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Personalised Efudix Treatment

Efudix Cream is a prescription cream commonly used for early precancerous lesions. It can reduce the development of skin cancers and the need for surgery.

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What is Efudix Cream?

Fluorouracil (Efudix) cream is a very commonly used prescription cream for early precancerous lesions. When used appropriately it can reduce the risk of skin cancers and the need for surgery.

Fluorouracil preferentially blocks DNA replication of abnormal, cancerous cells which in turn destroys them. It has little effect on normal cells.

The most common lesions treated with Efudix cream are:

What else can it treat?

Other conditions that can also be treated with fluorouracil cream include superficial BCCs (sBCC), viral warts, and genital warts.

It is important to note that it cannot be used on all cancerous lesions and is only effective for superficial lesions.

It can be used on individual lesions or as a field treatment to clear a larger area of skin from numerous lesions and microscopic pre-cancerous changes.

Is the cream effective?

Many people report very good outcomes after treatment and find that their skin is smoother, more youthful, and healthier in appearance. It is subsidised by the government and is available for the cost of a standard prescription charge.

Studies have demonstrated that Efudix treatment is very effective, 75% of people maintaining 75% clearance 12 months after treatment. This is superior to other more expensive treatments.1Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized Trial of Four Treatment Approaches for Actinic Keratosis. N Engl J Med. 2019;380(10):935-946. doi:10.1056/NEJMoa1811850

Recent studies have shown that the cream can effectively be combined with calcipotriol (Daivonex) to reduce the duration of treatment which has historically been one of the biggest downsides of Efudix. Some have even suggested that the combination is more effective than Efudix alone. Other studies have also suggested that it may reduce the development of squamous cell carcinoma.2Mohney L, Singh R, Grada A, Feldman S. Use of Topical Calcipotriol Plus 5-Fluorouracil in the Treatment of Actinic Keratosis: A Systematic Review. J Drugs Dermatol. 2022;21(1):60-65. doi:10.36849/JDD.2022.6632,3Dlott AH, Spencer SA, Di Pasqua AJ. Calcipotriol and 5-Fluorouracil Combination Therapy for the Treatment of Actinic Keratosis in the Clinic: A Review Article. Clin Drug Investig. 2024;44(10):733-737. doi:10.1007/s40261-024-01392-w,4Rosenberg AR, Tabacchi M, Ngo KH, et al. Skin cancer precursor immunotherapy for squamous cell carcinoma prevention. JCI Insight. 2019;4(6):e125476. Published 2019 Mar 21. doi:10.1172/jci.insight.125476

How does Efudix cream work?

Efudix cream preferentially kills rapidly dividing cells, which includes abnormal cancerous cells. It does this by interfering with the cellular replication process of these rapidly replicating cells.

What are the downsides of Efudix cream treatment?

We will be honest, the treatment can be unsightly. As it kills abnormal cells, Efudix cream treatment causes an inflammatory reaction that manifests as a red, scabby eruption sometimes with superficial ulceration. This is temporary, however, it can be uncomfortable for some. Depending on where and how the treatment is undertaken, the reaction can last anywhere from one to four weeks.

Adverse Effects

  • Nausea: When used on a large area, some people experience nausea during treatment. The maximum area that can be treated at one time 500 sq. cm (approx. 22 x 22 cm, or an A4 sheet of paper).
  • Discomfort: If the skin becomes very sore, stop treatment for 2-3 days, then restart.
  • Light sensitivity: Avoid using if you will be exposed to strong sunlight during the day. It is best to treat between May and September.
  • Incomplete treatment: Repeat treatments may be required.
  • Allergy: is very uncommon and results in premature, inflamed skin.
  • Efudix treatment can trigger the development of skin cancers.
  • Efudix should not be used when pregnant or while breastfeeding.
  • Avoid treating the eyelids or near the eyes.

A small proportion of patients can be sensitive to Efudix and may experience abnormal, exaggerated skin reactions. If the cream is used on a very large area all at once, people may absorb some of the cream into the body, causing nausea. Your dermatologist will normally provide instructions to limit the area that is treated during a course of treatment.

How to use Efudix Cream

Efudix should only be used under the direction of a doctor. Inappropriate treatment of skin cancers, instead of just pre-cancerous lesions may complicate and delay treatment of skin cancers.

Using Efudix Alone

Apply Efudix once daily in the evening to the specified treatment area for:

  • Lip: 1 week
  • Face: 3 weeks
  • Body: 4 weeks (includes scalp, trunk and arms)
  • Legs: 6 weeks

Expected Progress

  • Week 1: Minimal reaction to mild redness (lip will react)
  • Week 2-3: Red, inflammation, crusting, possibly uncomfortable
  • Week 3-6: Gradual improvement, may remain slightly pink for up to 10 weeks.

Using Efudix with Daivonex

Mix Efudix and Daivonex together 50:50 in a pot and use within 3 months. Apply mixture twice daily to the specified treatment area for:

  • Face: 4-5 days
  • Body: 7 days (incl. scalp, trunk, arms)
  • Legs: 10 days

Expected Progress

  • Days 1-2: Minimal reaction to mild redness
  • Days 2-7: Red, inflammation, crusting, possibly uncomfortable
  • Week 1-3: Gradual improvement, may remain slightly pink for up to 6 weeks.

When is the best time to use the cream?

Fluorouracil can react with strong sunlight and is best used during the cooler months, such as between Easter and Labour weekend. The combination of Efudix and Daivonex can be used during summer, provided that the treatment area is protected from exposure to strong sunlight.

References

  • 1
    Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized Trial of Four Treatment Approaches for Actinic Keratosis. N Engl J Med. 2019;380(10):935-946. doi:10.1056/NEJMoa1811850
  • 2
    Mohney L, Singh R, Grada A, Feldman S. Use of Topical Calcipotriol Plus 5-Fluorouracil in the Treatment of Actinic Keratosis: A Systematic Review. J Drugs Dermatol. 2022;21(1):60-65. doi:10.36849/JDD.2022.6632
  • 3
    Dlott AH, Spencer SA, Di Pasqua AJ. Calcipotriol and 5-Fluorouracil Combination Therapy for the Treatment of Actinic Keratosis in the Clinic: A Review Article. Clin Drug Investig. 2024;44(10):733-737. doi:10.1007/s40261-024-01392-w
  • 4
    Rosenberg AR, Tabacchi M, Ngo KH, et al. Skin cancer precursor immunotherapy for squamous cell carcinoma prevention. JCI Insight. 2019;4(6):e125476. Published 2019 Mar 21. doi:10.1172/jci.insight.125476