Efudex topical cream for the treatment of skin cancer

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Topical cream (applied only to the skin) is a common treatment for basal cell carcinoma, the most common type of skin cancer in the world. If your healthcare provider has prescribed Efudex (fluorouracil), one of those options, it is important that you learn more about the drug to make sure you are using it safely and effectively.

Fluorouracil is available as a generic drug and also under the brand names Tolak, Carac, and Fluoroplex.

Get Medical Information / Cindy Chang

Indications

Efudex is a topical cream used for the treatment of superficial basal cell carcinoma when conventional methods are impractical, for example in the case of multiple lesions or difficult-to-treat areas on the face or scalp. It is also used to treat actinic keratosis (also called solar keratosis) which, if left untreated, can lead to more serious invasive squamous cell carcinoma .

In a more potent injectable form, fluorouracil is also used to treat cancers of the breast, stomach, intestines, and esophagus .

How does it work

Efudex is a chemotherapy drug ("antimetabolite") that interferes with the production of DNA and RNA, which are essential for cell growth and division. This inhibition leads to the death of fast-growing cancer cells, which absorb more fluorouracil than healthy cells. cells.

Efficiency

The effectiveness of treatment for basal cell carcinoma with fluorouracil is approximately 90 to 93 percent. … And unlike surgery, Efudex is unlikely to permanently scar or discolor areas of the skin.

However, isolated and readily available basal cell carcinomas must be treated surgically, as this method has a nearly 100 percent success rate for such lesions.

Efudex Cream has the same success rates as Aldara Cream (imiquimod) . However, a 2016 review shows that, unlike imiquimod, Efudex is best used to treat only superficial lesions, as it can improve the appearance of the surface by allowing tumors to continue growing under the skin. Notably, the same review reported that the relapse rate dropped to 6 percent when curettage (mild skin scraping) precedes use.

Talk to your doctor about which treatment is best for you.

Use

For basal cell carcinoma, it is recommended to apply a 5% fluorouracil cream twice daily in an amount sufficient to cover the lesions for at least three to six weeks. However, treatment can take 10 to 12 weeks for the lesions to disappear .

To apply this medicine, use a cotton-tipped applicator or wear gloves. When applying with unprotected fingertips, it is important to wash your hands thoroughly after applying the cream. Avoid contact with eyes, nose and mouth.

Side effects

In general, the treated areas can be aesthetically unsightly during therapy and for several weeks after discontinuation.

The action of fluorouracil occurs in four phases:

  • Early inflammatory phase: mild inflammation occurs during the first week of use.
  • Inflammatory phase: During the following weeks, redness and swelling with scabs and burning appear.
  • Tumor disintegration phase: the lesions dissolve as the skin exfoliates.
  • Healing phase: Within a week or two, new skin grows in the treatment area.

Specific side effects that generally do not require medical attention include:

  • Red or dark skin
  • Erosion (loss of the top layer of the skin)
  • Eye irritation, including burning, itching, tenderness, tingling, or tearing
  • Hypersensitivity of the skin to the sun and ultraviolet light.
  • Pain and burning in the affected area.
  • Dryness, peeling, or swelling of the affected area.
  • Skin rash or itching in the affected area.
  • Sensitivity

Of course, tell your doctor or healthcare professional about them if they persist or cause concern.

Tell your doctor as soon as possible if you experience more serious side effects:

  • Abdominal pain
  • Bloody diarrhea
  • Threw up
  • Hot
  • Shaking chills

Security advice

Avoid sunlight if possible while using Efudex, as this can exacerbate side effects. If you are in the sun, wear a hat and use sunscreen.

Contraindications

Efudex cream should not be used by pregnant women planning pregnancy or breastfeeding, as it may harm the fetus.

It should also not be used if you have a deficiency in the enzyme dihydropyridine dehydrogenase (DPD), as it can lead to serious side effects. DPD is an inherited disorder that affects 3-5 percent of the population and requires a special genetic test for diagnosis.

Also, tell your doctor if you are receiving radiation therapy or have had an unusual or allergic reaction to fluorouracil, chemotherapy , other medications, foods, dyes, or preservatives in the past.

Discussion guide with a skin cancer doctor

Get our printed guide to your next doctor's appointment to help you ask the right questions.

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