Fluorouracil for sun-damaged skin

About fluorouracil cream/solution

A solar keratosis is a small, thickened, scaly growth which develops on the skin. It is the most common skin condition resulting from sun-damaged skin. Solar keratoses are also known as actinic keratoses. Solar keratoses usually develop on areas of skin which have received a lot of sun exposure. They are usually harmless, but there is a small risk that they may eventually turn into skin cancer. In themselves, solar keratoses are not cancerous.

Topical treatments (meaning you apply them to the skin) are useful if you have a lot of small solar keratoses. Fluorouracil is one of the treatments often used. It kills the abnormal skin cells and fresh normal skin grows back. The brand name for fluorouracil cream is Efudix®. Salicylic acid is another treatment that is sometimes used. It softens hard areas of skin. A solution containing fluorouracil with salicylic acid (brand name Actikerall®) is particularly helpful if the skin growths are thickened.

Fluorouracil cream is also used as a treatment for a type of skin cancer called basal cell carcinoma. This kind of skin cancer typically develops on sun-exposed areas of skin, and is usually caused by sun damage.

Before using fluorouracil

To make sure this is the right treatment for you, before you start using fluorouracil it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.

• If you are under 18 years of age.

• If you have any problems with the way your kidneys work.

• If you have ever had an allergic reaction to a skin preparation.

• If you are taking any medicines, particularly if you are taking medicines to treat chickenpox or shingles.

How to apply fluorouracil

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about fluorouracil and a full list of the side-effects which you may experience from using it.

• Use the preparation exactly as your doctor tells you to.

• If you are using Efudix® cream, it is usual to apply a thin layer of the cream to the affected area, once or twice daily. You may be asked to use a dressing to cover the area after you've applied the cream, if this is practicable. Remember to wash your hands thoroughly after using the cream. This is so that you don't inadvertently get it on healthy areas of your skin. The cream is usually applied for 3-4 weeks, but your skin will continue to heal for a month or two after the treatment has finished.

• If you are using Actikerall® solution, dab a little of the solution on to the affected areas using the brush provided, once daily. It will form a film over the areas as it dries. You will need to remove this film on the following day, before you apply more of the solution. Remember to wash your hands thoroughly after each time you use the solution. You may be asked to use the solution for up to three months, but your skin will continue to heal for a month or so even after you've finished the course of treatment.

• Only use fluorouracil on your skin - you must avoid it coming into contact with your eyes and mouth. If this does happen, wash the area with plenty of warm water straightaway.

• As you use fluorouracil, the area of skin you are treating will become red, itchy, swollen and sore. The top layer of skin may bleed, blister and peel before it begins to heal. This reaction can be quite severe, but it is only temporary. Your doctor can prescribe a corticosteroid cream to help ease the discomfort.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.

• Some people find it helps to apply a moisturising cream to the skin around the damaged areas to help soften the skin.

• Sunlight can increase the inflammation caused by fluorouracil. To prevent this, try to stay out of direct sunlight as much as possible while you are using the preparation. On bright or sunny days, use a sun cream with a high sun protection factor (SPF). This will help to prevent further sun damage and will also help keep your skin moisturised.

• When you have had a lot of sun exposure, your risk of developing a skin cancer (melanoma) on some other part of your skin is increased. Check your skin regularly and tell a doctor if you notice any changes, such as new moles, small dark patches developing, or a change in an existing mole.

• There is some general advice which will help prevent any further sun damage to your skin. Avoid being out in the sun between 11 am and 3 pm. Always use a broad-spectrum sunscreen with an SPF of 30 or higher, and which protects against both UVB and UVA light. Apply plenty of the sunscreen, and re-apply it regularly, particularly after swimming and if you are sweating a lot.

• You must avoid getting pregnant or fathering a child while you are using fluorouracil products. Women of childbearing potential must use effective contraception during treatment with fluorouracil and for seven months after stopping. Men must avoid fathering children for four months after they have finished treatment. Make sure you have discussed with your doctor which types of contraception are suitable for you and your partner.

Can topical fluorouracil cause problems?

Local irritation including itching, redness, a burning sensation, peeling, swelling and inflammation can all occur. These effects are normal and show that the fluorouracil is working. If the discomfort becomes severe or troublesome, discuss it with your doctor, as a corticosteroid cream can be prescribed to help ease the reaction.

If you experience any other symptoms which you think may be due to fluorouracil, speak with your doctor or pharmacist for advice.

How to store fluorouracil

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

• Check the expiry date information on the package. Once the cream has been opened, it will only keep for three months and should not be used after this time.

• The solution is flammable. Make sure the bottle is stored tightly closed.

Important information about all medicines