Wringing My Hands Over Confusing Instructions

One of my tennis teams was called Mass Confusion because we were based in Massachusetts and we were confused (though we did win a lot). Well, I now have three Massachusetts dermatologists whose instructions contradict each other, leading to Mass Confusion on the dermatology front.

I previously wrote about having two dermatologists for two diseases of the skin; for the purposes of this discussion, I’m adding my Mohs surgeon.

Conflicting information from my docs

For starters, my primary dermatologist said to take 500 milligrams daily of niacinamide, the dosage on the bottle. The Mohs surgeon said to take double that amount. I called my dermatologist’s office to get clarification but did not get a callback. For now, I’m just taking 500.

For seconds, there is mass confusion about my messed up hands. The skin has sun damage from playing tennis, running, and other outdoor activities. Little bumps pop up. Some flakey spots turn out to be squamous cell cancers. Some are actinic keratoses that may or may not turn into cancer. When my hands get wet, some spots turn white and puffy. Some of them are warts, which sounds witch-like and horrible but are really basically viral outbreaks due to being on prednisone for the past 10 years.

How do I use Efudex?

So, in the past, they smoothed over (partially) after a treatment of Efudex – 5-fluorouracil or (5-FU) – also sold under the brand names Carac and Fluoroplex. According to the American Cancer Society, “It is typically applied to the skin once or twice a day for several weeks.¹ Another resource says “Most patients will use the cream for 2-12 weeks, depending on the condition being treated and the response to treatment.”²

The first time I did it, I got some improvement from applying it for several weeks as dermatologist #1 instructed. But my Mohs surgeon said it had to be longer (I forgot by how much) and it had to be under occlusion. This meant they had to be covered in plastic wrap for the cream to sink in. I couldn’t get the wrap to stay on, so I settled for purple exam gloves. They improved.

Treatment, revisited

Over the course of a couple of years, they got bad again. A few months ago, dermatologist #2 said to apply Efudex twice a day for two weeks and to wear gloves for 30 minutes to an hour after applying.

“Don’t they need to be covered all night?” I asked, remembering what the Mohs surgeon said. Derm #2 said I didn’t need to do that. I wasn’t going to argue with her, and it was better for me, so I did it her way. When you sleep in gloves all night, your hands get so sweaty that it was a relief not to have to do it.

"They all do it differently"

After that treatment, I had an appointment with the first dermatologist. She said no, they should be covered all night and I would need to re-treat. When I told the nurse about the conflicting information, she said something along the lines of, “They all do it differently.”

I understood her point but wasn’t happy about having to start over again. I thought maybe the nurse could have been more sympathetic, even though It wasn’t life or death. In any case, I treated AGAIN and they're the smoothest they've been for a while. Who knows, maybe the re-treating was good for me after all.