- Best Results1 session
- Treatment Recovery28-50 days
- Procedure Time2 minutes
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- Back to Work4-8 weeks
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
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How do you know if it is working?
Trust me, you will know. Efudix kicks in at around 5 days. Your treated area will start to scale & become red & itchy. This usually increases in severity and peaks at week 2 to 3. In most cases there will be a spill over reaction, meaning other non-affected areas are red & irritated. This is most likely due to your nighttime application as Efudex is smudged on your pillow.
Are treatment breaks allowed on Efudix?
Yes. Be guided by your treating dermatologist, as we all have different protocols. If you have significant discomfort, or blisters, stopping the application for three to seven days is sensible. You can use an occlusive moisturizer such as Dermeze, La Roche Cicaplast or QV Intensive three to four times a day during the break period. If inflammation is exaggerated, your specialist may ask to apply hydrocortisone or another corticosteroid.
What is the clearance rate of sunspots following Efudex therapy?
Depending on the papas you read, the clearance rate ranges from 30 to 85%. In reality it’s probably towards the 70-80% mark, if a three-week course is completed.
Efudex is in the top 3 therapies when it comes to efficacy, including laser assisted PDT (highest clearance) followed by PDT.
What are other treatment options for sunspots?
There are many other treatment options that are equally as effective as Efudex. They include-
- Laser assisted photodynamic therapy (in office) using blue or red-light illumination. This gives the best clearance.
- Laser assisted PDT with daylight illumination.
- Photodynamic therapy with LED illumination
- PDT with daylight activation
- Aldara or Imiquimod
- High density thulium laser resurfacing (least downtime)
- Jessner TCA chemical peels or phenol croton oil peels
- Solaraze (pretty shi* treatment)
What is the best treatment for sunspots - solar keratosis?
The best treatment depends on what equipment & training your dermatologist has, as well as your budget.
If you are going by what the research says, laser assisted photodynamic therapy has the highest cure rate, approaching 90+%. Laser pre-treatment gives better clearance compared to normal PDT. Lasers can target hypertrophic (thick actinic keratosis), as well as pigmented SKs, as compared to conventional PDT.
What is pulsed Efudix?
This is intermittent use of Efudix over a long period of time. I prescribe this pulsed application method in patients with extremely aggressive field changes. My usual prescription pattern is-
- Apply Saturday & Sunday nights only. End-point of very mild, if any irritation. Apply to areas that I have instructed.
- Other nights apply the retinoid cream I have prescribed to you.
- If you have any questions, please do not hesitate to contact my nurses.
Can Efudix cure all skin cancers?
Nope. This treatment is best for thin solar keratosis as well as IEC or intraepidermal carcinomas, also known as Bowen disease. As with all cancer treatments, there are failure rates. Aggressive field changes are seen in older patients, previous history of sunspots, immunosuppression & rare genetic conditions.
What is the meaning of combination field treatments for sun spots?
The current literature supports the use of combination therapy for sunspots. Efudix can be used as a ‘mop up treatment’ (this is my most frequent mode of application), following field treatments such as PDT, laser assisted PDT & fractional laser resurfacing.
An example is twice a week application of Efudix to isolated solar keratosis, starting 4 weeks after laser assisted PDT. This can be used long term as chemoprophylaxis, or increased to cure remaining sunspots post PDT. Application frequency is tailored according to the patient.
What are the side effects of Efudix?
As always, it is important to differentiate the side effects from expected effects of Efudex. Expected effects include skin irritation, redness, itching, crusting & photosensitivity. This will last for the duration of treatment (often kicking off at day 5 to 7 after starting), & one or two weeks after ceasing.
Side effects include exaggerated skin inflammation including erosions, & blistering. Actual allergic reactions are very rare.
How to reduce skin irritation from Efudix?
Your dermatologist will have their own specific routine to extinguish the inflammation following treatment. Most of us prescribe a corticosteroid ointment under wet wrap occlusion post treatment. Be guided by your specialist.
How long will the skin be sensitive after application?
In most cases skin sensitivity will decrease within 2-4 days of stopping application, however your skin may not fully recover for another 4-8 weeks.
If you have sensitive skin or rosacea, Efudix will flare up your condition. See a dermatologist for solutions. Pulse dye laser is best for prolonged redness.
Can this be used to treat sunspots on the body?
Yes. It is effective on all parts of the body; however the application frequency may be slightly different. Your dermatologist may instruct you to use this segmentally, namely one area at a time.
Lower limb Efudix application may be modified to help reduce skin ulceration.
Who should you see for Efudix treatment?
Ideally a dermatologist should manage your treatment, however if you cannot get to see one, a GP (skin cancer GP) can possibly manage your treatment.
I don’t use Efudix much nowadays, as evidence shows that other treatments are better, both in terms of effectiveness and decreased downtime, regardless it is a good treatment for actinic keratosis.
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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