Sometimes the medicine appears worse than the disease

I must be crazy to post these online for the world to see, I know. But I’ve so appreciated others who have done it before me, I want to help them raise awareness about skin cancer and this particular treatment called fluorouracil (brand name Efudex or Carac or Fluoroplex). I’m using the generic in 5% strength.

Fluorouracil is a topical chemotherapy, an anti-metabolite for you chemistry types. Basically it destroys the DNA of the cells that absorb it. Since abnormal cells multiply more rapidly than normal cells, only the abnormal ones end up absorbing it. It doesn’t last long enough to affect normal skin cells. So wherever the stuff causes a reaction, like redness, swelling, blistering… that’s where the bad cells are lurking.

The types of cells specifically targeted by this treatment are superficial basal cell carcinomas (an active cancer, though not terribly dangerous) and actinic keratoses (the earliest stage of squamous cell carcinoma, which can be more dangerous). I have both types.

Warning! Truly disgusting photos follow. Do not read further if you are squeamish!

I started the fluorouracil on January 9, and it took a while to get started. One week later the only redness was one spot near my lip, lower-left. It stings in the shower. This photo was taken January 23 when a lot of redness started appearing on my cheeks and chin, plus a big spot under my right eyebrow. There’s another big spot on my nose but that’s where the dermatologist blasted a big AK with liquid nitrogen, so it was red to begin with. My forehead is reacting a little bit, which is surprising since I just treated it a few years ago.

Just 3 days later, January 26. More general redness, plus my right eyelid is starting to swell. Lots of reaction around my lips too. (Umm, by the way… I’d probably get into big trouble with my dermatologist for getting so close to my eyes and lips. But I’m not a model patient. I read somewhere that both areas are particularly vulnerable to skin cancer, so I figure it’s better to be proactive.)

Another 3 days later, January 29. The swelling is constant, I feel like I’m bruised under both eyes, I’m popping a lot of ibuprofen and don’t want to move much. Supposed to apply the stuff twice a day but I must admit to skipping an application here or there. I’ve started using Vaseline regularly; it’s the only relief during the day. Each morning I wake up with my right eye stuck practically shut, and have trouble opening my mouth enough to shovel some food in! Washing my face is miserable. Soap stings like needles, and afterwards even the air hurts.

February 4. Wow. This is the photo that made my husband (who’s been back in Congo this whole time) say “Stop!!”

At this point everything is super blistery and swollen. Here you can really see the difference between my first-time-to-treat face and second-time forehead. I’m disappointed to have even this much reaction on my forehead, but it is so much better than the first treatment a few years ago. Maybe I didn’t do it long enough then, which is why my goal is a full 30 days this time.

I think I made two more applications after this, and fell short of my 30-day goal by just 3 days. But I just couldn’t go on anymore! Several nights in a row I’ve been unable to sleep much.

February 7, healing day #2. Others have reported too that after stopping, it actually gets a little worse before it gets better. Yesterday was the absolute worst day of this whole process. My right eye is super swollen, my lips are all scabby, and I must apply gobs of Vaseline every few minutes. It just seems to disappear into my super-dry scaly skin. Blowing my nose & brushing my teeth are questionable activities – both make certain spots bleed & burn. By the end of these horrible 2 days, though, things started improving rapidly.

February 10. A lot less redness and swelling. Within a couple days, most of the dead skin will finally be gone (with my help under the shower or under Vaseline), leaving fresh new really pink freckle-free skin. The only trouble spots remaining are my right eyelid and lower left lip. I started using polysporin on my eyelid and even used band-aids to help keep it closed as much as possible, since I felt the crease hurting every time I blinked. Feb 11 was the first shower that didn’t hurt too much – still some stinging after the second face wash with soap, but not as bad as before. Needed Vaseline as soon as I got out of the shower to calm the stinging plus instant tightening after drying off, but not for the rest of the day. Surprised to note when I woke up Feb 12 that my face feels very numb. Don’t know if it got too dry during the night, but it’s extremely tight – it hurts to yawn or laugh (actually always has during this process) – maybe this is what a face-lift feels like? After Vaseline first thing, much later in the day I still feel numb & swollen, especially on my upper lip, oddly. Like I’ve been to the dentist.

Today, February 16. What a difference! Lips are completely healed, eyelid almost. There’s a big spot on the bottom of my chin that I’ve been worried about the last few days, so I’ve continued to treat that, which is why the area is still red. I still need Vaseline once or twice a day, but otherwise there’s no more pain or discomfort.

I’ve been treating my left arm, shoulders, and upper chest this whole time as well, which are just now getting to the really-red-and-inflamed stage. They have been nowhere near as uncomfortable as my face. It’s been tempting to reach for the Vaseline when it feels itchy & dry, but so far am grateful to avoid it as long as possible, since it would create quite a mess under clothes. My goal is to reach 7 weeks there. The left arm takes priority over the right (there’s not enough in my tube to do both!) because I’ve had 4 confirmed basal cell carcinomas there already, including a new one. So far ZERO on my right arm. I find this curious… you would think the damage I did trying to tan during my teenage years (ok, and beyond) would be equally distributed. But dermatologists say that incidental sun exposure is worse than deliberate because it accumulates without you realizing it or protecting yourself. Also that left arms are frequently worse than right arms for those of us who’ve spent a lot of time driving. It’s not like I had my arm hanging out the window all the time… but UV light goes through windows, darn it, and I did love me a lot of driving back in the day. I even have an impressive collection of speeding tickets to prove it.

I haven’t left the house since January 21… gettin’ a little stir-crazy! Ready to get out and about again this weekend, and maybe say hi to Mickey or Shamu. Only this time with tons of sunscreen! 😉


  1. Jen, OMG..I’m so sorry to had to endure all of that. I hope you are healed soon. At least by your B-day 🙂 Miss ya!


  2. Jen,
    Thank you so much for sharing your ‘journey’ with Efudex. Skin cancer affects every family in one way or another and most of us are pretty cavalier about it until we get a diagnosis. This is a great product but important to know what you are getting into when you start it. So glad you are through the worst of it – you must have got a lot of books read – or ALL the Academy Awards nominees watched!


    1. Hi Lauren, sounds like you have some experience with this stuff? I’d love to hear your perspective! Despite all the reading I’ve done on Efudex I still have lots of questions. One question I’ve never gotten answered is what does “maintenance” look like after doing it? I would assume my freckle-free virgin skin is now even more susceptible to cancer. I try to be more careful about sunscreen than ever before. Which leads me to my next question… how do I make sure I’m getting enough vitamin D?


    1. Thanks Sherrie! It all healed, eventually… sorta. I definitely overdid my eyelid and it’s still not entirely normal. But better than the alternative! 😉


  3. O.M.G.! Jen you are one gutsy woman! Can I send you some Paw Paw ointment?
    Do you need some 30+ or 50+ sunscreen for sensitive skin from Switzerland. Let me know and I can get it for you!!!


    1. Ha ha, yes I wear like SPF50 every day! Now my newest problem is a Vitamin D deficiency. Which can lead to even worse kinds of things. Sigh. Maybe I should move to Switzerland!! (More like Sweden…)


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