How is Efudex (fluorouracil) cream used?

How to Use Efudex (Fluorouracil) Cream for Actinic Keratosis

For actinic keratosis treatment, Efudex (fluorouracil) cream should be applied twice daily in an amount sufficient to cover the lesions for 2-4 weeks until reaching the erosion stage. 1

Application Method and Duration

Standard Application Protocol:

• Concentration: Available as 5% or 0.5% cream
• Frequency: Apply twice daily 1
• Duration:
  • 2-4 weeks for standard 5% concentration 1
  • 1-4 weeks for 0.5% concentration 2
  • Continue until inflammatory response reaches erosion stage 1
• Application method:
  • Apply with non-metal applicator or gloved hand
  • If applied with fingers, wash hands immediately afterward 1

Expected Treatment Response Sequence:

1. Erythema (redness)
2. Vesiculation (blistering)
3. Desquamation (peeling)
4. Erosion (at this point, treatment should be terminated)
5. Re-epithelialization (healing) 1

Treatment Efficacy and Outcomes

Efudex is highly effective for actinic keratosis treatment:

• Complete clearance rates of approximately 70% 3
• Long-term efficacy demonstrated in clinical trials, with benefits lasting more than 2 years after a single treatment course 3
• Daily application is significantly more effective than weekly application (complete clearance vs. partial reduction in lesion count) 4

Important Considerations

Treatment Areas:

• Primarily used for face, scalp, and ears 5, 2
• Caution: Avoid application to mucous membranes or near the eyes
• Warning: Never apply to scrotal skin due to increased absorption and risk of severe dermatitis 6

Side Effects Management:

• Local skin reactions (soreness, redness, crusting) are expected and necessary for efficacy 4
• Inflammation correlates with treatment success - patients with higher inflammation scores show better clearance rates 4
• For severe reactions: reduce application frequency, take short breaks during treatment, or apply emollients 2

Rare but Serious Adverse Events:

• Systemic absorption can occur, potentially causing severe neutropenia in rare cases 7
• Monitor for unusual symptoms like fever, unusual bleeding/bruising, or excessive fatigue

Follow-up Care:

• Complete healing may not be evident until 1-2 months after treatment completion 1
• Regular follow-up is essential to evaluate treatment success
• Lesions that fail to respond to appropriate therapy require further evaluation, including possible biopsy 2

Special Applications

Actinic Cheilitis (Lip Keratoses):

• Efudex can be effective for treating actinic damage on the lips
• Preliminary biopsy of suspicious areas is mandatory before treatment
• Careful follow-up is required to ensure complete healing 8

Superficial Basal Cell Carcinomas:

• Only the 5% strength is recommended
• Apply twice daily for at least 3-6 weeks, sometimes up to 10-12 weeks
• Success rate approximately 93% 1

Remember that sun protection is essential during and after treatment to prevent new lesions and optimize treatment outcomes 2.