Efudex The Easy Way

So your Dr. has prescribed Efudex and all you've heard about is horror stories and pain.  You've maybe seen some photo diaries and are scared to wits to start treatment. 

Well, don't be.  It can be easy and not that painful.

 1. Talk to your Dr about the research done at Ohio State University and the Univ of Alabama.  Efudex is 70% more effective when combined with celecoxib (Celebrex).  See your GP or a cardiologist as Celebrex can be bad on the heart.  Don't just go with what your derm says.

2. Prepare.  Dig out your old pillowcases, sheets, clothing etc.  There will be, at the minimum, lotions and ointments getting everywhere.   Some must have items for me include Vaseline, lots of fresh razors and Aveeno ultra calming shave gel.

3.  The first week will be easy unless you end up with a Celebrex script.  With the Celebrex skin becomes very painful within 24 hours.  

4.  The main thing to know is that flourouracil is absorbed within the first three hours of putting it on. It comes in a 5% solution in a base of petroleum jelly. A phone call to Valeant's 1-800 number will confirm the three hour absorption rate.

You know how reapplying Efudex soothes the irritated skin?  Well you can get the same effect from applying Vaseline on top of the medicine as long as you wait three hours. 

5.  Time for the second daily application.  Here's the tough part.  You have to wash and scrub ALL of the Vaseline and any dead skin off.  I use shampoo, Garnier fructis, and a washcloth.  It's the only thing I have found so far that will take off the Vaseline and not burn.   

6. At this time I also shave.  I use the Aveeno Ultra Calming Shave Gel, no fragrance and no burn at all.  I use a new razor each time.

7.  The worst part of the day: as soon as the water stops running and I pat dry my face the burn sets in.  BIGTIME.  The worst burning I had with just 5FU was about a level 3.  But with the celecoxib, it is 10+... basically unbearable.  I can tell you, worse than being shot, having broken ribs, any pain I've ever known.  

The only relief is to get the Efudex back on the skin.  You can't do it fast enough if you're on the 5FU and Celecoxib.

8.  Over the next three hours the skin will burn and itch mildly and you will look forward to the vaseline.  

9.  Like clockwork apply the Vaseline after 3 hours and enjoy.  You will be tempted/distracted to rub your fingers all over your face for hours at a time.  It feels really good. Really good.

You look all glossy and red so it's tough to go out in public but you're fixing a long term problem before it gets out of hand.  It is worth it.

Here are some links for the research I've found as well as some important excerpts:

I was unable to find celecoxib creme in any form.  I am taking 3 x 200mg a day of Celebrex to coincide with applications times (twice) and a dose 6 hours after the AM application.

I am certain that oral Celebrex gives the synergy stated in the research due to the vastly higher irritation.  

Additionally, in the first 10 days of 5FU alone, I seemed to have peaked on darkened lesions forming, surfacing and dying in the first 6-7 days.  (I have very fast, high metabolism).

However, adding the Celebrex created a new series of these lesions as well as the 100% correlation with the stated research.

One last tip.  Butterfly swimmer is correct about this.  The Efudex does gather in the crease of the nose.  You want the medicine to get there, realize that sunglasses concentrate the sun there by reflection so you don't want to not put medicine there. 

Put it on so it vanishes like everywhere else then after waiting about 30 minutes run a Q-tip gently through the crease to remove any excess.

When you apply Efudex the idea is that you always apply sparingly enough that the creme vanishes.  If it's still white, it's too think and too strong.

One more thing for men, although shaving may be the last thing on earth you'd like to do you want to shave as it prevents fosse action around each whisker.

If you've ever deep powder skied, fosse is that hollow area around tree bases where the snow is absent.  When doing efudex is a minor gathering place for an unnecessary concentration of the medicine.

Use a new razor each time and the only thing I've found that actually feels good is the Aveeno Ultra Calming Shave Lotion with Feverfew and no fragrance.  I found it at wal-mart so it should be available everywhere. 

Jef1963 -

Some really good info, but if you noted my post earlier, I am post TX on hands and arms and now entire top of arms scabbing over and so tight it really is painful. Aquaphor or Vaseline are fine, but painful to apply with hair on arms with so many enflamed areas. I know face treatment is different, but same chemo, so how long before the inflamed skin and erosion starts to calm down??

Also have had some "experts" say let the erosion stay dry and not to lubricate too much so healing will go faster.  Does this make sense?  Seems new skin is growing back at same rate either way, right?

Whitey

The information I received from my dermatologist, pharmacist and package enclosure was only a two hour wait after application of Efudex.

And either vaseline, aquaphor, or cetaphil lotion.  Nothing else.

Please indicate where on the insert is reads "two hours".

 http://www.valeant.com/fileRepository/products/PI/Efudex-40_

The only verified information I have is by calling Valeant's 1-800 number where I was told 3 hours and only Vaseline which is 100% identical to white petrolatum, the base for Efudex.

Whether healing goes faster or not is hard to say.  However, I recently had a mole removed via scapel  and was to keep the stiches and entire area covered in Vaseline until the stitches were removed and for a week after by my derm.

Skin cells grow from the inside layer out so I don't think whether the outer layer is wet or dry matters as to rate. 

However, if you have pain that may affect your ability to complete the treatment (mine was, once on the celebrex + 5FU ) then vaseline was the only option.

Call Valeant, and then relay to your derm the info.

 Here's a point, the average derm has to know and fix 1000 different diseases.  You have 1, become an expert on your affliction.  

 I think the amount of disinformation and ignorance in the community (not just here ) is outstanding.

 One example is the bloodroot guy that believes he caught cancer from someone else or the flax seed cures cancer guy.

 If either of these were true they would be on the front cover of Time and Newsweek like Bruce Springsteen was back in 1975.

Your discussion of learning as much about your condition and not just relying on your Dr. is a very good one and often not appreciated enough.  On the other hand, some of these health boards have very poor and even dangerous recommendations, so do complete research.

At any rate, my acute reaction to 5-FU treating AKs on my arms and hands is finally susiding, and honestly the cocoa butter cream really worked the best to "calm" the nerves and soften the erosions.  I literally poured it on this last week.  From my elbows to wrists were 50 to 70 percent inflamed.  That's great stress on the imune system and I really had a tough time the week after 28 days of 2 a day application.  Hopefully no skin infection and this will continue to heal.

This is how the arms looked yesterday:

http://i31.tinypic.com/2mez4ee.jpg

Regerds, Whitey

Yes.  There is a lot of rumor and false information that get propagated on the internet.  Case in point is the 2 hour recommendation above where a post reads "2 hours" is on the package enclosure.  

 I followed up by posting a link to the insert.  I am unable to find ANY reference to absorption rate, or any time interval where it's recommended to apply any product or a recommendation of a product.

 Again, I ask everyone to verify by calling the 1-800 number themselves.

I am using the cream base, and the directions say not to put anything else on the skin.  So far I am only on day 7, so maybe I am not experiencing the full extent of the medication.  The doctor did not say anything about treating in combination with other medications - perhaps I am being too trusting about all this, but I feel my doctor is the expert and should know all the info.  She is a skin cancer specialist.  I would rather go along with her recommendations than find numerous conflicting information on the internet - which would drive me crazy!