Actinic Keratoses and Efudix
I just had an appointment with a dermatologist after my GP referred me (UK, NHS)
due to a freckle on my back that got larger and darker.
Luckily it turned out to be normal. (Yay!)
When I mentioned a rough patch on my nose, the dermatologist said it was actinic keratosis and prescribed Efudix cream.
I'm now feeling a bit confused because as he dictated his notes he said "Actinic patches on nose and left cheek."
I have a spot just on the very edge of my cheek next to my nose but I also have my big freckley splodges on my cheekbone too. (Well, very pale skin and freckler...I have brown splodges all over the place!)
The label just says "apply to the affected area(s)"
I don't know if that means exactly where I feel the roughness or the whole of my nose? Or how much of my nose/cheek I need to apply it to.
I've been trying to read up online about Fluorouracil cream and have seen conflicting info. Some says it will make normal/healthy skin go red. Some says it doesn't affect or harm normal skin.
I was trying to find out if it would be okay to apply it to the general area to make sure any AK gets covered, without potentially damaging healthy skin?
Have others had similar vague instructions?
I'm not sure what to do. I don't know if I phoned the dermatology clinic if the doctor would even remember what exact area it was, given how many patients they probably see each week.
I wish I'd asked him to draw a picture! But I have attention and memory problems and at the time it just didn't enter my thoughts.
I'm also a little unsettled because he hadn't noticed it and I randomly mentioned it as he was typing up notes after the examination. (Makes me wonder if there are other AKs that he didn't notice - I assume he was only looking for melanomas etc when he examined me)
Also a quick question: the leaflet says to only wash the area with plain water. But he also told me to use factor 50 sunscreen.
I can't get factor 50 sunscreen off my skin with just water. What do people do?
Sorry to ramble - I just want to do this properly first-time around so I don't have problems later down the line.
Tilly
...I am so sorry you got such mixed messages from your appointment--you are certainly not alone. Many patients report the same experience, sadly.
You bring up some really great questions about application and cleaning the skin.
Since the instructions stated to apply to affected areas, I think I would apply to just the rough patches you mentioned. Many people spot treat pinpointed areas instead of applying to the entire face. It only takes a very thin layer to get the job done. Keep in mind that the more you apply and the larger the area you apply it to, the stronger the reaction you may get. The general consensus is that the cream will only create a reaction in damaged skin, but many of us have pretty strong reactions across the entire area in which the cream is applied. It's important to note that we are all different, and no two patients seem to have identical experiences.
As far as washing with plain water goes, that is correct. My dermatologist suggests the same thing. I have been told that I should only clean with water and not use soaps, lotions, or moisturizers on the treated area as long as I am applying. That includes sunscreen. If you choose to spot treat those smaller areas and not apply the cream to your entire face, you could still use sunscreen on the rest of your face. I have always been told not to apply products during treatment as they may impact the effectiveness of the cream. Avoiding the sun as much as possible during treatment or at least keeping covered a little more than usual will help cut down on sun exposure during treatment.
I am including a few articles you may find useful as you begin treatment.
https://skincancer.net/life-with-skin-cancer/tips-for-efudex-users
https://skincancer.net/life-with-skin-cancer/efudex-side-effects
This one addresses spot-treating:
https://skincancer.net/life-with-skin-cancer/spot-treatments-efudex
I am wishing you the best as you move forward. Please know we are here for you!
April, SkinCancer.net, Moderator
Thank you April!
Apologies for the delay in replying.
Yes, I'm sticking with just gently wiping my skin there with soft bamboo "eco fake cotton-wool pads" and water.
Today I received a copy of the letter the consultant sent to my GP. Made me smile (wryly) ... just says "nose and cheek" and nothing more specific. Given that I have big sun spots and some red patches on both cheeks.
Indeed I didn't/don't want to cover my whole face. But given the uncertainty about where exactly I am meant to put it and the general thin and very pale skin (several times sun-burned) I've decided to do a sort of band across my nose and tops of my cheeks...the areas that catch the sun quickest/most in the summer.
It's been a week and I haven't really seen any reaction at all, but today the small patch on the side of the nose is getting a bit 'angry' and there's a smaller similar spot just below it now. It's found a friend.
At least it's winter, and Covid means face-masks when we go out 😉..."Angry" is such a great way to describe the feeling. It sounds like you have a good plan in place to treat the areas most exposed to the sun. The creases around the nose can become especially uncomfortable--be ready for that.
You hang in there! It may become much more uncomfortable before you are done. You are certainly not alone--we are here for you!
April, SkinCancer.net, Moderator
Thanks again April.
I've started getting more spots showing up. I don't know if they are just pimples from the cream blocking some pores, or other AKs that weren't visible. I'm certainly not getting general red skin. I'm on day 20 (and new red spots still popping up)
...When I treat with Efudex, I usually stop seeing new spots in the last week. That's when things begin to scab over and become very uncomfortable. If you are not seeing scabbing (the erosion stage) yet and continue to see new spots appearing, your doctor may have you continue past the prescribed time. It would be worth checking in with him if possible to see if he thinks you have treated long enough. We are all so different--it's difficult to say how quickly you will react. I hope you have any easy treatment overall and your side effects are minimal.
I am including a couple of articles on erosion that may come in handy as you progress.
https://skincancer.net/life-with-skin-cancer/efudex-cream-how-long
https://skincancer.net/life-with-skin-cancer/efudex-erosion-stage
I am sending you lots of positive vibes! We are here for you!
April, SkinCancer.net, Moderator
