5-fluorouracil (Efudex) is a cream (or liquid) you apply morning and night to the sun-exposed areas to treat precancers, i.e., actinic keratoses.
It is best to treat just one area at a time, e.g., the scalp only or one side of the face only, for 7-10 days. 5-fluorouracil is not for widespread use. On the arms or trunk, you can use it 10-14 days. (For the lip, I usually recommend just once a day for 7 days.)
The area will get inflamed, red, scabby, etc., for the time that you are using it. It is okay for the 5-fluorouracil to get on normal skin as normal skin will not react. However, if the skin has subtle sun damage, it may react and you may develop more inflamed areas than you thought you would. It is always fine to take a break for a few days if the inflammation gets too severe. Make sure to protect your skin from the sun with sunscreen.
After you stop, the skin will take a week or so to heal. During this time, you may apply vaseline, hydrocortisone 1% ointment or cream, or other emollients to soothe the area. Sometimes there is some residual redness for a few weeks to a month after the therapy, but the roughness should be gone. If redness persists, covering the area with makeup is fine (often a green-tinted one is optimum for covering the redness).
It is critical to use sunscreen religiously after you have used 5-fluorouracil. The newly treated skin will be very sensitive to the sun. In fact, without daily sunscreen, the skin will become damaged again.
After the initial treatment has been completed, some patients like to use 5-fluorouracil once or twice a year to keep their skin "in shape." Some like to spot-treat individual lesions that come up. That is fine if they are red and scaly. But any brown or black lesions should not be treated.
Finally, 5-fluorouracil will not treat skin cancers, just precancers. If you have any growths, tumors, bleeding spots that won't heal, or black/brown irregular moles bigger than a pencil eraser, let the doctor know.
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