Efudix For Sun Spots

  • Best Results1 session
  • Treatment Recovery28-50 days
  • Procedure Time2 minutes
  • Skin SpecialistDermatologist
  • Duration of ResultsVariable
  • AnaestheticNA
  • Back to Work4-8 weeks
  • Cost$

Efudix For Sun Spots

Efudix (5-FU) cream has been used for more than five decades. This chemotherapy cream selectively destroys abnormal cells including sunspots or solar keratosis as well as superficial skin cancers. Your dermatologist will guide you as to the application regime, typically twice a day for three to six weeks. Though newer treatments are better with more clearance and less downtime, Efudix is one of the most cost-effective treatments for sun damage.

FactsFacts on Efudix Treatment

  • Efudix still remains as one of the best treatments for actinic keratosis
  • It is certainly the most cost effective- about a dollar a day
  • Expected downtime ranges from 4 to 6 weeks
  • Marked skin inflammation, itch & crusting are expected outcomes
  • Efudix can be used on the face, neck, torso & limbs
  • PDT & laser treatments are useful alternatives

What is Efudix?

Efudix is 5 Fluorouracil. It is a chemotherapeutic agent. This treatment was discovered serendipitously when doctors noticed an improvement in solar keratosis on a patient who was treated systemically with 5 fluorouracil.  Efudix (Efudux in the US) works by inhibiting DNA synthesis in abnormal sun damaged cells. 

How good is Efudix?

It’s probably the best agent bang for bucks for the management of solar keratosis. Cheap & nasty, but it works. The downside of this treatment is the marked discomfort felt during the long & retracted application period (usually 3 to 6 weeks).

Clearance rates of 60-85+% are normal, providing patients undertake the entire course of treatment

How long do you need to use Efudix?

About three to six weeks. Be guided by your treating dermatologist. Solar keratosis- actinic keratosis treatment, is about three weeks, whilst superficial Bowen disease treatment is about six weeks (dependent on site).

My most frequently prescribed course is pulsed therapy, typically after lasers or PDT. 

How to apply Efudix cream?

Prepare by washing the area with water. You can use a basic cleanser like Cetaphil, QV wash or LRP Effaclar.

  • Apply a thin layer to the area with your fingertips
  • Wait 20 minutes before SPF application (for the am application)
  • Don’t let cream come in contact with your eyes
  • Protect skin folds with Vaseline (use a cotton bud to apply)
  • For evening application, use it after a shower at least 1 hour before bedtime
  • Duration of treatment will be discussed by your treating dermatologist
  • Sun protection is mandatory for the duration of treatment

Davin’s Viewpoint on Efudix Treatment

Though I hardly use topicals for the management of sunspots-solar keratosis, I do acknowledge that Efudex is one of the better treatment modalities for field changes of cancerization. The biggest downside of this treatment is marked & severe skin inflammation that occurs in everyone. This starts after day five of application & continues for up to six weeks. It is the cheapest way of treating sunspots, & hence why it is offered in many skin cancer clinics.

When I was training in the UK, we admitted patients to hospital for Efudix treatment, namely full body & face application for 3-4 weeks. Typically, patients stay for five weeks, screening bloods were conducted weekly to ensure white cell counts did not drop, as 5 fluorouracil is a chemotherapeutic agent. Topical 5 FU was applied twice a day for 3 weeks. In most cases patients were on IV morphine at week 2 to week 3, as full body Efudix is associated with marked blistering & burning. The best bit was that the job of full body area 5FU is complete within 4-5 weeks.

In Australia the public system does not admit patients for topical treatment. A sensible routine is segmental management, namely areas such as the face, neck, chest, one arm at a time. It may take 2-6 years before finishing off the cycle, as in Brisbane, the most comfortable time of application is during the cooler months of autumn & winter. For actinopaths (those with severe sun damage), Efudix treatment is much like painting the Sydney harbour bridge, i.e.. After completing one cycle, start from the beginning. Most patients will have incomplete remission of 12 to 48 months depending on the level of photoprotection & previous DNA damage.

Newer formulations of Efudex are available overseas, namely low dose 0.5% 5FU & 10% salicylic acid. This has been useful as it causes low grade inflammation. With TGA regulations & the speed of roll out of new medications in Australia, expect to see this formulation in the next decade or two (no kidding).

In the capacity of a procedural dermatologist, even though lasers are far more efficient at clearance of sunspots, I still prescribe Efudex as pulsed therapy. For example, one or twice a week application to cause subclinical inflammation. In some cases I prescribe topical retinoids prior to application, in extreme cases oral retinoids such as neotigason can be combined with pulsed application for chemoprevention of dysplasia.

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