After researching treatments for solar keratoses, I decided to try Efudix. I want to share my experience with others considering treatment.
How It All Started
I grew up in a very normal Queensland family—plenty of time spent in the sun, yet always aware of the dangers of sun damage. I had red hair and plenty of freckles, which should have signaled me to always slip-slop-slap on some sunblock.
Now, at 31, I am well aware of the ramifications of our 'it'll be alright' attitude.
I am fortunate enough to have family and friends that constantly remind me to have my skin checked. At the age of 25, I had a very small basal cell carcinoma removed. At the age of 31, my dermatologist told me that there were many more signs of sun damage on my face and hands and that I would be in a world of pain if I waited to treat them.
As you can see from the above picture, I had no reason to think I was in danger, or that I would need to undergo any treatment that would involve topical chemotherapy. Little did I know!
After spending months considering the Efudix topical treatment, getting second opinions, spending hours researching on the internet, speaking with a natural therapist, and speaking with others who were treated, I decided to take the plunge. Not only did I hope my solar keratoses (skin spots) would be gone in a month, but I hoped for much younger-looking skin.
The following is my day-to-day account of my treatment.
Day 1: 5th September 2010
Today is day one. I have the cream and have prepared the family for what the next month will entail, which is especially hard to do given the unknowns. Once dinner is done, I will be applying the first round of Efudix. I am apprehensive and have concerns about the burning and itching starting right away. I am also a little excited that I am one day closer to the treatment being completed and a more youthful me.
After the first application, my only concern is whether I have used enough.
After 2 hours: There is some very slight tingling, but I am wondering if this is simply a result of me focusing on how my face is feeling.
Day 4: Now I Can Feel It
Day four has started in a fairly uninteresting manner—out of bed, into the shower, wash my face with just water (is that really washing?) then reapply at 6:30 am.
At this point, I am thinking that the first week is going to be a breeze.
It is now 12:30 pm, and I am just starting to feel some real effects. My face is feeling quite warm—like I have spent too much time in the sun. The itching is getting a little more consistent, and my face is starting to get red and blotchy.
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Day 6: So Far, So Good!
Well, I have almost made it through the first week, and so far, so good.
There have been a few moments during the course of the day when the consistent itch became a real irritation, and there have also been times where I would liken the warmth on my face to a hot flash. So far keeping busy and keeping my mind occupied seems to be helping.
I am applying the cream right after a shower twice a day, and am starting to find the cream is taking much longer to soak into my skin. Last night, I waited about 20 minutes after my shower to let my skin dry out before applying the cream, and I noticed that the application of the cream was a little gritty.
Having my face directly under the hot water in the shower is creating some discomfort, so now I have to just splash my face. No real issue.
I am also treating the skin on the back of my hands, and I can honestly say that I have not felt any pain or had any discolouration there yet.
You will see from the photo, the colour of my skin is not yet a real problem, though I have had some comments today about spending too much time in the sun. I think I am only days away from being particularly unsightly.
Day 12: It Is Becoming Challenging
It has been six days since my last update, and up until today, I had very little new experience to share. It was just more of the same—hot flashes, tightness in my skin and a slight headache.
Today was a different story.
I woke up this morning with a headache and a lot more stinging pain on my face. My morning routine since day eight has been simply a shower in a can and a quick splash of water on my face to get rid of any residue left from the night before. This prepares my skin for the next application. The direct water on my face is no longer bearable, and the steam in the shower is also causing some discomfort.
Between towel drying (very gently patting) my face and applying the next dose, my stinging skin bought some tears to my eyes, but I keep telling myself that it is fine, we are almost halfway through the treatment—stay tough. Then, as I apply the cream onto my dry skin, the grit and the scratching only add to the pain.
All the while, hubby and my five-year-old are in bed keeping a close watch making sure I am okay. What can I say? I am fine and just need a few quiet minutes to let my fiery skin settle down. After some quiet, and coffee and toast, we are back to where we were yesterday—just feeling generally uncomfortable and hot and scratchy.
Funny story, last night after dinner I noticed in the mirror that I had what looked like the remnants of a beautiful dinner on the edge of my mouth—which my hubby and I thought was pretty funny. Now that it hurts to stretch my mouth too widely during dinner (or if I laugh or smile too hard), it was quite possible that there was food on my face. But no! Closer inspection revealed parts of my skin flaking and clumping at the corner of my mouth—which is particularly unsightly.
So I will continue on with my day—headache in the background—not laughing too hard and continually keeping my mind busy to avoid the discomfort of my face.
I would love to hear from anyone else that has been through this treatment.
Day 14: This Is No Fun
It is hard to remain positive when you are running on limited sleep. Last night, after bedding down early (after an uncomfortable day in the office), I woke up at about 11:30 pm because my face was aching terribly, and the all-over itching was unbearable. After two Nurofen (ibuprofen), and two hours reading (to take my mind off the itch), I finally got back to sleep, although the rest of the night was quite restless.
This morning, I took my time dragging myself out of bed, then went through the morning ritual—shower in a can, a splash of water on my face and then more Efudix. It took a good 30 minutes for my face to calm down, even after more Nurofen. The headaches were not a problem today. The main issue was the constant aching and the stinging, dry feeling I am battling. There is a constant sense of pressure on my skin that makes me feel that if I smile too big my face will literally crack.
Both eating and speaking are much more difficult. My family and I are selecting our meals more carefully, eating only things that can be cut into small pieces.
I am meeting with my doctor on Monday (day 16), and I am hoping he will tell me that I am through the worst of it, but I think this is wishful thinking.
Thanks so much to my family. I really am so grateful for your love and support.
Day 15: Call the Doctor
What a day! After a restless night's sleep, I woke up in pain. The burning, aching, and itching feeling is constant and extreme. I had a home call from my doctor at midday and was given Panadeine Forte (acetaminophen and codeine) for the pain. The remainder of the day was quite bearable.
I am not going to be shy with pain relief—there's no point making this experience any worse than it needs to be.
Day 16: Efudix Follow-Up With the Dermatologist
What a day, and what a difference a few hours can make!!!
I slept a little better last night—the Panadeine Forte is doing its job.
What a sight (see the above pic). It seems that overnight more of my face has scabbed over, and the dryness on my face is much worse than what it has been up until now. BUT, today I have a good reason to soldier on. I am meeting with my dermatologist to review my Efudix treatment, and there is a little part of me that is hoping that he will say we have done enough, and I can stop applying the cream and begin the recovery phase.
Two more Panadeine, and hubby is driving me to the doctor. I am feeling extremely self-conscious because I am looking like a real sight. This is the first time my hubby has been out with me since I started treatment, and he is a little amused at the awkwardness he sees in the reaction of the people we pass. I have a slight (very slight) understanding now of how disabled or disfigured people feel when they are in public.
The first thing the doctor says is, 'Oh, you have had a fairly extreme reaction, it must be sore'! He then continues to tell me that while my reaction is extreme, it is a good outcome because we have gone deep enough—removed enough layers of skin—so we can STOP applying the Efudix! I am not sure whether to laugh or cry (mind you I am still pretty dopey from the pain medication). Oddly enough, I am apprehensive to stop and question his reasoning—I really need to be sure that we got it all. I don't ever want to have to go through this again. The doctor assures me that it is time to stop with the Efudix, and it's time to start putting moisture back into my skin and allowing the new skin to come through. It may take another couple weeks before we see any great results, but this a huge step forward.
Funny thing, my hands (which I have also been treating for two weeks) are still showing very little reaction to the treatment, so we will continue to apply the Efudix for another two weeks, at which time I will be meeting with my doctor again.
After coming out of the doctor's office, all I can do is cry. I cannot believe that this is almost over.
Day 16, Part 2: Recovery Begins
So in stage two, we begin putting moisture back into my skin and allowing my body to do its job and start the repairing process. I have a prescription for some steroid-based cream to reduce the swelling, the redness and the pain. This cream can only be applied once a day. I have also been told to get a very heavy, greasy moisturiser to keep my exposed skin covered while it heals. I can not wait to put some moisture back into my skin!
Fortunately, my sister is available to do a quick trek to the health food store to get me the best available creams to do the job. Within an hour, she arrives at my doorstep with some manuka honey moisturiser and some shea butter. This combination should soothe, heal and protect my skin.
After just the first application of moisturiser, I am feeling like a new woman. I can open my mouth without excruciating pain, I can rub my lips together, I can speak normally and I can smile. I will continue to apply these creams as my face gets dry, and will use the steroid cream if absolutely necessary.
As I look back over my day, I have mixed emotions. Looking at this morning's photo brings tears to my eyes. Now when I look in the mirror, my face is red and shiny. It's still a little itchy and sore, but it is SO much better.
Day 18: Recovery Day 2
Today is my second full day of the recovery phase, and I was thinking that things should start to improve. Unfortunately, that hasn't really been the case. The pain continues, and the itching is worse, but the upside is that I am now able to smile, smirk and speak without the fear of splitting my face open.
I am still taking the Panadeine at night because I need a good night's sleep to get me through the day. When I wake up in the morning, I feel nauseous, and I still have a headache. After breakfast in bed (thanks to my boys), I slowly make my way into the day with my new routine. I take a quick shower to splash the remnants of last night's moisturiser off my face, pat my face dry with a tissue and reapply the moisturiser. Then I am ready for the day.
The creams I am using are keeping my face moist until about midday. Around then, parts of my face start to dry out, while other spots are very moist, and the skin oozes a clear liquid (which has an interesting odor). I understand that this is normal. When my face gets dry and air comes in contact with the bare skin, it's painful. So I have to have a quick pat down then reapply the creams. For the remainder of the afternoon, the itch and stinging is unbearable. It is a good excuse to take an early mark from the office and get home to shower and repeat the moisturiser application process.
After two and a half weeks, this process is just getting me down. I cannot wait to get my life back. I hope it won't be much longer.
Day 20: Recovery Day 4
Not a lot of new experiences or information to share. More of the same—headaches, nausea in the morning, and all-day stinging and burning with patches of dryness. I am reducing the amount of painkillers I am taking, and fortunately, I am still getting a good night's sleep.
Earlier this week, I spoke with a friend who has done this treatment before, and we spoke about the oozing and the goop, and the smell that is particularly unsavoury. He described this smell as 'the smell of death', and I think he is spot on.
I am really quite tired of this ordeal, and I think I am becoming a lot less tolerant. I am usually considered a pretty tough person, but now I'm really questioning this. How do other people that go through this treatment cope?
I am going into another weekend that will be spent entirely at home. Exposing my face in public right now is uncomfortable and not my favorite thing to do.
I have attached pics from yesterday and today, and hope that the next time I upload a picture it will look very different. I am confident that by the end of the weekend the worst of it will be over. We'll see!!!
Day 24: Recovery Day 8
It is amazing the difference a few days and a tub of moisturiser will make.
The past few days have been pretty uneventful. The pain in my face has dramatically reduced and is really just a discomfort that comes when my face starts to get a little dry. The mornings are still tough after my face has gone hours without moisturiser. As I reflect on the past two weeks, I feel that I am in no position to complain; what I am dealing with right now doesn't even compare to what I was experiencing before.
Today's photo was taken this morning, and now five hours later I am seeing further improvements. I think I am getting some glimpses of what my new skin will look like. As the layers of dryness are removed, new skin that is smooth to the touch is revealed. So far it looks flawless. I can only hope that this is how my whole face will look in a few short weeks.
I am still applying Efudix to the backs of my hands, but have reduced the application to just the spots I can see. I am now, after three weeks, feeling some tenderness in these spots, but after the ordeal I have been through with my face in the past few weeks, I think I am pretty well prepared to see this through.
Just today, I have a spring back in my step and am confident that I will be able to show my face in public again in just a few days.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
KathGH on May 23, 2019:
I am about to embark on the Efudix torture over my entire face like you did :-)
I read through your article.
What I want to ask you is - besides removing the sun cancer spots, did you get a more youthful skin that you hoped for as the other benefit? That is definitely a motivation for me as I have pigmentation too which I cant remove with the hydrogen ice burns...
I don't see any photos of you once you are completely healed.
Thanks so much
Kath, South Africa!
Clifton Donnelly from Brisbane on December 29, 2017:
Many thanks for your most interesting description of your efudix treatment.
This is very informative & educational in what I might expect as I start treatment this week.(Dec2017)
The two or three photos my Dr showed me hardly covered the extreme results.
I am now so much better prepared to (lol)face the treatment and side effects, Thanks to your blog.
P.S. Everyone else starting treatment, I'd highly recommend reading thru ALL the comments below...
Many good tips & lots of slightly differing experiences to be learned!
Johann on June 15, 2016:
Hi there, I have been advised by my dermatologist to apply Efudix twice daily for 2 weeks. I am on day 5 and my skin is starting to feel tender to the touch and somewhat stiff. Not looking forward for what is still to come though . . .
goospanish on October 30, 2015:
Some do. cancercompass has a lot of information. I'm on day 2 of treatment
Maggie on October 24, 2015:
I used Efudix on my face, both cheeks and chin all areas. At day 15 of daily application, my reaction was so severe that my consultant said stop (my GP had prescribed it for 4 weeks use). I am into day 3 of recovery and my face is covered in dried up puss-y scabs. Just hope I don't get any permanent scarring. Any others get this?
Bill wilson on July 07, 2015:
Day 18 and now finished the cream,thank goodness! I'm a roof plumber,58 ,plenty of Australian sun,live in Victoria. Second time I have used the efudix cream . Hard work but the results are worth it.My information that I pass on are my results.Dont give up; itchy,sore,ugly,personally makes you feel to hide from public,lower esteem .But the good news,I remember the first time I used it,my face turned like a baby's bottom,a great result.Now,a week or so to go in recovery,I'm upbeat and ready to go! Bottom line ,it makes you look good and it kills those bad skin cells.Persist !
Joan on November 09, 2014:
I'm on day 31 with a spot which is getting larger due to the treatment. No headaches but the pain is increasing along with the itch. My forehead is very unsightly and strangers ask me what happened. I just tell them it is skin cancer and that I'm okay.
Donna on September 21, 2014:
I was so glad to find your article. I felt I was on my own doing this treatment. In a strange way it is rather comforting that so many others have gone through and are going through what I am now. You can feel quite alone and isolated. I am Day 18 and just reading your article and seeing what you have gone through makes me feel better. You were brave to post your journey but it certainly has helped mine. I have not experienced the amount of discomfort you did. Thanks again :)
Fiona on August 20, 2014:
Great to read your experience kirsty, im day12 and its good to see that what im going threw is normal, not very nice but the end result better be worth it
Frank on May 23, 2014:
another ex-Qld'er here - (highest skin cancer rate in the world - a lot of white people with an outdoor lifestyle in a sub/tropical sun - d'oh!) - I got my first BCC at 31, and have lost count of how many I've had frozen off or cut out - now 60 and with regular 6 monthly checkups (last week found a small BCC on my back - doc said 'make a 30min appt to cut it out - no hurry - these are slow growing), I've only just been told about efudix/fluorouracil by my partner (that her boss is using it on his forehead for a superficial area) so am reading about this for the first time.
My father was a doctor, I did a year of medicine so can scan such info quickly - metabolic inhibitor, targets fast growing cells, recommended for superficial pre-cancerous spots where usual removal methods are not suitable (I'm guessing eye lids or large areas on the face that have been left untreated for too long).
I'm a bit confused - read this story of nearly dying from anaphylactic shock from using too much of this stuff - http://www.heather-ellis.com/efudix.html - it almost looks like the same story.
My thoughts from 30 years of having skin cancers removed and my doctor's suggestions - if it's a real BCC better to cut it out - they can then biopsy it to check they've removed all of it - simply freezing/burning off the top layer can come back and bite you if it spreads further underneath while the top layer is 'healing'
if it's pre-cancerous/solar keratosis only - then maybe - but maybe don't use too much unless you're ready for a world of pain and can lock yourself away from visibility for a fortnight.
and of course if it's a rapidly growing spot - look out for dark/irregular/multi-colour/red or purple/raised/crusty spots - get it checked by a skin doctor - in Qld they should know - not like Taiwan where I went to the skin 'specialist' with a BCC - he looked at it (hadn't seen many I guess) told me it wasn't a BCC - OK - I came back to Oz, went to my skin doctor, he said yes it is and removed it. So don't trust everyone you hear - get a second opinion - it's your life - humans make mistakes all the time - keep looking until you find your answer !
Sharon S on March 20, 2014:
Omg - I've just completed Day 4, and I'm freaking out. The doctor gave me the script, $69.00 later, and it's only now I've wondered what I was getting myself into. I'm going to continue, but I had absolutely no idea what I was doing.....now I do, and I'm crapping myself ahhhhhhh
Tom on January 03, 2014: