thank you.
Week 2 vlog on Youtube for a compilation of thoughts and photos/videos;
Read on for week 3 update;