EFUDEX (5-Fluorouracil, 5-U)
General Information
1. Efudex is a chemotherapy medication when taken by mouth; however, in dermatology we use it totreat skin conditions such as warts, some skin cancers and most commonly actinic (solar) keratoses.
When applied topically the medication is not absorbed into the bloodstream and does not cause
typical chemotherapy side effects. It is safe to your body.
2. Efudex works by destroying the damaged cells on your skin. As a result it causes redness,irritation, and scabbing. This is a normal part of therapeutic skin response to Efudex.
3. The treated areas need to be completely protected from the sun during the treatment and therecovery process. If you need to go out into the sun, cover the area with a hat, long sleeve shirts,gloves, etc.
4. Treatment approaches very depending on the condition that is being treated. Your doctor will
specify which approach is right for you.
Instructions for Use
Approach 1: Continuous and daily therapy over a region of the skin
 This approach is used when you have widespread involvement over an area Use Efudex twice daily.
 The duration of treatment depends on the skin condition. Typically it takes 2-3 weeks for theface, 4-6 weeks for the scalp, arms and legs.
 You can make an appointment with our nurse one week into your treatment course to ensurethat your treatment is proceeding as expected. You can make this appointment at the time ofyour doctor visit or contact the Dermatology Department to arrange a nurse visit for Efudex
check.
Approach 2: Spot Treating
 This approach is used for an isolated lesion or for a few isolated lesions.
 Use the Efudex cream twice daily to individual lesions. You can apply the medicine with aQ-tip or use your fingers, but if fingers are used be sure to wash your hands thoroughly after
use to avoid irritation on other skin areas.
 The duration of treatment depends on the skin condition. Typically it takes 2-3 weeks for theface, 4-6 weeks for the scalp, arms and legs.
 The desired “end-point” of treatment is scaling, crust and redness at the treated site without abump being present to indicate the lesion is still present.
Approach 3: Weekly treatment over an extended period
 Your physician may recommend weekly treatment over an extended period. Specific detailsof this will be given by your physician at the time of your appointment.

What to Expect During Therapy
 Redness is caused by inflammation and destruction of the abnormal cells and indicates yourlesions are responding to the treatment. You may use an over-the-counter 1% hydrocortisone
ointment to decrease redness, although the treatment may be somewhat more effective if you
are able to avoid cortisone use. It takes 2-4 weeks for the redness to fade after stopping theEfudex; most of the redness resolves over the first 1-2 weeks.
 Crusting and peeling occurs as the sun-damaged skin is removed to allow for replacement
by normal skin. Cool washcloth soaks (washcloth soaked with cool water over face for 15-20
minutes 3-4 times per day) can help as well as a moisturizing ointment, such as Vaseline orAquaphor ointment. It is preferable to be moisturized rather than have the skin be dry. Itis fine to wash your face with plain water or a mild cleanser such as Dove or Cetaphil during
your treatment course.
 Itching and pain can be controlled with acetaminophen (Tylenol) or non-steroidal antiinflammatory medication (ibuprofen, naproxen)
In Addition
 You can apply the Efudex with a Q-tip (if spot treating), gloves or fingers. If fingers are used,however, remember to wash your hands thoroughly to avoid irritation on normal skin.
 Care must be taken with Efudex during sunny months because the medicine is reactive withthe sun. DO NOT USE EFUDEX IN SUMMER MONTHS unless specifically directed toby your doctor.
 Do NOT use Efudex on eyelids or lips unless specifically directed to do so.
 Care must be taken with Efudex in skin fold areas like the fold from the nose to the corner ofthe mouth. Try to avoid having any Efudex accumulate in those areas.
 Not all bumps will respond to the Efudex. There are benign types of keratoses that will notreact to the medication (such as seborrheic keratoses). If the area treated is not getting red itdoes not mean the medicine isn’t working.
 Consider the Efudex as an investment in the health of your skin; the benefits of “sticking itout” are worth it! Efudex is an excellent way to reverse many years of sun damage.
When to contact your provider
 Once you have completed your prescribed course of therapy, wait for a period of 4 weeks to
see if treated areas resolve. If you have lesions that have not responded, make a follow-up
appointment with your doctor in about 8 weeks. In evaluating unresponsive areas your doctor
will need the skin completely “settled down” this usually takes a period of at least twomonths.
 If having extensive burning, itching, swelling or tenderness call the Dermatology Department
to arrange an Efudex check with our nurse, who has extensive experience with Efudex
treatment. Although the Efudex treatment sometimes produces dramatic redness, crusting andpeeling, problems such as allergic reactions and infection are rare.