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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

  • Tojo
    4 weeks ago

    Hi April,
    Really good to read your account and to read other peoples experiences it truly does help!
    Ive just been through using efudex for the last 3 weeks I had sun damage all over my face, and all seems good my nose doesnt seem to have done too well as that was the worse but maybe its early days. I experienced the pain and itching which were unbearable at times. I started on my forehead and nose ( but stopped the nose after 10 days due to infection) then 7 days later carried on with the nose. I then done my cheeks and temples, my forehead took time to react but the cheeks and temples reacted after only 8 days very red and sore but surprisingly the redness and pain seemed to move all down my face which also have become red and sore? Im now experiencing the tightness and pain and my skin is flaking everywhere (except at the bottom of my face) of course I look terrible but hope the skin will bring a new me so to speak I just hope it doesnt take so long!
    Again many thanks for your information from a rainy Scotland!!

  • April Pulliam moderator author
    4 weeks ago

    @tojo…I’m so sorry you’ve been hit hard with the side effects of Efudex. It’s so hard to tell exactly how the cream will affect each user. Infections are more common than you might think with this treatment, and the nose seems to be a very sketchy area to treat. The creases of the nose are just the worst!

    I’m including an article on the healing phase with some tips for you since you’re about to head into the homestretch. Wishing you all the best! April, Skincancer.net, Moderator

    https://skincancer.net/life-with-skin-cancer/efudex-side-effects-tips/

  • jbraziler
    2 months ago

    Hi April, thank you for your post. Very informative and I understand individuals and react or respond differently. I have been recently diagnosed with pre cancerous skin damage on my face. I’m using the efudex cream for 10 days now. My doctor only advice was to use the cream for about 6 weeks once a day. Nothing else so I know nothing and I’m finding your post very helpful. From washing the area to the part of when to stop using the cream (which is so important). I get the burning and itchiness after applying the cream. The skin has now lost it’s hardness and is soft, tender and red. Not crusty yet. I did notice yesterday a crack in the area and possibly very small seep. In your experience do you think I should continue applying as directed until it’s crusty? Thank you and I do understand it’s just your experience and you won’t be directing me to do anything. It’s just I didn’t know any of the things you talked about in your post.

  • April Pulliam moderator author
    1 month ago

    @jbraziler…I apologize for taking so long to reply and I hope you are making it with as little discomfort as possible. I will say this, at one point when my skin began to crack around my nose, I visited my dermatologist’s office to let the nurse check me. She advised that I continue at least two or three more days. As difficult as it was, I did and after my skin began to seep fairly heavily, I finally stopped applying the cream.

    The length of time recommended by doctors varies greatly. I have always treated twice daily for 3-4 weeks. You may or may not have to treat the full six weeks. Definitely check in with your doctor if you feel your skin as progressed to a point where the cream has done all it can do (erosion stage–seeping and cracking.)

    I wish you all the best! Please keep us updated on your results. I’m including an article on what to expect after you stop application and how to deal with healing. Hugs, April, Skincancer.net, Moderator

    https://skincancer.net/life-with-skin-cancer/efudex-side-effects-tips/

  • Deanna Dee Taylor
    2 months ago

    Thank you for these tips! These are very helpful and informative. I am about to have my 4th and 5th Curettage and electrodesiccation for SCC’s on my scalp (I have been having this done since January 2019). My doctor says he wants to discuss starting the use of Efudex to treat my scalp due to the rapid growths of SCCs and AKs I keep having to have frozen off. I cannot find any accounts from people with experiences on the scalp or much information about scalp treatment and so I appreciate the comment from the reader about the scalp. I am not bald and am wondering if it is best to consider shaving my head in advance of the treatment. Also how painful it is to wear a head covering during scalp treatment.

  • rolanstein
    2 months ago

    Hi Deanna (and thanks to Nina M for the tag.

    First, an encouraging word. As someone with multiple actinic skin lesions all over my scalp, I have found Efudex a far superior treatment to cryotherapy in that it’s like a “carpet bombing” – and thus clears up just about all the lesions, including many in a very early stage you can’t see or even feel. If any make it through the treatment, they can be zapped with cryo once the post-Efudex-treated skin is less tender.

    So, the result is a year or more of smooth scalp, and no need to those regular cry sessions.

    The downside is the 3 weeks or more the Efudex treatment takes, and the side-effects, which are well-documented by April in her excellent article.

    And yeah, it IS challenging. But I think the results are worth it.

    I am bald and my Efudex treatment has always only been to the bald area of my head (which is where all the sun damage is – funny, that). I don’t imagine it would be anywhere near as effective if applying the Efudex to a scalp covered with hair, so I imagine shaving your head would be a good move. But of course, your dermatologist/GP would be the one to advise on this.

    The treatment can be painful and your scalp will become tender (it can hurt even having a shower, so you have to keep moving around and have the water pressure turned down – and adjust the temperature to warm, certainly not really hot). Also, there will be weeping and perhaps pus from the multiple reactive lesions under treatment. This will make wearing a head covering a messy proposition.

    However, I do wear a hat (loosely!) when out in public during my treatments, because of the unsightly appearance of the scalp. Just be prepared to have to sponge clean the areas of staining from your oozing scalp. Probably best to wear a loosely tied bandanna or scarf, which can easily be washed. It won’t be painful, unless areas stick to the scalp, in which case you’ll just need to gently and patiently prise the material loose.

    The pain is not excruciating, by the way, at least it hasn’t been for me. I’ve found the itchiness by far the worst side-effect. Resist scratching (difficult!). Best to pat the itchy areas gently and repetitively, but even this will cause the itchiness to flair up. If you can possibly just leave it alone, that’s best.

    That’s about all that comes to mind. Hope it’s of some help. If you have any specific questions, no probs – just fire away.

    Good luck! Just remember, 3 weeks of unpleasantness and looking ghastly for 1 year+ of clear scalp – not a bad payback.

    Cheers!

  • Deanna Dee Taylor
    2 months ago

    Hi @rolanstein! This really helps me a *lot*. I’ll find out tomorrow more details from my doc. Some challenges for me are: I have thinning hair but it’s about shoulder length and I work full time starting a new job on August 5, so I won’t have much sick time to take off when I start the treatment. my doc indicated starting in late September, when it starts getting cooler. Everyone at my new job knows about my issues with the SCCs so it won’t be new news, but still…..I just want to be sure I”m not oozing out stuff on the job so I like the idea of bandanas/loos scarves and I have lots of those. 🙂 I will keep you and everyone here posted! Thank you again.

  • rolanstein
    2 months ago

    Damn, typos and no edit function. “Cry sessions” should be “cryo sessions.”

  • Nina M moderator
    2 months ago

    Hi @deanna-dee-taylor, I’m tagging @rolanstein here to make sure they see your comment. It’s fantastic to hear that more hair actually grew back – definitely something you should report to your derm so they can take note. Hopefully we’ll hear from more folks about Efudex on the scalp and get a conversation going. Thanks for commenting!

    – Nina, SkinCancer.net Team
    Want to connect with the community? Join us on the Community page: https://skincancer.net/community/.

  • rolanstein
    2 months ago

    An excellent summation of the Efudex experience!

    Here’s something positive I wasn’t expecting out of applying the cream to my scalp. This is my 4th treatment of 3-4 weeks each time over the past 4 years. I finished the 4th treatment a few weeks ago, with good results. Actually, better than good. Not only have I been left with no discernible actinic skin lesions, but some hair has started re-growing on my scalp!!! I have male pattern baldness, and this new hair is growing right on top where there was ZERO hair before this most recent treatment.

    I am certainly not advocating applying Efudex to stimulate hair growth! I have done some googling on the phenomenon, and did turn up one other medically documented case. So, I’m not delusional!

    This re-growth did not happen with any of my other 3 treatments.

    Also, going by my web research, it’s more common for patients to complain of hair LOSS after applying Efudex, not hair re-growth.

    Go figure – I can’t! But can’t say I’m not just a bit chuffed. That said, I don’t have so much hair re-growth that people are going to notice. My partner did, which made me realise I was not imagining things (I hadn’t mentioned my observations of re-growth to her). Anyway, if anyone else has had this phenomenon happen to them, I’d be most curious to hear from them.

    Best all.

  • April Pulliam moderator author
    2 months ago

    @rolanstein…I have to say you have had some amazing results! I don’t believe I’ve ever read of any patient saying they had such luck with regrowth of hair. You’re right about hair loss. Though it’s different from person to person, many do complain of some manner of hair loss during treatment. You are definitely one of the lucky ones and likely in the minority.

    I’m anxious to hear if others experienced the same effect.

    Best wishes as you continue to recover! April, Skincancer.net, Moderator

  • nwsmithus
    6 months ago

    Thanks for the very lengthy and helpful reply. As it happens I did go ahead and put it on again yesterday. And I woke up this morning (and regularly through the night) seeping all over the place–the sheets were soaked! I have done this several times over the last few years and always had it take a week or 2 before any redness appeared and then another week or two for full erosions. The 2 areas that I did this year on legs and chest were just different–bubbling up red by the first day–didn’t know what caused the difference or how to handle it so I was seeking advice. Your words were very helpful.

  • nwsmithus
    6 months ago

    I have been using efudex for a number of years but 2 years ago had very bad time with treatment to my face and then last year to my legs (which have sensitive thinning skin anyway as I am getting older–73). Both times my doctor said to stop that she thought I had done it too long keeping up application after the crusty part. Several months after efudex my legs even required plastic wrapping in prescription cortisone cream to get them to settle down (which happened quickly with the cream). So this year my doctor said to do legs again (have 3 SCC surgeries on one leg so she wants to be preventive). But this time she prescribed 1x daily M-F for one week on my legs and it all turned red w/sores right away and I kept it up an additional 2 days past the 1 week–can’t say it was crusty or seeping this time (as I am familiar with from past times). So it was all not too unpleasant and healed okay. I went ahead and did the same for my upper chest which reacted strongly right away and I kept doing for 7 days while it was swollen, red, itchy and not letting me sleep but again like the legs was not crusty yet. Talked to doctor a month or so later and suggested to her that since it had gone relatively smoothly, how about if I just repeated it. I put it back on my chest for another week. It is very uncomfortable now but again not quite crusty or seeping yet–and I’m trying today to decide whether to stop or keep going. So after being long-winded, my question actually is about what happens if you don’t do it long enough or try doing it sequentially with a break in between and letting it heal? Does it do no good, just not as much as it would if you did it longer, starts up again at same point if you repeat or does it start over?

  • April Pulliam moderator author
    6 months ago

    @nwsmithus…it sounds like you have really been through the wringer with Efudex treatments–I’m so sorry. I’ve never been told to take short breaks between treatments. I can’t speak for your doctor and can only speak from my own experience, but I always treat until my skin seeps and cracks–the erosion stage. Once I am there, I stop applying the cream and begin using moisturizers religiously.

    From what I understand, the cream works deep below the surface to bring precancerous cells to the surface. I have to wonder if maybe those cells aren’t quite making it all the way to the surface and that’s why you seem to require more frequent rounds of treatment. As far as I have read and from what I gather from others in an Efudex support group, those precancerous spots that you bring to the surface but don’t quite get with one round of Efudex can be pulled to the surface with another round.

    I think if you don’t treat long enough, you will likely require more frequent treatments as those cells are just pulled toward the surface but not making it to the top to be sloughed off. Treating until your skin erodes is certainly difficult, but it’s what my dermatologist always recommends.

    Since you are dealing with skin that tends to be thinner and more delicate, those shorter and more frequent rounds of Efudex may be necessary.

    You are a good judge of what you can stand and what is too far; if I were you, I would continue a few more days until I felt the seeping begin or until you believe you have had enough. As you continue, make sure to touch base with your doctor.

    If you haven’t discussed with your doctor some other options, you might want to ask about photodynamic therapy (blue light treatment). https://skincancer.net/treatment/procedures-surgery/photodynamic-therapy/

    I wish you all the best as you move forward. We are always here for you!

  • GuillermoHorne
    7 months ago

    Thanks again for your encouragement, tips and info, April. If I hadn’t been forewarned about the severity of my skin’s “withdrawal” from the cream, I might be in a state of shock as well as discomfort. I am using a lot of CeraVe moisturizing cream, alternating at times with a couple of creams that contain very little alcohol.

    I find that for me, cold packs are nice while they’re on my face, but as soon as I stop, everything is worse. Possibly the extreme low humidity we’re experiencing during the current cold snap (-30C at night) is a factor in that reaction. Thanks again for all your support!

  • April Pulliam moderator author
    7 months ago

    @guillermohorne…you’re more than welcome. You could be right about the low humidity. I’ve treated in cold weather and the 90 degree days of July. Those first days of healing are like nothing I’ve ever experienced. Doctors definitely don’t realize enough to warm us about that.

    Can’t wait to hear how you feel once it’s over! April, Skincancer.net, Moderator

  • April Pulliam moderator author
    5 months ago

    @guillermohorne…that’s awesome news! I’m so happy you came through the process unscathed and got such a positive report! We are here for you any time! April, Skincancer.net, Moderator

  • GuillermoHorne
    5 months ago

    I finally had my follow-up appointment with the dermatologist and she was very happy with my results (and the many photos I took). There was a small amount of slightly rough skin on one side of my nose which her intern sprayed lightly with liquid nitrogen. Next appointment in 6 months; she anticipates just having to spray a couple of places a year.

    My face has healed up pretty well: skin is smooth and some redness remains. I look as if I had some windburn, but it’s gradually fading with time. I’m being very diligent about putting sunscreen on whenever I go out in day time.

    Thanks again for all your tips and support!

  • Nina M moderator
    7 months ago

    @CanadianGuy, you might also want to check out the comments here! – Nina, SkinCancer.net Team

  • GuillermoHorne
    7 months ago

    I’m now at Day 24 of applying Edufex to my forehead, cheeks and nose. Skin has become like alligator hide with a bit of fluid oozing from underneath at times or when pressed. Very tight with lots of stinging as I approach the end of each 12 hours between treatment, then the moisturizers in the cream provide some relief. Some dry patches are flaking off; moist areas sometimes stick to my pillow in the night.

    I have mailed a photo to my dermatologist who lives a long way from me in order to update her on my progress. In the meantime, I am trying to decide
    1) if gently rolling or scraping off the looser patches of skin will provide more relief or slow the healing process taking place below the surface, and
    2) when I should stop applying Edufex.

    The doctor’s office previously said to continue “as tolerated” for up to six weeks. I read about continuing until the “ulceration stage”, but don’t know if my cracked skin indicates I’m there yet. I have fairly high pain tolerance, determination, and really great support at home and from friends, but if the Edufex has achieved most of what it can, I will be glad to start the recovery process!

    Three photos here: https://drive.google.com/open?id=1LMJh0qmNW_C9tics2bOgQLHbDneb9tQ1

  • April Pulliam moderator author
    7 months ago

    @guillermohorne…Oh! You are a rockstar! You had a fantastic reaction! I can’t speak for your doctor, of course. I can tell you that your photos are virtually identical to the cracking and oozing I was showing in the erosion phase. When this phase is reached, Efudex has done all it can do. A good rule of thumb is to stop when the skin begins to ooze a yellowish fluid or show signs of bleeding. I know that feeling of peeling my skin off the pillow well. It’s so uncomfortable. I am so sorry.

    It sounds like you are in good hands with your support system. That truly does wonders for one’s psyche during treatment. Keep us posted on your doctor’s thoughts. Know this from one regular user to another…you absolutely aced that course of treatment! Best wishes and positive vibes for quick healing! April, Skincancer.net, Moderator

  • GuillermoHorne
    7 months ago

    The dermatologist said, Yes, I could stop. She also said that peeling off flaky bits of skin was ok as long as it didn’t cause any bleeding.
    Onto the recovery stage…!

  • GuillermoHorne
    7 months ago

    Thanks so much for your encouragement and kind words, April. I really appreciate it! I’ll post a summary of my doctor’s comments when I hear from her. Best wishes.

  • GuillermoHorne
    7 months ago

    (zipped Jpegs)

  • April Pulliam moderator author
    7 months ago

    @guillermohorne…That is the best feeling, isn’t it? I am so happy you are on to the healing stage! As difficult as the treatment phase is, you should be prepared for a really difficult 3-5 days of healing. You mentioned earlier that the hardest time came at the end of the day when it was time to reapply–that’s because your skin was calmed by the cream. (Sounds odd, I know.) Your skin will now begin to go through a type of withdrawal and will crave the cream. The dryness and tightening is going to become really uncomfortable.

    Cold packs or cool towels help tremendously. I use Benadryl to help me sleep, I and keep my skin moisturized. Many like Aquaphor, but I prefer Vanicream. It’s important to use a product with no perfumes or colors. Watch the alcohol content as well.

    The peeling you are already doing is going to help. The more of the dead skin you can get off, the better you will feel. I try to soften it in the shower and kind of roll it off gently. The more moisturized you keep it, the more quickly you can get back to normal.

    Here’s an article with some tips for healing. https://skincancer.net/life-with-skin-cancer/efudex-side-effects-tips/

    You are going to feel back to normal before you know it! Best wishes! April, Skincancer.net, Moderator

  • InDC
    7 months ago

    Hi thank you for posting this, it is so helpful. My husband has just started his journey with efudex – currently treating two patches on his face. Currently on day 13 of treatment. After a week or so both patches were reacting ‘well’ getting very red and sore. And dry to the point where a few days ago he started applying moisturiser 20 mins after the efudex. In the last couple of days I swear the redness is reducing and we are now worried that moisturising is reducing the effectiveness of the efudex. Do you have any experience of this? He cannot consult his doctor at the moment so I’m guessing he should just stop the moisturiser to be safe. It would be great to hear your thoughts on using moisturisers along side treatment. Thanks again for sharing your story, it is such a step into the unknown all this and it helps having others out there!

  • April Pulliam moderator author
    7 months ago

    @indc…I can say that my dermatologist has always discouraged me from using any products other than the cream on my skin during treatment. If at all possible, I use nothing but water and a very mild soap or cleanser like Cetaphil. I have read that other users apply Vaseline to get some relief from the dryness and itching.

    Just to be safe, I would stop the moisturizer and try to apply cold packs when the pain and itching are at their worst. If moisturizing is absolutely necessary, I would wait a couple hours or more after applying Efudex to allow it plenty of time to absorb into the skin.

    Keep in mind that he may not need to treat the full time as prescribed by his doctor. Some react more quickly than others and reach the erosion phase before the prescribed time is up.

    Try reaching out to the doctor when possible to see what he/she recommends. Best wishes! Tell him to hang in there. I promise that it does get better! April, Skincancer.net, Moderator

  • mollydw
    8 months ago

    I am so very appreciative of your posts and information for Efudex treatment. I went into my treatment with no knowledge about what I was headed for. I have been in severe pain and discomfort, especially after finishing the 3 week course of treatment. Your suggestions for cold compresses, aquaphor and vanicream were very helpful, along with the tylenol, ibuprofen and benedryl. I slept well last night for the first time in a couple of weeks. I’ve been extremely emotional dealing with this, as I said, I had no idea what I was heading for. At one point I even thought I was having an extreme or allergic reaction to the treatment. Your comment that the 3-5 days after treatment could be the worst was of great comfort as that is just what I’ve felt. I’m now on day 3 post treatment. Unfortunately, my Dr’s office was closed for three days just when I had concerns, so your blog was really beneficial to me. I also had an outbreak of cold sores all over both lips just to compound my discomfort. Anyway, just wanted to say thank you for your good information, it has helped me get through this most difficult trial of my life a little more easily. Best wishes to you for no recurring problems.

  • April Pulliam moderator author
    8 months ago

    @mollydw You are more than welcome. I’m so glad some of the things I’ve tried have helped you, too. We all seem to react so differently to the cream–it can be really difficult to tell someone that one particular lotion or pain reliever will work without a doubt.

    I know you’re beyond ecstatic to be finished. I wanted to make sure you had seen this piece on feeling isolated as a user of Efudex. You are never alone in this journey!
    https://skincancer.net/life-with-skin-cancer/isolation-efudex/

    Best wishes for speedy healing! April, Skincancer.net, Moderator

  • Robpic26
    8 months ago

    Hi , thank you for the tips . I am Only day 2 into treatmeant on my nose and cheeks . I was going to put treatment off as I have a gala dinner at the end of February but decided I had better start immediately. I am a melanoma survivor so know how deadly the sun can be … was looking to find info on being able to apply makeup on my face but guess I will have to embrace my red face and try to avoid crowds – how long is it until the face usually starts to go red ?

  • April Pulliam moderator author
    8 months ago

    @robpic26 You’re smart to go ahead and get it out of the way before the weather warms up. Spring and summer are trying times to treat.

    I can’t say for sure when you’ll start to see redness. We all seem to react differently and at varying rates. I usually start to get pink in the first week. By the second week, I’m red and beginning to feel really itchy and tight.

    Makeup and other products are frowned upon by my dermatologist. I would check with my doctor if I were you to see if he/she thinks your skin can tolerate any products while treating.

    Be prepared for your skin to get raw and very sore. That’s a pretty common reaction in the final weeks.

    Your rate of reaction will also depend on how much damage you actually have and how frequently you are applying.

    I’m keeping you in my thoughts. Best wishes for a productive treatment with few side effects! Keep us posted on your results. April, Skincancer.net, Moderator

  • April Pulliam moderator author
    7 months ago

    @robpic26…I am so glad you found that peppermint works for you. I have heard that ginger can also bring relief for nausea. At Day 18, you are hitting those hard days mid-treatment. Hot and humid weather is the worst kind to experience during treatment; I don’t blame you for carrying a cold, wet cloth. Sometimes that is the only relief there is during treatment. I can totally see how the moisturizer you tried became uncomfortable. Anything with a water content will sting to some extent when your skin is growing more and more raw. I use Vanicream posttreatment, and even it stings when I first apply it. We are all so different with our side effects and have very different ways of relieving the burn. Some swear by petroleum products, but I find that they set me on fire. Efudex is a strange thing. Best of luck with the remaining days of treatment! Keep us posted on the results. In the meantime, try to stay cool and in front of a fan. It truly helps. April, SkinCancer.net, Moderator.

  • Robpic26
    7 months ago

    sorry been off radar for a bit – Unfortunately I am in Cairns North Queensland….. hot and sticky. I am now into day 18 and suffering – but reading peoples experiences is helping me get through. My nose and cheeks are extremely red and angry – parts are starting to flake but no oozing as yet. I I tried a moisturiser which was recommended by a chemist but after a few days it started to burn… I am suffering severe nausea but found a couple of drops peppermint oil under the tongue works a treat. Cold wet washer goes with me everywhere currently.

  • GuillermoHorne
    8 months ago

    It may sound counter-intuitive, and it might not be for everyone, but I’ve found hot towels helpful for drawing out the “heat” from affected areas during treatment. Will try it when I stop treatment to see if it helps then, too.

  • April Pulliam moderator author
    8 months ago

    @guillermohorne…I can completely see that being a relief. It sounds exactly the same as the relief I feel from just standing in the shower and letting the warm water soak the treated area. Warm water is a saving grace when I’m in those most difficult weeks. Cold packs and cool rags are a relief when the itching is at its height.

    I think it really comes down to wherever works for you and gets you through the roughest patches.

    I’m keeping you in my thoughts. I know exactly what you’re going through! Best wishes for speedy healing! April, Skincancer.net, Moderator

  • GuillermoHorne
    8 months ago

    Thanks for your info about aloe. A friend gave me a few fresh pieces from her plant; I can only imagine what a gel would do!

    The last few days (currently at day 20) I’ve woken up in the morning with a lot of swelling in my eye lids (my application areas are forehead, nose and cheeks). Drinking a lot of water to ensure I’m flushing the Edufex through and out of my system!

    btw I re-read parts of your blog every day or so and each time, I find something interesting, helpful or reassuring. I really appreciate how much information you have shared. Thanks!

  • April Pulliam moderator author
    8 months ago

    @guillermohorne…I have heard great things from a few people who have tried aloe. It goes without saying that you need to be careful not to get aloe vera gel. The alcohol content will send you into orbit. A friend uses hydrocortisone and keeps it in the refrigerator between uses. I’d check with your doctor before applying anything during treatment. I’ve seen varying comments from users. Some say they use Vaseline during treatment and others, like my doctor, say use nothing until after treatment is over. Your doctor can best advise you on how long to wait before using something topical to treat the burning and itching.

    In the mean time, keep pressing and tapping! You’re in the home stretch now! April, Skincancer.net, Moderator

  • GuillermoHorne
    8 months ago

    Thanks, April – much appreciated! I know a family whose daughter bumped a pot of boiling water off a stove and suffered severe burns. They got her into a shower and the girl had them crank up the hot water to a point she could just tolerate; she knew about this approach to burns. She screamed and howled a lot. Her skin healed up without any blistering. An interesting example of drawing the heat out at the time of the injury.

    I am part way through my third week with Edufex and well into the burned, blistered, swelling, peeling. At times I have felt as if I have the flu plus sunstroke and heavy fatigue, even a runny nose, but none of that for a few days.

    Your suggestion of pressing instead of scratching itchy areas has been very helpful!

    I live in a mountainous northern region with lots of snow. If I go out XC skiing, I wear #60 sunscreen and a balaclava, or wait until dusk and take a headlamp 😉

    Do you know of anyone applying fresh aloe vera to treated skin, or would that interfere with the regime?
    best wishes,
    Guillermo

  • stuthepom
    8 months ago

    Hi April, very helpful blog, thanks for that. Excuse me for the personal question but did you say you’ve done this treatment four times? I would hope once was enough. I’m two weeks in and yeah it’s full on, as you know. I was applying twice a day, as instructed, and returned to my Doc as I felt the reaction was excessive. They agreed, so I’ve dropped to once a day. Skin is on fire and I long for the healing process. I was livid to be told by my Doctor that they offer this treatment in a two hour appointment! It’s $450 Australian Dollars and I was livid they didn’t offer me this treatment once they advised to use Efudix. I would have jumped at this treatment compared to the close to three weeks of hell I’ve and now await Friday when I stop, and hopefully the healing process begins…

  • April Pulliam moderator author
    8 months ago

    @stuthepom…I’m so sorry you’re struggling with it. It’s such an intense treatment. I wonder if the alternative they failed to mention was blue light treatment. From everything I’ve seen, it has a similar effect with fewer of the harsh side effects. Too bad they didn’t lay out all your options for you in the beginning. I’m so sorry.

    I have used Efudex several times over the last four years. It’s kind of a vicious cycle. Sun damage is forever unfortunately.

    Be prepared for your side effects to intensify when you stop using the cream. The first 3-5 days following treatment are the worst for many users. Cold packs and soothing lotions like Vanicream or Aquaphor will be your best friends.

    Keep us posted on your progress! Sending you positive thoughts! April, Skincancer.net, Moderator

  • KevinVT2000
    8 months 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
    8 months 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
    8 months 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
    8 months 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
    8 months 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
    8 months 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
    8 months 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
    9 months 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
    9 months 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
    9 months 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
    9 months 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
    9 months 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
    9 months 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
    9 months 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
    10 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
    10 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
    10 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
    9 months 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
    11 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
    11 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
    1 year 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
    1 year 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
    1 year ago

    Thank you!

  • Minnymoo
    1 year 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
    9 months 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
    1 year 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
    1 year 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
    1 year ago

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

  • Ronni Gordon moderator
    1 year 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
    1 year 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
    1 year 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

  • Ronni Gordon moderator
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    1 year 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
    2 years 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
    2 years 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
    2 years 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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