Fluorouracil (Efudix/Tolak)
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- Fluorouracil (Efudix/Tolak)
Actinic keratosis(AK) also known as solar keratosis presents as rough, red scaly patches on sun exposed areas of the skin. They are precancerous and a common precursor to Squamous cell carcinoma (SCC). Treatment of AK is recommended due to its premalignant nature.
Efudix and Tolak contains the chemical Fluorouracil. This is a chemical proven to be effective against early forms of skin cancer such as actinic(solar) keratosis, Bowens disease( SCC in situ) and superficial BCC. It is taken up by the rapidly multiplying precancerous keratin cells and causes cell death.
Use the cream daily till you get a good reaction. Depending on the severity of the reaction you can dial up or dial down during the treatment. If the reaction is severe and uncomfortable you can skin a couple of days and then start using the treatment again. Use the cream for a total of 4 weeks.
The cream can be applied to either the individual skin lesion or to the surrounding area as well. If you are applying the cream to the surrounding area, skin that is not yet visibly damaged will also be treated – this is called ‘field treatment’. Different regions of the face can be treated at the same time, e.g. forehead and temples. However, if the sun damage is widespread you may find it easier to treat different sections in stages, one after the other. The larger the area treated the more dramatic the redness and inflammation
Apply the cream with a clean fingertip or using gloves. If you are treating your whole face, use four pea-sized amounts of cream; one on the chin, each cheek and the forehead. For selected areas, just use one pea-sized amount of cream. Wash your hands after applying the cream.
Moisturiser may be applied 20 minutes after applying the cream. Please wash or clean affected areas as normal, but avoid products which may sting or irritate your skin. Please use a gentle cleanser or a soap-free product to wash. You can apply a small amount of makeup 20 minutes after applying the cream, as long as the skin is not broken or irritated
Sunscreen is a very important part of treatment for sun damaged skin, to help prevent further damage. The cream can make you more sensitive to sunlight, particularly during the warmer months. The reaction may also be more severe if you have excess sun exposure during your treatment.A broad spectrum sunscreen (SPF30 or above) should be applied every day before going outdoors, and reapplied regularly through the day. Don’t forget to wear a hat, long sleeves and trousers (or a long skirt), to protect your skin.
The main side effect is skin irritation (dermatitis). The cream works by directly destroying the sun-damaged skin cells. This will cause intense inflammation, crusting, redness and oozing of the whole area treated. Inflammation is a good sign, as it shows the cream is having an effect. If the inflammation is too uncomfortable a steroid cream can be prescribed to calm down the inflammation. Sometimes treatment is reduced (for example, to use on alternate days) if the reaction is severe, but a full course of treatment is required – your doctor can advise you on this. Generally, the more intense the inflammation the better the end result!
After 2-4 weeks your skin will be red, crusty, and uncomfortable; this is what we want to happen. In some cases, such as for lesions on the backs of the hands, the body, it might take longer to get to this stage (4-6 weeks). The cream can then be stopped, to allow healing. Treatment can vary from person to person. Your doctor will tell you how long you need to use it for. The treatment can be repeated after a couple of months for any remaining areas of sun damage.
The time for results to show varies from person to person. The following is a guide as to when to expect results:
• 1-3 weeks – Inflammation with crusting and redness of the skin
• 3-6 weeks – Skin inflammation settling down
• 6-16 weeks – Clearance of the sun damaged skin
Follow up.
Please make a follow up appointment 3 months after treatment to assess
response and
assess need further treatment.