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My Journey with Efudex in Photos

Front Range Dermatology Associates provide a list of instructions for applying Efudex and hints for aftercare. In addition, their information sheet briefly mentions a few common symptoms. I am including the link to their instructions as means of comparing their suggestions to my journal of experiences.

Efudex Before


After Efudex: Days 1-7


Efudex Week 1

Day 1 (June 24) No visible reaction. Sensation that something is different. No pain.
Day 2 (June 25) Same as Day 1. Headache. Stomach slightly upset. Fatigued late in the day.
Day 3 (June 26) A little redness around spot on lower left cheek. No pain. No itching. Stomach upset. Fatigued late in the day.
Day 4 (June 27) Discomfort around nose in the crease and over top lip. Chin itchy. Bright red spot beginning to show left side of mouth. Nothing to speak of on nose. Irritation on right side of cheek near nose where I saw a scaly spot.
Day 5 (June 28) More discomfort around creases of nose. Chin itches some. Two prominent bright red spots on sides of mouth and nose. Small red spot showing up on left side of nose. Overall still not inflamed or swollen. Headache and stomach upset.
Day 6 (June 29) Basically same as Day 5. More general redness and beginning to feel tight when cream is cleaned off.
Day 7 (June 30) Stomach upset. Headache late in the evening. General discomfort spreading. Overall redness spreading. Painful to smile or open mouth to chew.

After Efudex: Days 8-14


Efudex Week 2

Day 8 (July 1) Lots of stomach upset. Aware of the discomfort all the time. Itches late in the day. Water feels good in shower but immediately feels dry. Mouth feels dry. Slight metallic taste. Headache woke me early this morning. Nagged all day even with Tylenol.
Day 9 (July 2) Stomach upset. Face tightening.
Day 10 (July 3) Stomach upset worsening. Strong metallic taste. Takes an hour for face to completely dry out after shower. Even then it stings to reapply.
Day 11 (July 4) Skin is very tight. Stomach upset was much better. Still have a metallic taste. Throbs horribly when I wash it off in the morning and after shower. I’m waiting about 30 minutes to reapply in the morning and over an hour after shower. Any sooner would be unbearable.
Day 12 (July 5) Face tight all day. Getting much harder to open mouth to eat. No cracking yet. No stomach upset.
Day 13 (July 6) Can’t open my mouth much wider than to slide in my toothbrush. Had a headache most of the day.  Feels like it might be seeping a little after it’s washed. Skin becomes soft enough in the shower to open my mouth wide as I want but hardens almost immediately after it’s dry. Stopped by doc and nurse looked at me. Says reaction is a good one and to try a couple more days at least.
Day 14 (July 7) Pretty much the same as Day 13 with more tightening.

After Efudex: Days 15-21


Efudex Week 3

Day 15 (July 8) Very little sleep even with Tylenol PM or Benadryl. Itched and burned a lot through the night. Couldn’t find a comfortable position even on my back. I can’t tell, but it feels like my face is beginning to sleep at night. I don’t see evidence on pillow and I’m not able to wipe away any wetness but face feels cool as if it’s wet in places. Extremely tight late in the day and several spots in nose crease and around chin are beginning to flake. Went to bed with worst headache yet.
Day 16 (July 9) Woke several times during the night. Got about 2 hours of sleep. Headache returned in the morning. I think I’m done. Bled in the shower a little. Very seepy after shower and after night application. Cracked and super dry. So tight I can barely open my mouth. Will wash in the morning and start recovery.
Day 17 (July 10) Day 1 post-application: Washed off night application. Waited two hours before using Vanicream. Stung horribly with first application of Vanicream. Headache persisted overnight and through morning. Lots of tightening throughout the day. Vanicream helps. Peeling begins.
Day 18 (July 11) Day 2 post-application: Woke with terrible headache. Slept better but had to take pain meds to do it. Woke at 3:30 to reapply Vanicream. Went right back to sleep. Very tight. Larger areas are beginning to lift but too stiff to peel and will bleed if pulled. 10 minutes after shower skin pulls incredibly tight. Took about two hours after shower to stop stinging. First application of Vanicream two hours after shower stings. Later in the night applying doesn’t hurt.  A few ulcers forming inside my cheeks. Had trouble falling asleep. Got up twice to apply Vanicream.
Day 19 (July 12) Day 3 post-application: Very tight again all day. Most uncomfortable day post app so far. Large sections coming loose but still attached in places. Vanicream lotion helps a lot. I wasn’t able to apply constantly all day because I was out for a few hours. The longer I was out and went without Vanicream, the more painful and dry I was. This seemed to make bigger chunks form though. Late in the evening I was able to work several large pieces loose and get them off by rolling and twisting. (If they are left too long they do begin to smell bad.) Shower felt good and I could move freely but tightening started about 10 minutes afterward. Some seeping still happening. Bleeding in a few small spots.
Day 20 (July 13) Day 4 post-application: Very hard day. I expected to be almost done peeling. For every spot that has peeled, more seeping has happened. Swelling in my cheeks, around mouth, and across chin. Tight after ice packs are applied and so tight after shower it feels like I’ll split open and bleed.  Long after shower still tight and throbbing. Stinging.  Feels wet and looks dry and is dry to the touch from seeping having crusted over. Was extremely fatigued through the day. Didn’t sleep soundly last night. Could feel seeping from chin. Used hydrocortisone instead of Vanicream and it also burned. Finally stopped after about 10 minutes. Seeping was somewhat less overnight. Slept hard in one position with pain med.
Day 21 (July 14) Day 5 post-application: Somewhat easier than yesterday. Washed after getting up and used hydrocortisone. Washed early afternoon and tried Vanicream. Both absorb very quickly.  Swelling in the afternoon and evening. So much stinging after shower I took pain pill early. Nose is almost completely peeled and smooth. Parts of cheeks are smooth. Both sides of nose and all of chin keep seeping and recrusting. Very frustrating. Chin is now tightest part making it hard to eat and talk.

After Efudex: Days 22-28


Efudex Week 4

Day 22 (July 15) Day 6 post-application: Chin is still scabbed and very tight. The longer the day went on the more swelling I felt. Eating is still hard. Several spots cracked and bled. Stiffened after shower and stung horribly. I used Vanicream on left side of face and chin and hydrocortisone on the right side before bed. Vanicream stung much less. Hard to fall asleep. Woke a few times through the night.
Day 23 (July 16) Day 7 post-application: Chin is crusted. The spot I first noticed before derm visit on left cheek is tender and still scabbed. Small red spot right side of nose on cheek before derm is also scabbed. Nose is fairly clear.  Corners are almost clear.  This was first morning Vanicream didn’t burn with first application. Rolled off a few pieces in shower. Stung after shower. Vanicream after shower stung as well. Noticed today I have a half dozen red spots that have appeared on my chest. They don’t itch.  I’m just over it.
Day 24 (July 17) Day 8 post-application: Felt much better. Stiff cheeks and a little peeling beside nose and in the two trouble spots. Chin peeling quite a bit. The only pain is on chin. Able to eat larger bites of food.
Day 25 (July 18) Day 9 post-application: Ate normally. Slept well with Tylenol PM last night. No stinging this morning. A little stiff across cheeks and very center of chin under lip hurts if I stretch it. Got a lot rolled off chin in shower. Just a tad stiff after shower. Only spot that hurts at all is dead center of chin directly under my lip. Hard scab there.
Day 26 (July 19) Day 10 post-application: Scab under chin is smaller. Red area has faded and is a little smaller. No sleep meds. Eating normally with no pain.
Day 27 (July 20) Day 11 post-application: Scab almost gone.  The only sensation I have now is a little twinge when I stretch my mouth wide enough to yawn. Redness is fading.
Day 28 (July 21) Day 12 post-application: Sleeping normally. A little lingering headache. Redness is still fading. Last of the scab is gone.

After Efudex: Days 29-35


Efudex Week 5

Day 29 (July 22) Day 13 post-application: Tried sunscreen on red area. Was terrified it would burn. Haven’t had anything but Vanicream on it since post app. Used Blue Lizard spf 30 for sensitive skin. Didn’t burn at all. Feel completely normal. Slight headache early in the morning. Redness is fading. Indoor lighting makes it barely noticeable. In natural light, it’s still visible.
Day 30 (July 23) Day 14 post-application: First day of vacation. Used Blue Lizard spf 30. No burning/stinging. Treated area grew bright red outdoors in the heat. Stayed under hat and reapplied sunscreen several times through the day.
Day 31 (July 24) Day 15 post-application: Red area is still very defined. Used Blue Lizard spf 30. Umbrella. Bright red in heat.  Headache.
Day 32 (July 25) Day 16 post-application: Same as day 31
Day 33 (July 26) Day 17 post-application: Bright red in heat. No stinging, just red and very well-defined.
Day 34 (July 27) Day 18 post-application: More fading. Pretty much the same as day 33. No headache today. Drank lots of water all day.
Day 35 (July 28) Day 19 post-application: Heading home from Florida. Used Blue Lizard spf 30. Less red today.

After Efudex: Days 36-43


Efudex Week 6

Day 36 (July 29) Day 20 post-application: Home. Using Vanicream to help the dryness of new skin. Feels a little tight after washing. Still fading.
Day 37 (July 30) Day 21 post-application: About the same as day 36
Day 38 (July 31) Day 22 post-application: No significant change from day 37
Day 39 (August 1) Day 23 post-application: Redness continues to fade
Day 40 (August 2) Day 24 post-application: Similar to Day 39
Day 41 (August 3) Day 25 post-application: Similar to Day 40, more fading. Makeup covers easily. I do see a lightly defined red area without makeup.
Day 42 (August 4) Day 26 post-application: Still notice a defined red area under makeup and in the heat.
Day 43 (August 5) Day 27 post-application: Feel like I’m ready to go back to school Monday without the redness being too noticeable.


Using Efudex cannot be succinctly described, and no one can predict the results each subsequent treatment will produce. One Efudex user chronicled his experience and documented his results in photographs. He, unlike many others with whom I have talked, was duly warned by his doctor that the results during treatment could be quite horrendous. I have found that large numbers of Efudex patients are provided with little or no warning regarding the worst-case scenarios during and immediately following treatment. In fact, it seems quite common for dermatologists to compare effects to a “bad sunburn.”

My history of sun damage will lead me to remain vigilant with sunscreen use, sun safety, and regular self-checks of my skin. In my preteen years, I set the stage for a long string of events that will hopefully now prevent others from following my lead. Every difficult morning and each sleepless night spent using Efudex is worth the end result. Each time I have treated, my dermatologist has been pleased with the outcome. Areas of concern have been eliminated with new, healthy skin taking their place. Granted, skin cancer is a never-ending journey. New spots will continue to appear, Efudex will likely be prescribed, and I will repeat the process.

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.


  • Myhoney
    3 months ago

    Hi April,
    Thank you for an informative piece on this treatment. I have recurring basal cel for the past 15 years. Many surgeries and I keloid. I tried Imiquimod and had a reaction (extreme fatigue, mental fogginess) so we stopped that. I was given Efudex. I tried it for less than two weeks on my shoulder. I was again exhausted, ambivalent yet weepy, and again in a mental fog. I just came from the doctor. He insists that Efudex doesn’t cause that type of reaction and wants me to try it again. Did the fatigue wear off after a few days for you? Do I just push through it? I really don’t want to because I just wasn’t myself but if it’s short term I suppose it’s better than surgery (?). Although with all my scarring what’s a few more? If I knew he fatigue/fog was only short term, I’d do it. But I can’t imagine living like that for a few weeks.

  • April Pulliam moderator author
    3 months ago

    @myhoney…I wish I could tell you without a doubt that the fatigue many experience is short-lived, but there is no normal with Efudex. It seems we all experience varying side effects and varying degrees of each.

    I struggle with fatigue for the better part of treatment. It does seem to be much worse in the first few days. There are other side effects that seem to take priority as the weeks go on. That might be the reason I don’t notice the fatigue as much.

    I am so sorry you are struggling with all of this. I know it’s a mental strain and much harder when your doctor doesn’t give you a heads up about possible side effects.

    I can tell you this, though. You are not alone and don’t have to go through this treatment by yourself. There are many out there finding themselves asking the same questions as you and wondering if it will ever end. We are here for you any time you want to know what to expect or any time you wonder if what you are feeling is typical for Efudex users.

    I am including some links to other articles on Efudex you might find useful.

    Here is a link to the Facebook group I recommend beyond all others. It has been a real lifesaver over the years as I have treated with Efudex. There are many members who are active daily and give fabulous advice to the group. You can find people in all stages of treatment. It’s a private group and the best support you will find on Facebook.

    I am keeping you in my thoughts–I know how hard it is. Pleae keep us posted on your progress. April,, Moderator

  • Moonmomma
    8 months ago

    Oh my goodness I had no idea how awful your experience was. I personally feel sometimes doctors “overlook” or glaze over what it’s really like. I think they do this either because they deal with it so often it’s “normal” to them or they don’t want to freak you out. I was having pain mid thigh (below where I had lymph nodes removed) and was freaked out by it. My surgeon told me she put small metal clips on the vessels when they removed the lymph nodes and they could be hitting a nerve or it could be scar tissue. I was a little thrown. I said, “How come you didn’t tell me this right away?” She said everyone’s experiences are different and it didn’t even occur to her to say anything because they do that all the time when they remove lymph nodes. I know this is getting long (I apologize), but given your experience would you use the Efudex again? I was also wondering what brought about your doctor wanting to do this treatment? Did you have a lot of spots to “get rid of”? I am curious why do this cream versus other treatments? It seems so painful. I am so sorry for all you’ve gone through. Hang in there. You are beautiful and strong.

  • April Pulliam moderator author
    8 months ago

    @moonmomma….I don’t know what some doctors are thinking. It really seems like they would want to keep us updated on all the decisions they make as they make them. I’m so sorry you have had to deal with this and even more sorry you weren’t told up front!

    I have used Efudex yearly since 2014. The first time was an eye-opener for sure. I had no clue what to expect and was floored. I was told it would feel like a bad sunburn–not even close.

    My doctor suggested Efudex a few times prior to going ahead and prescribing. I battled with precancerous spots for years. Each visit, I was having several spots frozen off. She finally suggested that this cream could take care of a large area at once. I was glad to try it. Even though it’s tough, it really does do the trick. I have treated my face and my chest and do spot treatments when necessary. I’ll continue to use it when needed. I prefer it to having more and more scars– especially around my mouth.

    Thank you for your kind words and I hope you are doing well now!

    April,, Moderator

  • Paige Tucker
    12 months ago

    April, thank you so much for sharing. My doctor has prescribed this cream for me to use for 5-6 days, but I have to admit I’m freaking out about it. I teach school, and do NOT want to go to work (or in public) looking like a burn victim. I know it sounds vain, but it’s just me being honest. I’m 57, red-headed, fair-skinned, and grew up sunbathing without sunscreen…I think you get the picture. What do you recommend, based on personal experience? Thanks for sharing your personal journey. God bless.

  • April Pulliam moderator author
    12 months ago

    @paige-tucker…I think we are the same person! I’m also a teacher and have fair skin and reddish hair. I’m actually surprised the prescribed time is only 5-6 days. If I had to guess, I’d say your damage must be very mild or the time would be much longer. Most of us are told to use for at least 2-3 weeks.

    Which area are you treating? I’ve treated my lips during school and am about to spot treat a spot below my lip before school is out for spring break. I typed up a letter explaining things to my parents so everyone would be prepared for the effects. It didn’t make it less uncomfortable, but it certainly helped the kids understand somewhat.

    If you are still feeling unsure, talk to your doctor and see if waiting until summer is a viable option for you. I know it’s a hard decision. Thinking of you! April,, Moderator

  • April Pulliam moderator author
    1 year ago

    @ronnigordon…It sounds a little silly coming from a 44 year-old, but all I can hear is my mom telling me as a kid to stop picking because it will leave a scar. My sister and I were bad about picking at mosquito bites. Those words have stuck with me all these years, and I hear them every time I’m covered with healing scabs from Efudex.

    I agree with you. You really may need to step up the moisturizing. Vanicream really helps my skin stay soft, and it helps work those loose flecks off much faster than if I let my skin stay dry and irritated.

    Let my mom’s words be your guide too! Best wishes for fast healing. April,, Moderator

  • Ronni Gordon moderator
    1 year ago

    Noticed your link to this piece when I was posting my own Efudex story. Still not sure how to have the self discipline to keep from picking at the scabs. I think I sort of do it unconsciously by “playing” with a little guy which before I know it is half off, and then I have to finish the process! Never to happy about it afterwards unless they are TOTALLY ripe for and ready to come off. I think maybe I need to use more Vaseline.

  • David
    1 year ago

    April, thanks for sharing your efudex experience. I’m currently in day 17 of a 21 day application now and have used your post to track my progress as well as set my expectations on what is to come. Like you, my biggest pain point thus far has been my chin.

    I have done levulan (blue light therapy) annually over the past 11 years with diminishing effects over that time. After my long-time dermatologist retired a few years ago, my new dr suggested efudex. I googled it and saw photos of others experiences and kept putting the treatment off. Maybe next year…we’ll see. After my 6th mohs surgery on my face and head in the last 18 months, I finally gave in to my dermatologist’s recommendation. By comparison the efudex is much more intense than the light therapy ever was and from your post, the road to “normal” skin again for me is still quite a ways away. I can’t say that I’m looking forward to future efudex treatments but I realize it’s probably part of my future treatment plans. I had my first basal cell surgery at 24 and in the 28 years since, I’ve had more than 50 surgeries. It’s probably time to take a different approach.

  • April Pulliam moderator author
    1 year ago

    @david…I’m blown away by “more than 50 surgeries!” You’ve definitely been through the worst of the worst. I’m so sorry.

    Isn’t it amazing how such small movements can be so painful around the mouth and chin? It’s so difficult to explain in words to anyone who hasn’t experienced it.

    Blue light therapy has been on my doctor’s list of treatments for me for a while, but we have yet to try it. Efudex seems to be doing the trick. I’m glad you’re giving it a try and hope you get fantastic results. I will say that each year since my second year I have noticed fewer spots on my chest. I have overall sun damage, but my AKs seem to be becoming fewer and farther between. I’m glad you mentioned that Efudex is more intense than blue light. That’s helpful to know for members who are debating trying one or the other. Like you, I realize it’s a never-ending cycle.

    Wishing you the best as you head into healing! Keep us posted on your results. April,, Moderator

  • April Pulliam moderator author
    1 year ago

    @david…here’s a piece I did on Efudex and both stages–during and after. The section on healing may come in handy in the next few weeks as you heal.

    If you are are on Facebook, there is a fabulous support group for users of Efudex. You can find it by searching “fluorouracil aka Efudex” and ask to join. It has been a wonderful source of information and tips. April,, Moderator

  • donny
    1 year ago

    hi. great post April, so much valuable information. It is true, when given the script for efudex, there is no true explanation what to expect during the weeks of treatment. This my second time, now at day 16, my face & forehead is harsh, pain, redness, blisters, scab over, some starting to peel. I would like to post a couple pics. thanks again for putting yourself out there. cheers

  • April Pulliam moderator author
    1 year ago

    @donny…Thanks so much! You’re becoming a pro at it yourself it seems! It looks like you have had a great reaction this time. As hard as it is to endure, it’s worth it in the end. You’re so right about our doctors. They really don’t seem to know exactly what to tell us as far as expectations. It’s quite a sticky situation when you head into things blind. I’m glad you are nearing the end of this round. Keep us posted on your progress! We are glad you are a part of our community! April,, Moderator

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