Efudix for sunspots

Efudix or 5 FU cream is a commonly prescribed treatment for sunspots, solar keratosis and Bowen’s disease. This treatment has been readily available in Australia for the past 20 years and is the cream of choice for both Skin Cancer Doctors and Specialists. It destroys sun damaged skin and abnormal cells. Efudix can be used on most areas of sun damage, with treatment regimes lasting between 2- 8 weeks.

Important Facts on Efudix for Sunspots

This is the most commonly prescribed cream for the treatment of precancerous sunspots or solar keratosis
The usual application regime is twice a day, for 3 weeks
Limitations on its use include the prolonged treatment period and ‘downtime’ for the patient
During the treatment process, patients are limited to indoor work only
The total treatment process may take up to 5-8 weeks to complete
This treatment is ideal in patients with no limit on downtime
Newer treatments such as laser and PDT are equally as effective, however cost more than Efudix
Specialists will tailor a treatment based upon your lifestyle, amount of sun-damage, and history of other skin conditions

What should I know about solar keratoses?

Solar keratosis or sunspots are very common pre cancerous lesions, seen in over 25% of Brisbane’s population over the age of 40. The high UV radiation in Queensland predisposes their residents to sun-damage and solar keratosis.

Solar keratosis, also known as sunspots, present as red, scaly, rough, dry and sometimes stingy persistent patches on the face, neck and hands. Sun spots should be treated due to their pre cancerous potential. Treatment depends on your age, location of sunspots, and your lifestyle.

How does EFUDIX work?

Efudix is also known as 5FU or FLUROURACIL topical. This is chemotherapy for sun spots, solar keratosis, and some forms of skin cancer including intraepidermal cancers (Bowen’s disease or SCC insitu). It does not work well for the treatment of BCC or Basal Cell Cancers.

Efudix is a chemotherapy and works by destroying abnormal skin cells, cancerous cells and pre cancer. The more sun-damage you have, the bigger the reaction.

Patients need to apply the cream twice a day for a specified time frame (on average 3 weeks to allocated areas.

What can I expect during Efudix treatment?

All patients should receive some form of reaction after applying Efudix to sunspots. The more sunspots your have, the larger the reaction, or inflammation you will receive.

Day 1-4: Mild reaction, not much may happen during the first few days of treatment, persist as per application guide.

Day 4-8: Efudix starts kicking in, and the skin will be red, slightly at first, increasing as the days go by.

Day 8-14: This is when things really start to cook. The skin may have a mild, moderate or severe stinging or burning sensation, and you may start to itch. Dry crusty areas will form. Your skin is now looking angry and irritated. These are all normal reactions following Efudix application. As the treatment continues, sores and crust may appear.

Day 14-21: You will need to see your Specialist or skin cancer doctor during this period. During this appointment, we will check your progress, and determine how much longer you should be on the cream. We may prescribe an anti-inflammatory cream to help you recover from Efudix once the treatment stops.

Day 21-28: Your skin will start to heal. Slowly at first, then more rapidly after 3 days of stopping Efudix. Redness may take a few weeks or months to settle.

How do I use Efudix?

Efudix can be used to treat either sun-spots, also known as solar keratosis or for the treatment of Bowen’s Disease. Treatment protocols will vary, however as a guide, Efudix is used-

Twice a day, either to spots or specified areas of sun damage
Treatment periods vary from 2 weeks to 8 weeks
Apply a thin smear morning and night, wash hands there after
Avoid sweating, swimming, exercise, sunlight and cosmetics for the duration of Efudix treatment
Arrange for a follow up visit with your skin cancer specialist 2 weeks into the regime

Your skin cancer doctor- specialist will give you an extensive and comprehensive treatment guide before you commence on Efudix treatment.

How long will I need to be on Efudix to treat sunspots?

As a guide, you will need to be on Efudix for 2- 8 weeks. Treatment intervals depends on –

The location of sun-damage
The type of sun-damage and skin cancer treated
How you react to Efudix
Any background skin conditions you may have, such as eczema, dermatitis, or rosacea

Most treatment regimes are tailored according to your skin condition and lifestyle factors.

Are there any people who should not use Efudix for sunspots?

Efudix has a great safety record spanning over two decades, however this treatment should not be used if-

You have an allergy to Efudix or 5FU
If you are exposed to sunlight or work in areas of high UV exposure
If you can not have a ‘downtime’ of at least 3 weeks
If you have conditions such as rosacea, or flush and blush easily
In pregnancy or lactation

What should I avoid if I am on Efudix treatment?

Efudix treatment, after 20 years, is still an excellent method for the management of sun spots and sun damage; however you will need to limit your lifestyle during the treatment. This includes-

No make up or cosmetics during Efudix for sun spots
Limitations on daily strenuous activities such as swimming, exercise or sweating
Limitations on sun exposure
Limitations on social events (if you are self conscious)

Time limits will vary between 2-8 weeks, depending on your treatment regime for sun spot clearance.

Can I wear cosmetics or use a moisturiser to cover my sunspots whilst on Efudix?

No. The treated areas should NOT be covered with makeup or sunscreen. You may start using cosmetics and skin care 3-5 days after stopping Efudix Cream.

How long after Efudix treatment will my skin look irritated?

Redness will ensure for the course of treatment, and will take upto 3-4 weeks to settle down. In patients who are red to begin with (rosacea type skin), Efudix is not the first choice treatment. Treatment with either 1927 Fraxel Laser or with PDT is considered a better choice in this patient subgroup.

In most patients, redness following Efudix treatment will start to settle within 3-5 days of stopping the treatment.

What other types of treatment can I consider for my sunspots?

Specialists and leading skin cancer doctors can give you treatment options for removing sunspots, apart from Efudix. Treatments such as Fraxel Laser or PDT can be an excellent method of sunspot removal, without the 4 week downtime of Efudix. A suitable treatment will depend on downtime, convenience, and costing for each patient.

Treatment	Downtime	Cost	Limitations	Advantages	Comment
Fraxel 1927	5-7 days	From $990	Cost; may need two procedures if severe sun damage	One off treatment, very quick recovery time – less than 7 d.	Helps with skin rejuvenation
Efudix	21-28 days	$160+ including follow up	Downtime, follow up visit mid treatment	Cost effective, works very well	*Best option if downtime is not an issue and tolerable skin type
PDT –photodynamic therapy	7-8 days	$2500- $3500Face and scalp	Cost	Short downtime, very effective, one off application	Good treatment for smaller areas of sun-damage. Eg upper lip
Picato	5-7 days	$150 for 5 cm by 5 cm	Cost; variable levels of inflammation.	Shorter downtime	Variable inflammation; needs physician monitoring.
Aldara	4-8 weeks	$300-$700 including follow ups	Long treatment regime	–	Limited use

What treatment should I consider if Efudix treatment is too long for me?

Regardless of bad press, Efudix is still considered a very effective and cost effective treatment for sun spots, solar keratosis and sun damage. The downside of this treatment is the prolonged regime of Efudix. Downtime can be up to 8 weeks or longer.

Shorter treatments for sunspots include –

Fraxel 1927 laser

Read more about Fraxel laser for sunspots

PDT or Photodynamic therapy

What is the cost of Efudix treatment for sunspots?

Efudix is one of the most effective, but also one of the most cost effective methods of sun spot removal. A tube of Efudix ranges from $50 to $75. In most patients, one tube will cover treatment for the entire face.

On average, Efudix treatment remission ‘’lasts ‘’ for 4-6 years.