Actinic Keratoses
Treatment of Actinic Keratoses with 5-Fluorouracil
Actinic keratoses are rough gritty red spots that occur on sun-exposed skin. These are often treated with liquid nitrogen application because a small fraction of these “precancers” may become true skin cancers over time. Treatment of these “precancers” with a cream containing 5-fluorouracil (5-FU) can reduce the amount of visible spots and can also destroy lesions that are barely evident to the eye. This approach will lead to less of a need for painful liquid nitrogen treatments over time and can leave the skin looking and feeling healthier.
Your doctor has prescribed you a 5-FU containing cream. There is anticipated redness and irritation during treatment. The areas of treatment will appear red and irritated during the treatment and for 2-3 weeks afterwards during the recovery phase.
Treatment Tips
Apply the cream the entire area or areas to be treated at night time, wash off in the morning. If you have had a large number of actinic keratoses, you may want to start by applying the cream to one section of the face for your first course, perhaps the scalp alone or just the forehead.
The length of recommended treatment varies between 1 and 4 weeks, with 2 weeks being the average length of 5-FU cream application. You should notice the irritation beginning within the first several days of treatment. Try to continue for 2 weeks, but stop at 1 week if severe irritation, crusting, ulceration, or pain occurs. It is normal to have areas of crusting, pain and redness. The face will usually require 10-14 days of treatment, and arms or chest will require longer, probably 2-3 weeks. If minimal irritation occurs after 1-2 weeks, apply a slightly greater amount of cream and continue for a full 4 weeks.
After showering or washing off the treated area in the morning, apply a moisturizing cream; Vaseline is probably the best for this. Your doctor may prescribe a cream to calm down the irritation after treatment. This is optional. Triamcinolone is a topical steroid that is commonly used for this purpose. Apply twice daily for 1 week after you finish with the 5-FU cream. A lot of the symptoms of pain and irritation come from dry skin so keep your face moist with Vaseline or some other thick moisturizer, applying several times a day.
If you have a severe reaction, remember that this is the intent of treatment. If you are concerned and would like to be seen by your physician during your treatment period, call our clinic and we will see you within several days. We cannot guarantee a same day appointment, but we will try to get you in as soon as we can.
You might feel like you do not want to go out in public during treatment. Although make-up can cover some of the redness, it will be difficult to cover everything. Be confident! Facial skin heals very well and you will have benefited greatly from the treatment when all is said and done. Use of a titanium-dioxide-containing sunscreen will lighten redness to some extent. If people ask, tell them that you are undergoing a treatment for sun damage which will lead to healthier, younger-looking skin and less precancerous spots over time.
