5FU (Efudix) and Imiquimod (Aldara) Creams
• Aldara and 5FU Cream are used to treat solar keratoses and Bowen's disease
• Dr Fairris has been using Aldara and 5FU cream since the 1990s
What are they?
5FU cream is an anti-cancer drug called 5-flurouracil or Efudix and is mainly used to treat solar keratoses and Bowen's disease.
Imiquimod cream, Aldara cream, is also an anti-cancer drug. It can be used to treat solar keratoses, Bowen's disease and flat basal cell carcinomas.
What are the advantages?
They can be used at home and leave a good cosmetic result.
What are the disadvantages?
They are both powerful destructive medicines that cause the treated skin to become red, sore and weepy for several weeks and sometimes even cause skin ulceration and bleeding.
The cure rate is lower than that of surgical procedures.
Which areas respond best?
5FU cream works best on the face and scalp and rather poorly on other body sites.
Imiquimod cream works well everywhere but can cause severe and prolonged irritation and weeping and so can be unpleasant to use on the face.
Are they safe?
Yes.
Do they hurt?
Both treatments produce soreness. Occasionally imiquimod causes pain.
What do I have to do before treatment?
No particular preparation is needed for either treatment. Occasionally, when using 5FU on the forearms, hands or legs, pre-treatment for two weeks with tretinoin is needed.
What does the treatment involve?
5FU cream is usually applied twice a day until the treated area begins to weep. Treatment is then stopped and it takes six to eight weeks for the skin to settle and turn white again.
5FU should be rubbed into all of the treatment areas with a fingertip. It is important to apply it to all the skin and not just visible lesions. Afterwards, rinse the finger thoroughly with water.
Imiquimod cream comes in sachets. Pierce the sachet and squeeze out a small amount of cream onto your finger and apply it to the area that requires treatment. Then, seal the sachet with a paper clip and put it in a cool place.
When treating a flat basal cell carcinoma, apply the imiquimod cream once a day, on five days a week for six weeks.
What about aftercare?
Once treatment has finished, apply sunscreen to any exposed treated areas daily for a few weeks.
How many treatments will I need?
If treating solar keratoses, the treatment will probably need to be repeated after a few years.
Are there any side effects?
Both 5FU and imiquimod cream produce redness and swelling at the treatment site. This is followed by ulceration, weeping and crusting, and sometimes, bleeding. Occasionally, 5FU will produce a severe eczema or the treatment site will become infected.
Imiquimod cream will occasionally produce mild generalised side-effects such as fever, fatigue, headache, nausea, diarrhoea and muscle pain.
Who shouldn't use them?
Neither cream should be used during pregnancy or breastfeeding.
