Skin cancer creams or gel are mostly used for the treatment of sun spots. Some types of skin cancer may also respond to topical treatment.
A Fact of life for many Australians!
What is Efudix used for?
Efudix® cream is the most widely prescribed treatment for sun spots (Solar Keratosis). SCC in situ (Intraepidermal carcinoma) is a sun spot ‘that has turned,’ and responds to a longer course of treatment.
How does Efudix work?
Sunlight damages DNA – aka genes – in the cells of the upper skin. You can think of a skin cancer as made up of DNA-damaged cells that are replicating. Efudix works by blocking the production of DNA and RNA in Keratinocytes that are found in the epidermis.
An important benefit is that efudix will help to stop abnormal proliferation of keratinocytes in normal-looking skin. In othe words, Efudix also suppresses the growth of abnormal skin cells that you can’t see.
A region of sun-damaged skin, such as the back of the hands, that is treated with efudix describes the practical concept of ‘field treatment.’ Red patches will appear both on the sunspots and areas of skin that previously appeared normal.
Where do I apply the cream?
Australians that would benefit the most from Efudix have signs of sun damaged skin in-between multiple sun spots. However, an occasional sunspot on a background of healthy-looking ‘pristine’ skin can be treated with small areas of efudix.
The maximum surface area that can be treated at one time is 500 cm² (23 cm x 23cm). This corresponds to the following areas:
You might therefore be asked to treat the face + forehead first, followed by the forearms later.
Treating large areas of skin with efudix can be an intense experience. Treating the face and forehead can be split up into two separate treatment periods if the area affected is greater than 500 cm², or for your comfort.
What are the side effects of efudix?
The treated areas of sun-damaged skin typically become red, inflamed & sore after a couple of weeks. These side effects indicate that the cream is working!
The list of side effects are pretty much any skin side sympom you can think of: Itching, redness, a burning sensation, severe peeling, intense swelling or inflammation, blistering, ulceration, crusting, irritation, pain, hives and a rash.
Allergy to efudix needs to be distinguished from a normal side effect. Efudix will normally caused red patches with clear skin in-between. In contrast, an allergic reaction to efudix makes the skin inflamed in all areas that have been treated.
Scarring may rarely follow if the inflammation causes excessive inflammation.
Efudix may rarely cause a systemic reaction including fever.
Most guidelines advise that you see a doctor 1-2 weeks after starting treatment for the first time. You certainly should see your doctor if you are experiencing significant side effects, or you just need reassurance that it’s ok to continue. Eudix needs to be stopped when there is a risk of scarring, infection, a systemic, or an allergic reaction. A steroid cream may be recommended to help settle the side effects. Efudix will rarely need to be stopped.
Efudix gets a bad rap – but is highly effective for sunspots.
How long is Efudix used for?
The Efudix treatment schedule for sunspot is highly variable – depending on the severity and location of sunspots. A typical regime is:
For SCC in situ (IEC), efudix is generally used twice per day for around 6-8 weeks.
How is Efudix Cream used?
A pea-sized amount of cream is enough to cover a cheek or chin or forehead. Four pea-sized amounts of cream covers the whole face and forehead. The maximum area treated at one time should not exceed 23 x 23cm.
Avoid contact within 1cm of eyes or mouth, and avoid use under the arms or in the groin. It’s important to minimise sunlight and use sun protection.
Wash your hands well after application. You may apply moisturizer 20 minutes after application of the efudix.
How long do the results last?
There is no conclusive answer.
A large review study found that over 60% of people required re-treatment with efudix after 1 year.⁴ The author finds in his practice that patients tend to need re-treatment every 2-4 years. Patients do not generally wish repeat treatment annually.
This brings us on the the clincher. Sun protection absolutely reduces the development of further sunspots. So it’s really important to protect your skin, and this will help reduce the frequency of re-treatments. It may even be possible to go 5 years between treatments.⁵
Long term regular sun protection will ensure that all the hard graft of ‘doing efudix’ will pay off for years to come.
Can efudix be combined with Vitamin D?
A small randomised trial published in 2017 indicates that Efudix may be combined with Calcipotriol to treat sun spots.
Compared to efudix used alone, the combination seems to:
Imiquimod cream is commonly used for superficial BCC.
What is Imiquimod (Aldara®)?
Imiquimod cream is available as branded Aldara® or as generic Imiquimod cream.
The cream works in the treatment of some types of skin cancer & genital warts by stimulating the immune system to attack the skin cancer cells.
Aldara® is available under a medicare authority for superficial BCC if surgery is not appropriate.
How often should I used Imiquimod, and for how long?
The following schedules are a baseline for discussion with your doctor:
Treatment intensity and duration are individualised to the patient.
How is Imiquimod cream applied?
The cream is applied to the lesion at night and washed off in the morning. Wash your hands after applying the cream. You may apply moisturiser around half an hour after application.
You should treat a margein of 1cm around the edge of the lesion to ensure that abnormal skin cells hiding near the edge of the lesion are also treated.
The treatment is not approved by The TGA for use within 1cm of the eyes, mouth, nose or ears. Although doctors may advise treatment on on these areas, particular care should be taken when used near the eyes.
What are the side effects?
The following mild to moderate side effects may be expected:
A more severe reaction is suggested by.ulceration, oozing, weeping, scabbing or crusting. Severe reactions may indicate that treatment is stopped. Studies suggest that treatment breaks do not reduce the effectiveness – provided the total number of application days remains the same by the end of the treatment period.
Skin pigment may be reduced (hypopigmentation) or less commonly increased (hyperpigmentation). Skin pigment changes are may rarely be permanent.
Flu-like symptoms are reported to occur in 1% of patients. The systemic symptoms may include:
There is no need to stop treatment for mild symptoms.
See your doctor for specific advice.
How effective is Imiquimod for Skin Cancer Treatment?
Aldara has the following clearance rates:
SCC in situs and superficial BCC are suitable for topical treatment in low risk areas.
Local skin reactions with Efudix or Aldara indicate that the cream is working. But get checked early if you feel the reaction is excessive.
A good treatment for small sun spots but relatively expensive.
What is Picato gel?
How effective is Picato gel?
The 8 week sunspot clearance rate quoted in the original trials¹ are:
The recurrence of sunspots at 12 months was 54% for the face/scalp and 56% for the rest of the body.
It’s fair to say that Picato was released with a fanfair of optimism. Who would not want to replace a 3 week course of skin-reddening cream with a 2 or 3 day course? Unfortunately, Recent evidence suggests that Picato is not as effective as efudix. However, Picato gel is still an option for small areas.
What are the side effects of Picato gel?
Side effects include:
Localised skin reactions:²
Systemic symptoms such as headache may rarely occur.
There have been rare reports of severe allergic reaction (anaphylaxis)³.
Diclofenac gel has mild to moderate anti sun-spot properties.
What is Solaraze Gel?
Solaraze® Gel is 3% Diclofenac Gel and licensed for the treatment of Solar Keratosis.
Diclofenac is commonly used in weaker strengths (e.g. 1%) as a topical anti inflammatory for aches and pains (eg. Voltarol gel). Solaraze is inthe same class of medication as Ibuprofen / Neurofen.
How is Solaraze Gel used, and how long is it used for?
Solaraze is applied to a whole field of solar keratosis twice daily for around 3 months.
What are the side effects of Solaraze?
Side effects are common but usually mild:
A small amount is absorbed through the skin (as with other anti-inflammatory creams and gels). There are cautions therefore with its use. For example, it should not be used with an active stomach ulcer.
How effective is Solaraze Gel?
Solaraze Gel is generally considered to be the least effective of the main topical treatments for solar keratosis – but also has the fewest side effects.
The author’s observation is that patients rarely remember the name of any past skin cancer topical treatment!
However, you can work out the name of the product by asking yourself how often you used the products.
For sunspot treatment:
Superficial skin cancers require longer and more intense treatment.
Refer to full product information & follow directions from your doctor. The areas treated and duration of treatment, in particular, will vary from patient to patient.
You are welcome to make an appointment to discuss treatment of your skin cancer at our clinic in Cleveland, Brisbane Bayside.
Author: Our Doctor
Last Modified: 18/4/2020
First published: 18/8/2014
