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A woman with red splotches on her face stands in a dark classroom

Efudex And The Teacher

Efudex users are as diverse as the side effects produced by this powerful topical chemotherapy. From twenty-somethings to men and women in their sixties, Efudex is being prescribed across the board to those of us with sun damage and histories of basal cell carcinoma, melanoma, and squamous cell carcinoma. No matter the original diagnosis, we all have to find a way to face the world outside our comfort zones at one point or another during the course of treatment.

The Efudex time line

The standard time for treatment lasts from 2 to 4 weeks with the most physically striking effects hitting somewhere around the second week and lasting through the first days of healing. It’s virtually impossible to avoid human contact and the ongoing need to explain the reason our skin looks so incredibly red, raw, and painful. Some of us need to face more than just a handful of people outside the home; some of us have to face children.

Explaining chemotherapy

Explaining topical chemotherapy to children is a daunting task. As an elementary teacher, I have found myself talking in a strange circle as I try to help my third graders grasp that a medicine designed to help my skin is actually making my skin look worse every day–talk about strange looks. Quite honestly, that’s a difficult concept for most of us adults.

The choice to send a letter

Last spring, I was prescribed Efudex for use on my lips and a suspicious spot on my temple. I had four spots requiring treatment and wanted to get them done before the hot, humid Tennessee summer set in. I had treated my chest during school prior to this round but never a highly visible areas like my lips. I decided to clue my students in this time as I knew there might be lots of questions. (If I were a third grader watching my teacher’s lip swell, redden, and begin to scab, I would have questions–lots of them.) I also wanted to allow my students’ parents and guardians the opportunity to ask any questions prior to beginning treatment. Let’s face it, there are plenty of questions surrounding Efudex.

A letter written to the parents of April's students explaining Efudex

Sending it home

I typed up a letter briefly detailing my history, the upcoming treatment, and what their children might describe having seen each day as treatment progressed. It was important to me not to alarm parents, but I certainly wanted them to feel they were in the loop. Prior to sending the note home, I talked with my classes and gave them a little heads-up that I would start to look a little different over the next week and noted that, at first, they would hardly notice a difference.

When I gave my third graders the chance to ask questions, there were plenty fired my way. Most popular: “Does it hurt?” Did I play it down? Not for a minute. If not now, when?

Answering student’s questions

The upcoming process was the perfect opportunity for me to educate my students on sun safety. I explained that the areas would first become itchy and red and that the cream would make me feel bad–headaches are usually the first side effect to show up for me. I also told them that I would soon look like a had some scabs on my face and not to be alarmed. It would be uncomfortable, but they would see them fade away after a few weeks.

Day 1 of Efudex treatment around mouth
Day 13 of Efudex treatment around mouth
Day 15 of Efudex treatment around the mouth
Day 17 of Efudex treatment around mouth

Children understand

While I try to treat with Efudex during the summer when possible, I am not always fortunate enough to wait that long. When I can’t, I now have a system for preparing my students and their parents. The time it takes to have a quick conversation makes all the difference when you have to serve your Efudex time beyond the comfort of your home. If you work with children, you might be surprised by the level of understanding and support you will receive from students and parents alike. I encourage you to jump at the opportunity to advocate for skin checks and sun safe practices.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • kdinva
    12 months ago

    Thank you for sharing this article with the skin cancer community and your students. I think it is admirable and courageous that you share and are open with your students and parents about this. I recently went through Mohs surgery to remove a Basal cell carcinoma (BCC) so I can somewhat relate to your treatment.

  • April Pulliam moderator author
    12 months ago

    @kdinva…thank you so much for your kind words. I hope your recovery has been easy. Mohs can be quite an experience in and of itself.

    I fretted for weeks over how to explain it to my students, and really had no way around doing during the school year. Children really are understanding and ask the best questions. This was the perfect opportunity to teach them some important life lessons, and I wanted that to spread to their parents at the same time.

    Best wishes for continued healing! April,, Moderator

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