Efudix Cream 5% (Fluorouracil)

Efudix general information

What is Efudix used for?

Efudix Cream is a topical treatment for several types of skin lesion both pre-malignant (lesions that have not become cancerous) and malignant (lesions that have become cancerous). Efudix Cream is used to treat actinic keratosis (also known as solar keratosis), a pre-malignant skin lesion characterised by thick raised scaly patches of skin caused by too much exposure to the sun. This is usually found in fair-skinned people on exposed parts of the body; when associated with aging this is known as senile keratosis. Keratosis refers to the overproduction of keratin, which is a fibrous structural protein in the outer skin layers (epidermis) and can also be caused by arsenic, a natural mineral used in industrial or agricultural compounds (arsenical keratosis); this form of keratosis can be found on the palms of the hands of soles of the feet. If left untreated keratosis can develop into squamous cell carcinoma (SCC), which is a non-melanoma type of malignant skin cancer. Efudix Cream is also used to treat basal cell carcinoma (BCC), which is the most common form of skin cancer and although it is malignant (invasive) it is not usually harmful. BCC develops in the basal layer of the epidermis, is found mainly on the head, neck and other exposed areas in skin of fair-skinned people and is caused by excess sun exposure or repeated sunburn. BCC grows slowly and varies in appearance from small translucent nodules to larger brown, reddened or thickened patches of skin and can form ulcers and bleed easily. Keratoacanthoma is a form of skin cancer that develops from a hair follicle and can be triggered by sun exposure or a minor injury; it appears as a dome-shaped nodule on the skin. These lesions respond to treatment with Efudix Cream, whereas SCC does not, because although it develops from the epidermis it grows down into the deeper skin layers (dermis). Efudix Cream is only used for SCC when no other treatment is possible. Efudix Cream is also used to treat Bowen’s disease, which is thought to be an early form of SCC and develops from the epithelium beneath the epidermis. It can occur anywhere on the skin, where it appears as a patch of reddened crusty and scaly skin.

How does Efudix work?

Efudix Cream contains fluorouracil, which is an antimetabolite that blocks the use of another metabolite used in a normal metabolic process. In this case fluorouracil in Efudix Cream is a pyrimidine analogue. Pyrimidine are precursors for the nucleotides that form the backbone of DNA and RNA. Fluorouracil in Efudix Cream is converted into several active cytotoxic metabolites. One of these metabolites ( 5-fluoroxyuridine monophosphate) becomes incorporated into RNA instead of the nucleotide uracil and this blocks the processing of RNA within the cell. Another metabolite inhibits the enzyme thymidylate synthase, which is needed for the synthesis of thymidine, a nucleotide used for DNA replication. The action of fluorouracil in Efudix Cream inhibits cell growth and eventually leads to cell death. Fluorouracil in Efudix Cream is most effective on cells that are growing rapidly, such as neoplastic cells (abnormal growth of pre-malignant and malignant cells) because they take up fluorouracil at a faster rate than normal cells. Efudix Cream is a topical treatment that is absorbed into the skin but small amounts do get into the blood stream and may have some systemic effects.

What does Efudix contain?

Efudix Cream contains the active ingredient fluorouracil (5% in a white opaque cream base), an antimetabolite used to treat pre-malignant and malignant skin lesions. It also contains methyl hydroxybenzoate, soft white paraffin, polysorbate 60, propyl hydroxybenzoate, propylene glycol, stearyl alcohol, purified water.

Treating skin keratosis with Efudix

Efudix Cream contains fluorouracil that is used to treat various types of keratosis, which is a pre-malignant skin lesion, characterised by the overproduction of keratin, a fibrous structural protein in the outer skin layers (epidermis). Actinic keratosis (also known as solar keratosis), appears as thick raised scaly patches of skin caused by too much exposure to the sun and when associated with aging it is known as senile keratosis. It is usually found in fair-skinned people on exposed parts of the body, but can also be caused by arsenic, a natural mineral used in industrial or agricultural compounds (arsenical keratosis); this form of keratosis can be found on the palms of the hands of soles of the feet. If left untreated keratoses can develop into squamous cell carcinoma (SCC), which is a non-melanoma type of malignant skin cancer. Fluorouracil in Efudix Cream is an antimetabolite that blocks the use of another metabolite used in a normal metabolic process. In this case fluorouracil in Efudix Cream is a pyrimidine analogue. Pyrimidines are precursors for the nucleotides that form the backbone of DNA and RNA. Fluorouracil in Efudix Cream is converted into several active cytotoxic metabolites that interfere in DNA and RNA synthesis. The action of fluorouracil in Efudix Cream inhibits cell growth and eventually leads to cell death. Fluorouracil in Efudix Cream is most effective on cells that are growing rapidly, such as neoplastic cells (abnormal growth of pre-malignant and malignant cells) because they take up fluorouracil at a faster rate than normal cells.

Treating skin carcinoma with Efudix

Efudix Cream contains fluorouracil that is used to treat basal cell carcinoma, which is the most common form of skin cancer and although it is malignant (invasive) it is not usually harmful. BCC develops in the basal layer of the epidermis, is found mainly on the head neck and other exposed areas of skin of fair-skinned people and is caused by excess sun exposure or repeated sunburn. They grow slowly and vary in appearance from small translucent nodules to larger brown, reddened or thickened patches of skin and can form ulcers and bleed easily. Fluorouracil in Efudix Cream is an antimetabolite that it blocks the use of another metabolite used in a normal metabolic process. . In this case fluorouracil in Efudix Cream is a pyrimidine analogue. Pyrimidines are precursors for the nucleotides that form the backbone of DNA and RNA. Fluorouracil in Efudix Cream is converted into several active cytotoxic metabolites that interfere in DNA and RNA synthesis. The action of fluorouracil in Efudix Cream inhibits cell growth and eventually leads to cell death. Fluorouracil in Efudix Cream is most effective on cells that are growing rapidly, such as neoplastic cells (abnormal cell growth of pre-malignant and malignant cells) because they take up fluorouracil at a faster rate than normal cells.

What are the side effects of Efudix?

The most commonly reported side effects when using Efudix Cream include: pain, itchiness, inflammation, burning and darkening of the skin at the site of application. More serious side effects include: dermatitis, scarring, soreness, tenderness and photosensitivity.

When should Efudix not be used?

You should not use Efudix Cream if you:

• are allergic to fluorouracil or any ingredients in Efudix
• spend a lot of time outdoors exposed to the sun as this can cause a reaction
• are pregnant or are breastfeeding
• have an inflammatory skin condition including like chloasma (darkening of skin during pregnancy) or rosacea (chronic rash)
• have dihydropyrimidine dehydrogenase (DPD) enzyme deficiency as this can result in a toxic reaction with Efudix Cream

How should Efudix be used?

You should apply your Efudix Cream as a thin layer to the affected area once or twice daily, morning and evening, but not just before going to bed. Use a non-metal applicator, such as spatula, cotton bud or glove. If you use your fingers, make sure you wash your hands thoroughly after application and avoid contact with eyes, mucous membranes like inside the nose and mouth and unaffected areas of skin. You should not need to use an occlusive dressing, but if you do, it may cause inflammation. After the first 3 to 5 days of applying your Efudix Cream, your skin will appear to get worse and become temporarily reddened, peeling, blistered and sore. This is an important reaction and part of the treatment process. Eventually the affected skin will flake away and your skin will heal. You should continue to apply your Efudix Cream for the full course of treatment as recommended by your doctor, which is usually 3-4 weeks, but may be longer, depending on what you are being treated for. Your skin may take up to 2 months to heal after treatment is complete.

How long should you use Efudix?

You should continue to apply your Efudix Cream for the full course of treatment as recommended by your doctor, which is usually 3-4 weeks, but may be longer, depending on what you are being treated for. Your skin may take up to 2 months to heal after treatment is complete.

Missed dose of Efudix

If you miss a dose of Efudix Cream take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.

How should Efudix be stored?

You should store your Efudix below 30°C in a cool dry place.