Side Effects of Carac or Efudex

This is Kathy again. Because using Carac cream is so unpleasant, I've been online trying to learn everything there is about it. What I just read on one site suggests stopping applications once the "erosion" stage is reached. I have lost the entire top layer of my facial skin (prior to reading the information today) I called my dermatologist to ask if I should continue treatment (prior to reading the information about erosion/stopping treatment) and she said to continue for the full 28 days. I'm confused..because I am now applying the cream to an entirely new layer of skin. Any comments?

This is Kathy again. Because using Carac cream is so unpleasant, I've been online trying to learn everything there is about it. What I just read on one site suggests stopping applications once the "erosion" stage is reached. I have lost the entire top layer of my facial skin (prior to reading the information today) I called my dermatologist to ask if I should continue treatment (prior to reading the information about erosion/stopping treatment) and she said to continue for the full 28 days. I'm confused..because I am now applying the cream to an entirely new layer of skin. Also, several years ago I had 6 sessions of IPL (intense pulse light) which "removed" 'age spots.' I am now wondering if this has any cause/effect on AK's (masking them?) which only means they resurface later? Might it have increased the sensitivity ofmy skin to the sun? Any comments?

Hi everyone,
Have been on this round of Efudex for 15 days.
My GP recommends the 28 treatment regime (twice a day for 14 days) But I have read that the treatment should be longer (3-6 weeks). I have AK's and bCC's.
My question to everyone is: Has anyone tried using Vitamin E, topically, after the treatment to speed up the healing process? I know for a fact that in my case, other wounds heal much faster. But can not figure out if one wants fast wound healing in this case.
Thanks,
Mike

Hi Mike. Good question regarding Vit E...I have also wondered the same. I am now on day 25. I recently read that six weeks is recommended for some cases. My Dr. definitely wants me to do the full 4. I have read much contridicting information regarding the use of efudex/carac. One article suggested cleansing the area using soap, another urges not to use soap, only water. One instructed to stop using the cream once the erosion stage is reached; another urges continuing the treatmet the full 4 (in one case) weeks. Not one article mentioned OTC vaseline but my dermatologist has; also antibiotic ointments are ok. The main thing here being the 2 hour waiting period. I read one article that detailed the use of efudex or carac twice daily; my Dr. urged NOT to do that as did another article. It goes on and on so; to answer your question...I don't know but, logic suggests you might be on to something. I have wondered if (and this might be a great example of pretzel logic) if (now follow me, here)efudex/carac might inhibit the healing process stimulated by Vit. E/neomyicin, etc???? Hmmmmmm...I CAN say that week 3 was, by far, the most difficult and that the pain and burning stopped just into week 4.

Thanks Lucky Cat,
I THINK that the reason most Docs don't prescribe the twice daily treatment is that one gets REALLy sore (no pun intended), quickly. And at this point (16th day at 2/day) sure isn't pretty. :>) The other continuing mistake I'm making in that regard, is I have not stopped the heavy sweating from the intense exercise program I'm on. (Higher body temp equaling faster reactions?)

As far as cosmetic appearance, frankly I am not too concerned as "this too shall pass."


I was thinking that I may try the Vitamin E (as d-alpha tocopherol), after completing the entire regime. BUT-------am wondering if this is self-defeating.

My limited understanding is that Efudex works by alerting the body to the cancer cells. The body then sends mechanisms to fight these rogue cells, thus destroying them. And what we see on the skin surface is the result of that battle. Therefore, it could be that even though one has stopped the treatment, cancer cells are still being destroyed by the activated immune system. By introducing Vitamin E, one may prematurely stop the battle. Any thoughts?

Hi again Mike and others in our sorry state(s)..(mine being California!!) Anyway, my understaning of the reading materials I've perused is that flourouracil topical cream (active ingredient in efudex and carac) identifies and isolates rapidly growing cells. It then effects these cells by inhibiting their ability to utilize RNA and DNA thus stopping cell division which eventually (and rather quickly, it seems) kills the cell. In our cases, AK's or BCK's are destroyed. Technology is wild, isn't it? Your question about Vit. E -which aids in rapid healing - which just might be impaired by flourouracil because it identifies rapidly dividing cells?!? I don't know, but I do wonder. Same w/antibiotic creams which are touted to aid (and abet?) healing...I think we're getting off track here a bit.

But, as I have noted previously, there do seem to be quite a few contradictions and/or varying styles of prescribing this medication. I'm using a petroleum based super skin soother just because the dryness is almost unbearable at times. The emolients have helped.

All this for ignoring all the advice of my elders and believing that I was the exception; impervious to harm...oh well.

Hi again Lucky Cat,
Somehow, I may not be expressing myself correctly. The whole Vitamin E idea is to use it only after the Efudex regime is completely finished. Purely as a way to heal the "cosmetically challenged" areas. (How's that for PC?) :>)
As a side note, I tried a little Vit E on the area between my nose and cheek intersection, as this was a particularly sore area. And certainly not cancerous, I don't think. Anyhow, within just a few minutes, the area was not nearly as tender! Amazing! Again, this is day 17 of at LEAST 2/day treatments. (After heavy sweating I have been reapplying the Efudex) So, that makes at LEAST 34 applications. Interestingly, every day the lesions have been getting redder and more have appeared. Until this morning. Earlier today, I noticed that some of the sores have actually "peaked" and are not as red as they had been. Hmmmmmm Anyhow, I am going to continue the 2/day treatments till Friday and then quit. Then, the decision as whether or not to use the Vit E will have to be made. I may try contacting Efudex directly.
Thanks for your input and would love to hear your opinion.
Mike

Hi Mike. I see now what you are saying about end of treatment use of Vit. E. I'd ask your dermatologist about the Vit. E (at the end of treatmets)in its purest form (natural Vit E as you mentioned). I think it would be beneficial. Are you using anything to ease the dryness now, during treatment? My skin became so dry by the middle of the second week that I had to start using vaseline. That has helped so much. Now, there is still more localized pain and deeper reddened areas and I have only 3 applications remaining including tonight. What is happening now is that my skin is pealing (erroding) again...a second time. My sores peaked as well and it is downhill from that point; less pain, discomfort, and scary appearance. Also, you must have a great ability to withstand discomfort. I can't imagine working enough to perspire or being too active while using carac. When I'm gardening or painting outside, I don't last nearly as long as normally. Also, hot weather is difficult for me. California, right now, is experiencing an intense heatwave which seems to magnify my discomfort. But, there is light at the end of the tunnel and I am thankful for this treatment even though it is about as wierd as it gets. It will be interesting to see how my skin heels and appears afterwards.

Hi again,
I believe the reason my skin didn't dry out is that it was almost all the time covered with the (profanity here) Efudex! :>)
Are you doing the twice a day treatment?
Believe me, I'm a wuss when it comes to pain. :>)
But maybe by the time one is 60, the nerve endings are less likely to be firing. :>)
Oh, I am not in the care of a Dermo Doc, this was prescribed by my GP doc (Also my Flight Surgeon and very good buddy)
Can't wait till Friday!
Please keep in touch, and let me know how you are doing.
Mike

Mike; we are on the same timetable. Friday is my last day of 28 once a day applications. I think, had I been given the option, I would have chosen your schedule w/2 applications as it would not have been drawn out for so long. I pity the people who are given 6 week prescriptions...yikes! So, tomorrow I celebrate (at least, feel relief). During this time, I've given up 5 SF Giants game tickets and my Steely Dan tickets. Such a sacrifice! Let me know how you feel to be FREE of the process...I know I'm going to love it. This has taken on a life of it's own w/restrictions and precautions I don't usually endure. Let me hear!!!
Kathy