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 a dermatologist may or may not think to tell patients when beginning treatment with Efudex.

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

Efudex application

I apply a small amount of the cream to a tissue and spread a very thin layer across the treatment area and washed my hands immediately afterward. Some use gloves, but I find the tissue helps absorb any excess I may squeeze from the tube. It only takes 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 through the day when possible.
  • Crackers, toast, and pretzels were my regular choices.
  • I also 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.

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 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 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 as 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.

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 seem 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.

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

Comments

View Comments (46)
  • KevinVT2000
    3 days ago

    Thanks, April, for an insightful blog. Helped me be prepared for what might happen. The dermatologist doesn’t always prepare you for what might happen. As you said, everyone reacts differently and I am sorry your experience was so painful. You definitely seemed to experience most of the adverse side effects.

    I began a 2 week treatment on my face (except forehead, chin/mouth) on 1/1 where I was instructed to apply Efudix twice a day. For folks who are curious why nothing presents itself after a few days, this is common. I applied the cream similar to how April describes…..using enough to coat the area but rubbing it in so no white still showed when done. It takes a minute or two to do this so don’t be alarmed that it does not immediately absorb.

    I have sensitive, fair skin and expected mayhem right away. Not so. I had no discernable side effects during treatment except dry/burning sensation when cream was not on my face (which only was for a short period after AM shower and after washing face in PM before next treatment). I did not use anything on my face (e.g., moisturizer) while cream was on it.

    After 1 week, I only had a few red marks in certain areas with no discomfort. I, too, wondered if the medicine would do its trick. By day 10, things went into overdrive. I experienced some stinging/weeping in some spots after applying cream. Areas that were red and my sores began to converge and by day 12 my face looked like a lawnmower ran over it. However, my face generally felt fine with Efudix on it, as it seemed to act as a soothing agent. At this point, I also noticed I was not seeing new sores/splitting develop as most of my sores began scabbing over.

    Today was day 15 and I saw the dermatologist. She said my skin reacted very well and I could stop treatment. I am now using Aquafor twice a day and so far, no real discomfort or itching.

    Hope this helps others who are about to go through this. I feel lucky in that I had the reaction I was supposed to with minimal discomfort. The biggest issue for me, and I would suspect most of us, is self-confidence being in public. I got more than a few stares in the last few days. I would strongly advise, if you have the option, to discuss working remotely for a period of time. It’s hard to predict when you would need to do that. I just told my leadership that I might be out of pocket for a couple of weeks in January. I worked in the office until 1/11 but my appearance was becoming unsightly and I decided to work from home through this week. My dermatologist says with the Aquafor, I should be able to return on Monday. Best of luck to everyone who goes through this treatment and thanks, April, again for posting about your experience.

  • April Pulliam moderator author
    3 days ago

    @kevinvt2000…I’m so glad my article helped you. It sounds like you hit the motherlode mid-treatment. I see so many fellow users who become discouraged and think the cream is ineffective in those first few days. No one can tell us when to expect the harshest side effects or if we will experience them at all. Efudex is truly a conundrum–even to some doctors it seems. I’m glad you were able to work from home in the worst days. That has to be a huge relief. Facing the public is a true test of your will. Wishing you all the best! April, Skincancer.net, Moderator

  • ShelliAS
    6 days ago

    I used Aldara years ago for a SCC on my face, and I had to stop after three weeks. My face had turned to raw hamburger, constantly weeping, oozing, etc. My jaw bone throbbed constantly. I did have to cover it with bandaids off and on as I deal extensively with other people throughout the day and needed to be considerate. But I digress a bit. I am now on Efudex again for a SCC on my face, and I need some information. I currently do not have a source to ask about my concern. I may have someone in a few weeks, but I need some information now. When I opened the tube of Efudex, about 25% of it shot out of the tube. I live at a high elevation and that sometimes happens with liquids/semi-liquids. Anyway, I was concerned about the loss of so much product, and I scooped it up and placed it onto a sealed ziplock bag. (And yes, I cleaned my bathroom counter and everything else the cream got on. I know it is toxic.) That is what I have been using for the treatment of the two areas on my face with the SCCs. As of day 9, there has been zero reaction with the affected areas of my face. I have applied the thin coating, in a concentric pattern over the impacted areas, as directed. With the Aldara, I reacted in less than a week. The Efudex is new to me, so I do not know if this is normal. I have not taken many chemistry classes. Could the fact that I am using the “squirted out” cream that is in the sealed ziplock be a factor? I didn’t want to waste it. There is no oxygen access into the ziplock to degrade the Efudex, but I am just wondering. Might anyone know? or might anyone have a good reference to an article about how Effudex reacts with O2? Thank you,

    Shelli

  • April Pulliam moderator author
    6 days ago

    @shellias…I don’t know that I can help with your questions about altitude, but I can tell you about my experience with an old tube of Efudex. I treated one fall and had about half a tube left. I was really apprehensive about trying to use it a year later after it had been opened and used several times. Like you, I didn’t want to waste time or money. After about a week, I was sure I had been right. I was hardly reacting at all. My chest was barely pink, and it was itching but not to the extent it had by that point the last time I treated. After a few more days, I saw I had been wrong. My skin began to flare up, redden, and the burning set in.

    If I were you, I’d definitely give it a little more time. A thin layer applied twice a day always yields results for me. There are many different reaction times across the thousands of users, though. I have seen people react immediately and some who don’t react until well into the second week.

    Hang in there! Keep us posted on your progress. If you don’t react, definitely call your doctor for advice. April, Skincancer.net, Moderator

  • GloryB
    6 days ago

    I have just started my once-a-day treatments and these tips have been wonderful as part of my research. But I have a question not addressed elsewhere. I understand the cream to be applied in a thin layer. (I’ve chosen to do my entire face.) When I apply a small amount of cream using my finger, it appears white and I rub it in until it disappears; then I continue to the next area. Is that considered the ‘thin layer’? Should it stay white after application or am I correct in rubbing in the cream? I do not want to put on too much. Since I’m only on day 3 I haven’t seen any results yet and want to make I’m getting the basic application correct. Greatly appreciate the article and all the comments.

  • April Pulliam moderator author
    6 days ago

    @gloryb…It sounds like you are applying it exactly the way I do it. I feel like “thin layer” means a layer that covers completely (slightly greasy) but absorbs into the skin fairly quickly. The whiteness you mentioned is very common for me when I apply. If you are on day 3 and not showing results, don’t give up. Results vary from person to person with some people not showing any major signs until the second week. I always notice a slight tingling sensation after the first application and get red really quickly, but that isn’t typical for every user. When applying to your face, be careful to avoid the tender skin under your eyes, and be aware that the creases of the nose can become very painful as time goes by. Keeping you in my thoughts. Keep us posted on your progress and hoping you get some great results! April, Skincancer.net, Moderator

  • GloryB
    4 days ago

    April, I greatly appreciate your reply, information and concern. It’s great to have a source of experiences by real-world users. I’ve read many stories by twice daily users. My doctor insisted on my once-a-day/4-week treatment and I was wondering if there is any indication that the side effects would be less with daily application. Any insight is greatly appreciated. Susan

  • Achala
    2 weeks ago

    Have you tried Bio Oil after treatment is finished? It is excellent for scar reduction and doesn’t irritate. Also coconut oil is very good for the skin and has anti cancer properties. My specialist says during treatment the only cream she allows is paw paw cream. I used it when very crusty to soften things but it’s heavy and greasy so I think you need to wash with soap and water to apply next treatment… Not sure if it would act as a barrier otherwise. I found ice very helpful during treatment.

  • banksofthebann
    2 weeks ago

    Bio Oil is a wonderful product. A top plastic surgeon made it part of his post surgical treatment daily protocol after he removed some basal cells from the corner of my one eye, and from my opposite temple region. While it can be expensive, a small bottle has hundreds of applications.

  • April Pulliam moderator author
    2 weeks ago

    @achala…I haven’t heard of using paw paw cream. It’s always interesting to hear what various doctors recommend. I agree that coconut oil is wonderful for the skin. Anything that helps with dryness is such a relief in those days of healing. Thanks for sharing what has worked for you! April, Skincancer.net, Moderator

  • banksofthebann
    4 weeks ago

    From a previous treatment experience confined to my entire forehead, I followed post-app with applyingpure aloe Vera gel 2-3 times a day to the inflamed area. After a week, all the dead skin had sloughed off, and the open lesions had completely healed.

  • Nina M moderator
    3 weeks ago

    @banksofthebann, thank you for your additions for dealing with the beard when doing Efudex! And aloe is a good tip as well. Hopefully April’s articles can be a reminder that others have been through it, and that it will come to an end eventually. I believe you might be done by now – wishing you well with recovery! – Nina, SkinCancer.net Team

  • banksofthebann
    4 weeks ago

    This is a very complete review. I would add two points from my experience. As a man with an actively growing beard, I was surprised that the antimetobolite action had not slowed or stopped the beard growth. I shaved with an electric rasor from the start. Once there were scabs forming in the creases around the mouth, the beard stubble could not be reached while it continued to grow. These areas became extremely itchy to the point of interrupting sleep. Eventually, I started applying anti-itch cream. This helped. I next started taking an antihistamine at bedtime. After a few days, I lathered my beard with shaving gel then scraped off the scabs and remaining stubble with a safety radar. While this process was slightly painful, the relief that followed was well worth it. I had to apply ice-packs for about half an hour after. The localised itch never returned. I am now at Day 18 of a 21-day application. Finding your blog today was comforting.

  • April Pulliam moderator author
    3 weeks ago

    @banksofthebann…I am so glad you ran across the tips! I have seen several men complain about the extreme discomfort when dealing with hair growth. The itching is practically impossible to deal with. I totally agree with the use of antihistamines. They were a lifesaver for me when trying to get some rest. Wishing you the best as you continue to heal! April, Skincancer.net, Moderator

  • lauraspec
    2 months ago

    It was only broken out around my nose (either side) and my lips (corners especially). Since I stopped treatment, it has now spread to my cheeks and traveling down my chin. I have looked up the two cream products you have suggested but apparently Canada does not sell them.
    Help…:)

  • April Pulliam moderator author
    2 months ago

    Oh no! I’m so sorry you haven’t been able to find them. Try searching online. Many times EBay has them for a pretty fair price and free shipping.

    The first 3-5 days following treatment are the worst part of the process. You’ll feel tightening, see peeling, and feel lots of itching and burning. Those are very typical after effects. Don’t be alarmed if you feel worse than you did during treatment.

    If you feel like the redness is increasing and spreading, contact you doctor’s office. It’s possible you’ll see the cream continue to take effect for a while, but the red area should soon begin to shrink.

    Try to keep it moisturized and cool. Cool rags and ice packs will help to numb the area and get you some relief.

    Vaseline is a go-to for many patients. I don’t have luck with it, but it serves many well.

    Keep us posted and don’t hesitate to contact your doctor! Sending you hugs for fast healing!

  • lauraspec
    2 months ago

    Hello April,
    Thank you so much for your comments, I thought I was going crazy…my question is, I stopped a 14 day treatment in 12 days on my face. That was 4 days ago and my face is getting worse and the reaction is spreading daily. Is this normal? if so, how long will this continue before it starts healing?

  • April Pulliam moderator author
    3 weeks ago

    @lauraspec… Just checking in to see how you are doing since stopping treatment. I hope all is well and you are healing nicely. Keep in mind that the redness may last several months. Wishing you all the best in the new year! April, Skincancer.net, Moderator

  • Daisy
    3 months ago

    I am in the second week of using Efudex on my right arm for twice a day, and while I have numerous scabs some of which are oozing, my wrist is still looking horrible. Should I continue using Efudex on this area only? Would appreciate any help, thanks.

  • April Pulliam moderator author
    3 months ago

    Hi Daisy,
    It sounds like you reached the erosion stage fairly quickly. If I were you, I’d contact my doctor’s office and talk with a nurse. Sometimes they can tell you a bit more about when the cream has done it’s job.

    Generally, oozing means you’ve reached the end. Some areas may be affected faster than others. It’s quite possible they will have you discontinue use on the scabbed areas and continue with the rest until you reach a similar point there.

    It’s always best to touch base with the doctor’s office with any questions, especially at the end of treatment.

    Wishing you all the best as you heal! That can be the toughest part. Stay strong! Let us know what you find out. April, Skincancer.net, Moderator

  • Joanie
    4 months ago

    I am on day 6 of my first treatment on my entire face. I’m starting to get tightening, stinging, & many spots are coming to the surface. How soon after applying Efudex can I put on sunscreen or an additional moisturizer?

  • April Pulliam moderator author
    4 months ago

    Hi Joanie,
    Welcome to the world of Efudex. It’s quite a journey! I don’t use anything on my skin during treatment besides a mild cleanser and the cream itself. I was advised to avoid using any products on the area being treated until the course of treatment is finished. However, I am learning that that advise seems to vary by doctor. Some people I have talked to use sunscreen during treatment, and others use mild lotions or Vaseline to help with tightness and itching. Most people who use these products wait several hours before applying anything to allows the cream to fully absorb. I would talk to my doctor or nurse and see what they suggest before applying any products during treatment. I generally use Efudex twice daily for 3-4 weeks and apply after washing my face in the morning and before bed. Some patients prefer to wash the cream off after a couple hours; I’m not one of those people. (I am always afraid that might prolong treatment.) Benadryl and Tylenol help with the itching and pain. Keep us posted on what your doctor tells you and how you are progressing. I am sending you lots of positive vibes for an easy experience. We are here for you! April, Skincancer.net, Moderator

  • Joanie
    4 months ago

    Thank you!

  • Minnymoo
    5 months ago

    Oops you can tell I am a newbie!

    I am day 5 into my Efudix treatment for Bowen’s disease. I am treating my legs, wrist and whole of chest area. I am to apply the cream once a day for 6 weeks. As yet I have had none of the skin reactions but my skin was in a mess itching and burning before the treatment! It took 18 months to get a diagnosis.

    I tried the cream at first during the day but felt sick and had a headache all day so decided to try it at night. I was wondering can it cause insomnia? Like I said I am not at the part where I am being kept away with itching and pain, I just feel wide awake on it. Has anyone else had this? It could be that I am just worrying about everything.
    Thank you once again
    Minnymoo

  • April Pulliam moderator author
    3 weeks ago

    @minnymoo…I hope you have had enough time to heal completely and got great results. I apologize for not seeing your comments and responding sooner to your questions. Let me say that you are certainly not losing your mind and the worrying is completely normal. It sounds like you experienced very typical reactions to the cream. It always amazes me how quickly the headaches come and how quickly I struggle with sleep. We all seem to have very different reactions to the cream, but your symptoms mirror mine exactly.

    Keep us updated on your progress. Wishing you a happy new year with clear reports from your dermatologist! April, Skincancer.net. Moderator

  • Joanie
    4 months ago

    I am on day 6 also but am applying twice a day. Last night was the first time I couldn’t sleep. Like you, not because of pain, just wide awake. My stomach is upset within 30 minutes of application every time. It is chemo so ginger ale & saltines for me. The upside is, I may drop a few pounds 🙂

  • April Pulliam moderator author
    5 months ago

    Hi there! Let me tell you that you are certainly not alone! I am one of those users who has a lot of trouble sleeping while using Efudex. Strangely enough, my sleep patterns are thrown off pretty quickly after the first application. I’m definitely one to worry a lot, so I can relate to your question about the stress. As I have talked to more and more people who use it, I’ve found that insomnia is pretty common. Later, the itching and burning may keep you awake, too. For that, I use Benadryl at night. I apply the cream morning and night. Nausea and sick headaches go along with the treatment for me, as well. I’ve seen ginger recommended by friends who have trouble with nausea. Tylenol helps ease my headaches some. Sending you hugs. It’s not for the faint of heart! April, Skincancer.net, Moderator

  • Minnymoo
    5 months ago

    Hi there,
    Firstly thank you so much for this post and wonderful site.

  • RonniGordon
    7 months ago

    As I read this I am pulling at a loose piece of Efudex-treated skin on my neck. Picking is a big problem for me, especially on easily accessible areas. I think maybe I should start applying bandaids.

  • Rebecca
    7 months ago

    I totally hear you on this – lol – I am terrible when it comes to picking! I’ve actually do use band-aids to cover so I don’t pick. It’s the only thing that has worked on me so far. Sometimes I also use sports tape. I feel like I’m the cornerstone account for Band-Aid 🙁

  • April Pulliam moderator author
    7 months ago

    Hi there,
    I totally feel you! The scratching and picking is so hard to resist. Try keeping the area moisturized as often as you can if you are in the healing process. I use Vanicream liberally. Some people swear by Vaseline. I get pretty good results by gently rolling off the loose skin in the shower. That really helps reduce the peeling layers once your skin is dry after a shower. Try hard not to pick though. Your skin will heal nicely after the redness fades. You don’t want tiny scars in the nice new skin. Keep us posted on your healing! Hugs! April, Skincancer.net, Moderator

  • RonniGordon
    5 months ago

    In my latest post I wrote about picking my skin. It never occurred to me to roll it off when wet as opposed to going at it and making it bleed. This seems like good advice. Sometimes I do it when nervous and I don’t even know I’m doing it. I just read this comment from an unnamed user: Not doing well. Post fluorouracil and calcipotriene combo used for 2 weeks. Stopped 6 days ago. Still suffering. I just got prescribed the same combo and am now a little concerned.

  • keeneye
    7 months ago

    Yes ive been sliced and diced with this disease.a month ago i had one cut out of my forehead.17 stiches in an L shape flap.looking ok now.the rest of my face efudex WOW its the pits.cant wait for the itch and stinging to stop.sleeping upright in a chair as this helps by not rolling on the face.cheers.

  • Eileen.B moderator
    7 months ago

    I’m sorry you’re going through this right now, @keeneye. While I’m glad you’re getting the treatment you need, you’re so right — Efudex is the pits! Sleeping upright can’t be very restful, I hope you have a recliner? Wishing you good night’s sleep very soon. Hugs. -Eileen, SkinCancer.net Team

  • nadrowski
    9 months ago

    Since January I have had three Mohs procedures. One melanoma and two Basel cells all on my face (cheek and forehead). I just started the Efudex cream on my nose and upper lip almost two weeks now. My doctor prescribed two weeks of treatment then a hydrocortisone cream. I am at the 11th Day now and feel I have entered erosion stage. Some areas are weeping. The nausea is terrible and just facing people is something I wasn’t prepared for but as we all know it’s better than the alternative.
    Question on the healing stage what should I expect in the weeks ahead? Will the redness calm down quick? Did you ever hear of using the pca skincare brand and also do you think covering it with a make up would be bad?

  • April Pulliam moderator author
    9 months ago

    I’m so sorry. You sure have been hit with a lot at once! If you’re at the two week mark, it’s entirely possible you are at the erosion stage. Some people get to that point before others–it depends on the level of damage. Each time I have treated I knew I was done when the skin weeped, bled a little, and became hard and crusted after the cream dried. I would check in with the doctor treating you just to make sure he/she thinks you have reached the end of treatment.

    I haven’t used that particular brand of skin care products. You’ll hear different things from different people as far as the healing phase. I do want to warn you that it can be more painful than treatment. For aftercare, I use Vanicream lotion. Many people suggest using Vaseline to soothe the skin. I haven’t had much luck with petroleum products. My skin reacts terribly to petroleum based lotions or ointments during healing.

    Don’t be discouraged when everything you try to apply burns and stings. That skin is raw and irritated. The first application of lotion after a shower always burns, but through the day additional applications are much easier. It’s best to wait about 30 minutes to an hour after washing the area before you apply any lotion or Vaseline. Your skin should never be wet when you apply lotion to the healing skin.

    Your skin has gotten used to getting the cream and will almost crave it. When you stop providing it, the skin will “act up.” Expect your skin to tighten, become more irritated, and weep more. Soon, it will begin to peel. You’ll be able to gently roll that old skin off in the shower. Don’t force it. That could cause bleeding. Keep it slathered in a lotion. I prefer to use cold packs and Tylenol to get me through. Benadryl helps with the itching and allows me to get some sleep.

    The redness can take several weeks to a few months to subside. I don’t apply any makeup to the healing area until all the peeling has occurred. After that, I use green correcting cream to cut down the redness. My dermatologist suggests using no products on the treated area aside from soap during treatment and mild lotions following.

    It’s a long process but worth the effort. I think you would enjoy the support from a group I am a member of on Facebook. It’s a fantastic source of advice and shoulders to lean on. You can find it by searching “fluorouracil aka Efudex” and clicking “join.”

    Please keep us updated on your healing. I’m sending you lots of hugs and wishes for fast recovery! April, SkinCancer.net, Moderator

  • JoAnna
    9 months ago

    “The skin tightens and throbs much more so during healing than during treatment as it craves the Efudex.” I have not heard about this, nor have I seen this in any of the literature available. Can you explain how this happens? Also, how long before the redness and hyperpigmentation goes away? (It has been 6 weeks since I stopped using it.) Can you recommend any creams or lotions that will help? Thank you!

  • April Pulliam moderator author
    9 months ago

    Hi JoAnna, I’m glad you’re past the worst part of treatment! Some people don’t experience the harsh effects of healing. Others have a really rough 24-72 hours after the last application. For me, the worst has varied from three days to a full week. The best way I have seen it described goes a little like this: Your skin gets used to the cream and actually begins to need it. When it’s taken away, it begins to crave it and it really gets cranky. As I understand it, the cream contains a calming ingredient (that’s why it always feels better after application and begins to feel tight and itchy just before reapplication time). When that calming ingredient is taken away, look out! My face drew up so much I couldn’t open my mouth for hours at a time. It was horrible. If you were fortunate enough not to deal with this, I’m ecstatic for you!

    I’d recommend using Vanicream lotion. It’s very mild and soothes my skin. As far as the redness goes, it can last for a few weeks up to several months. Some areas on my face and chest become red months afterward when I get hot or when I take a steroid shot. (I lit up nicely following a sinus cocktail shot this winter.) I use green color correcting cream to cut the redness before applying makeup. Many makeup brands make green CC cream. It will fade; it just takes a while.
    Keep us posted on your progress! Wishing you the best! April, SkinCancer, Moderator

  • owen
    10 months ago

    Hi, I don’t know what to do with my arm after 6 weeks of Efudex, I have been cleaning it all the time as I am getting a yellow coat over the top and its sticky is that part of the healing or not as I clean it off, but it goes back to red flesh. or do I have to keep cleaning that away.the yellow stuff that is.its been two weeks.dont know what to do.still sore but getting better.is the yellow stuff the start of a scab ?? please help.cheers Owen.

  • April Pulliam moderator author
    9 months ago

    Hi Owen,
    I’m so sorry I didn’t see your comment earlier! If you are using the cream and start to see the yellowish seeping, it usually means you are in or nearing the erosion stage. That generally means it’s time to quit. During healing, that yellowish pus will continue for a few days and as the skin begins to slough off, you’ll want to gently roll it off in the bath or shower while the skin is moist. There is always the chance that you have developed an infection. I’m learning as I use the cream more often that some people do experience infection in the healing stage. I hope by now your skin has begun to heal. Keep us posted! April, SkinCancer.net, Moderator

  • JoAnna
    9 months ago

    I hope you did contact your doctor. You could have an infection, causing the “yellow stuff.” (In my case, it was green. Gross.) However, it cleared up pretty quickly with Gentamycin ointment prescribed by my derm. Your risk of infection in that area increases dramatically with the combination of skin breakdown and suppression of the immune system from the drug. Good luck.

  • April Pulliam moderator author
    9 months ago

    Great advice! Infection is always a possibility. I know exactly what you mean by “gross.” There’s nothing pretty about the process!
    April, SkinCancer.net, Moderator

  • April Pulliam moderator author
    10 months ago

    Hi Owen,
    I’ve treated four times now and I feel pretty safe in saying you have reached the erosion stage. That stage is usually a good sign that Efudex has done all it can do. If I were you I’d contact my doctor and let him/her know where you stand. Six weeks is a long time to treat and it sounds like you are done. Now comes the hard part. You’ll want to find a lotion that soothes and helps you heal. I use Vanicream and cool compresses. It takes me about a week to get past the worst part of the pain. I use Benadryl to help with the itching and Tylenol to combat the pain during the day. Keep us posted on your progress I’d like to know what your doctor thinks about what stage you have reached. Hang in there! You have a great support system in this group. I can also recommend a Facebook group if you are interested. April, Skincancer.net, Moderator

  • skgiel
    1 year ago

    This info is very helpful as I begin my regimen. I’m very curious how anyone manages to go out in public looking so red-faced!

  • April Pulliam moderator author
    1 year ago

    It’s not easy at all. I spent a lot of time indoors and around my home during the worst days. Some people ask questions. Others assume it’s a severe sunburn. I’ve learned to take the opportunity to educate and let those who ask know about my treatment and what brought me to this point.

  • pattiwoj
    10 months ago

    I am so grateful to you April for writing this article and sharing not only your experience, much like mine (chest) but the tips. Tapping the area with cool hands works great too.And Vanicream miraculous, along with an Aleve about two hrs ago have done the trick! Plan to share with family who are and have been going through skin cancer removal (basil & squamous cell) most of our adult lives.

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