A woman looks at a tube of topical chemotherapy cream.

Tips for Efudex Users

Efudex, or fluorouracil, has been an important part of my life for the last four years. Efudex, also known as Efudix, is one of several topical medications used by skin cancer patients. This particular cream is a topical chemotherapy applied to the skin in areas where sun damage has occurred. This intense cream works to bring damaged cells to the surface and remove them while preventing the further development of abnormal cells. While using this cream to treat precancerous spots on my face and chest, I have learned a few of the dos and don’ts that dermatologist may or may not think to tell patients when beginning treatment and applying Efudex.

The following tips are based upon my own treatment and, amazingly enough, vary from one treatment to the next.

How to apply Efudex

I apply a small amount of the cream to a tissue and spread a very thin layer across the treatment area and wash my hands immediately afterward. Some use gloves, but I find that the tissue helps absorb any excess I may squeeze from the tube. It only takes a thin layer to do the work.

Upset stomach

Though listed as a less common side effect, I found this to be quite prevalent with each round of treatment. I also discovered that stomach issues are fairly common among other users of this cream.

Tips for upset stomach

  • I ate small meals and snacked on fairly bland items throughout the day when possible.
  • Crackers, toast, and pretzels were my regular choices.
  • I avoided eating anything that normally upsets my stomach to avoid further issues: dairy products and spicy foods.
  • Regular water intake throughout the day helped, as well.

Itching, burning and irritated skin

This is, without a doubt, the hallmark of Efudex. As the damaged skin is treated and precancerous cells surface, the skin can become unbearably painful.

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Tips for skin irriation

  • Tapping instead of scratching helps the itching.
  • I tried to sit in front of a small tabletop fan to soothe the burning sensation.
  • I have read conflicting reports about applying lotions and ointments during treatment to soothe irritation. For me, anything, including water, burns the treated area. I chose to let the Efudex soak in and continue to dry as much as possible and opted not to apply any products other than very mild soap during showers.
  • Whenever possible, I wore tops that allowed my chest to be exposed. Fabric of any kind contributed to the itching and pain.
  • I cut the neck and chest out of old t-shirts to wear around the house and to bed at night. These were particularly handy when the healing phase began.

Throbbing pain

The pain of treating my face and chest increased as the days (up to 4 weeks of treating at a time) passed. Pain varies from a pinching feeling to a constant throbbing sensation.

Tips for pain

  • Alternating acetaminophen and ibuprofen helped with both the pain and inflammation.
  • Cold packs and cool cloths helped to temporarily numb the pain during the worst days.
  • I placed a sheet of plastic wrap between the packs and cloths and my skin, so neither stuck to the irritated skin when removed.

Trouble sleeping

Getting rest of any kind is extremely difficult for me during treatment. There is no way to find a comfortable position, and a solid night’s sleep is almost impossible.

Tips for sleeplessness

  • Accomplish any physically demanding jobs prior to beginning treatment.
  • Rest as much as work and home life allow.
  • Use Benadryl at night to help with the itching as well as the sleeplessness.
  • I tried to wait about an hour after applying Efudex at night before trying to sleep as the irritation is most intense immediately following application and right before time to reapply when the skin has dried out.

Difficulty eating and drinking

Tips on eating during and after treatment of the face

  • Small pieces and bite-sized chunks are important.
  • Dry cereal, pretzel sticks, small crackers-- I tried anything I could fit into my mouth without opening wide and cracking the skin or causing further pain.
  • Freezer pops and frozen sorbets were easy to eat and soothing.
  • Straws for drinking are handy since opening my mouth to drink from a cup became increasingly difficult.

Dealing with the healing phase

Once the skin enters the erosion phase, most patients are advised to stop treating. Only once in the four times I have treated, have I made it to the end of the initially prescribed time period before erosion begins. Erosion occurs when the skin begins to peel away and seeping occurs from beneath the surface of the irritated skin.

Tips for healing phase

  • Wait anywhere from 30 minutes to an hour after washing to apply any lotion or cream. The healing area is raw, tender, and any product will burn and sting excruciatingly.
  • Anything burns when first applied. I have found no product to date that feels soothing when first applied to the healing area. Some swear by Vaseline. I, for one, can’t use it due to an allergy to petroleum-based products. Aquaphor is another product many find highly effective during the healing phase.
  • Vanicream Lite Lotion is my go-to. Once I have stopped all application of Efudex, I apply Vanicream liberally several times a day. I use a travel size container to carry enough with me to reapply while at work or away from home any time my skin begins to feel dry.
  • Wash with water and mild soap in the shower and do not rub the area. Patting to wash and patting to dry is preferred.
  • The ten minutes following a shower or washing are key. The skin tightens and throbs much more so during healing than during treatment as it craves the Efudex. It will tighten significantly after a shower. I had ten minutes when my face felt normal and the skin supple enough from the shower to move freely. I accomplished everything I needed to do in those ten minutes including eating a bite or two and quickly brushing my teeth.
  • Cold packs applied throughout the day help with the continuing itching, burning, and pain.
  • Acetaminophen and ibuprofen can be alternated to help with pain and inflammation.
  • Resist the urge to peel the skin. The skin will begin to erode away, dry, and peel. I wait until showering to gently roll the loose skin off in pieces so as not to make the tender skin bleed.

Managing the Efudex journey

Efudex, though highly unpleasant when sun damage is severe, can be maneuvered. Every user experiences a different mix of symptoms and varying results. Dermatologists and prescribing physicians do not always think to fully prepare patients for the possibilities. If you are prescribed Efudex, do your research. There seems to be more blogs, photo diaries, and forums out there asking questions about side effects than there are suggestions from actual physicians. Treatment with Efudex can seem overwhelming and insurmountable, but it is definitely doable with the right support and tips.

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