Efudex (Fluorouracil) is a topical chemotherapy cream that is very effective in the treatment of actinic keratoses. It is applied to a small treatment area twice a day for 2-4 weeks. The area the cream is applied to becomes very inflamed and tender for the duration of the treatment and appears like a very bad sunburn. I warn my patients that during the treatment course the skin in the area Efudex is applied will look very inflamed. However, once the treatment is complete, the skin will appear very healthy and the sun damage will have been removed. It essentially gives the treated area a “restart” for several years and a reduced number of actinic keratoses will arise in that area. It is very important to remember to avoid all sun exposure during the treatment course with Efudex, as UV light will magnify the effects of Efudex and can result in very serious burns. I also recommend that patients choose a very small area to treat for 2-4 week stretches to limit side effects of irritation and discomfort. I find Efudex very valuable in patients with severe actinic damage in which individual actinic keratoses can not be clinically delineated. It is also great for patients who want to treat their actinic damage on their own schedule at home.
