What is the recommended approach for managing Bowen's disease with Efudix (fluorouracil)?

From the Guidelines

For managing Bowen's disease with Efudix (fluorouracil), the recommended approach is to apply 5% fluorouracil cream once or twice daily to the affected area for a period of 3-8 weeks, depending on the clinical response. This treatment regimen is based on the most recent and highest quality study available, which provides evidence-based recommendations for the management of squamous cell carcinoma in situ (Bowen's disease) 1. The application of 5% fluorouracil cream should be done thinly to cover the lesion and extend about 5mm beyond its visible margin. Patients should use a cotton swab or gloved finger for application and wash hands thoroughly afterward.

Treatment typically causes local inflammation with redness, crusting, and erosion, which indicates the medication is working. This inflammatory response usually peaks at 2-3 weeks and should be monitored. If severe irritation occurs, temporary interruption of treatment may be necessary. Following treatment completion, the area should heal within 1-2 weeks, though complete resolution of the lesion may take longer. Fluorouracil works by interfering with DNA synthesis in rapidly dividing cells, selectively targeting the abnormal keratinocytes in Bowen's disease while sparing normal skin.

Some key considerations for the treatment of Bowen's disease with Efudix include:

• The treatment regimen may need to be adjusted based on the patient's response and tolerance to the medication 1.
• The patient should be counselled about the potential side effects of the treatment, including soreness, redness, and possible crusting 1.
• Follow-up examination is recommended 1-2 months after treatment completion to confirm clearance, with periodic skin checks thereafter to monitor for recurrence.
• The treatment of Bowen's disease with Efudix is supported by guidelines from the British Association of Dermatologists, which provide evidence-based recommendations for the management of squamous cell carcinoma in situ (Bowen's disease) 1.

From the Research

Efudix Management of Bowen's Disease

• The recommended approach for managing Bowen's disease with Efudix (fluorouracil) involves topical treatment with 5-Fluorouracil cream, which has been shown to be safe and effective in treating the disease 2.
• A study published in 2003 found that topical 5-Fluorouracil cream was effective in treating Bowen's disease, with a recurrence rate of only 2 out of 26 lesions treated 2.
• Another study published in 2024 compared the effectiveness of 5-fluorouracil cream, methylaminolevulinate photodynamic therapy (MAL-PDT), and surgical excision in patients with Bowen's disease, and found that 5-fluorouracil was noninferior to excision and associated with better cosmetic outcome 3.
• The study also found that the proportion of patients with sustained clearance was 85.7% after 5-fluorouracil treatment, compared to 97.4% after excision and 82.1% after MAL-PDT 3.
• Guidelines for the management of Bowen's disease have been established by the British Association of Dermatologists, which recommend topical treatment with 5-Fluorouracil as one of the treatment options 4.
• Other treatment options for Bowen's disease include surgical excision, cryotherapy, photodynamic therapy, and imiquimod, but the choice of treatment depends on the individual patient and the specific characteristics of the disease 5, 6.