Cosmetic Effect of Efudex

I am very proud of my residency at the University of Wisconsin. During the 5 years that I was in Madison, not only did I learn from about 20 different dermatology faculty (a lot for a dermatology department), but I also learned from nearly 100 different internal medicine faculty. One of the most important lessons that I learned during that time is that there is not a one-size-fits-all way to practice medicine. Patient circumstance, disease variability, and doctors' preferences and finesse together determine a course of treatment.

One example of variability in practice is dermatologists can differ in how they approach the treatment of precancers (i.e., actinic keratoses or commonly called AKs). Some approach the majority of AKs by leaving them alone unless they are bothersome to the patient or they simply freeze the biggest ones they can see. Other dermatologists are more aggressive in treating "field areas" of AKs with medicines like Efudex.

Put me in the aggressive camp, and I'll tell you why. I do for my patients what I would do for myself. Unless otherwise directed by the patient, I strongly prefer to try to treat all precancers rather than just a few. Plus, when it's all over, I would want to have attractive, unscarred skin. We know that freezing can leave scars... and this is what is known about AKs. They exist in both clinically detectable states and subclinical states, so when there is one AK that I can see and touch, there is probably another one lurking in the skin that can't been seen.

How does Efudex work?

Efudex has been around for decades and is still considered the "gold standard" in treating AKs. It has a chemical mechanism that is specific for all AKs and treats both the clinically obvious and the subclinical AKs and works by causing the death of the fastest growing cells. It can be used pretty much anywhere on the body and is effective at treating small, thin skin cancers as well. It completely clears about 40% of people who use it and resolves 80-90% of AKs in the rest of people. It is a generic medicine, but not necessarily inexpensive. Current cash prices range in the $50-105 in our area with a coupon (see www.goodrx.com).

What are the downsides of Efudex?

It causes a slow process of inflammation, usually taking 2-3 weeks of active treatment and another 2 weeks to completely recover. During this time most people will have discomfort and will not be able to hide the inflammatory reaction from others.

What are the cosmetic side effects of Efudex?

Aside from excellent field treatment of AKs that logically prevents skin cancers, there are additional cosmetic benefits that I feel aren't emphasized enough. We've known about them for a long time, and a study in 2009 finally documented and measured them (read the cosmetic benefits study). Efudex treatment improves skin appearance by lessening coarse wrinkles, fine wrinkles, tactile roughness, mottled hyperpigmentation, lentigines (dark spots), and sallowness of the skin.

Sound familiar? That's right... these are the very popular cosmetic outcomes people desire when they choose to undergo chemical peels and laser resurfacing. After the treatment, my clinical experience has been that most patients are extremely satisfied with the improvement they see and would do it again if needed.

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