Fluorouracil

I finished the six week course of treatment I mentioned in my previous post. The area treated was on my upper left lip. I have previously treated this area with both cryotherapy and Imiquimod. Prior to this third treatment, the area had became very dry and flaky, covering much more surface than the initial "spot" I had treated. My makeup would settle into it, making it quite noticeable. It looked and felt similar to eczema, so I first treated it with everything I could think of for dry skin and eczema. I used all the lotions, creams, oils, both natural and prescription. I exfoliated to the point of acquiring a secondary infection, which made the patch even more noticeable and then looked like a huge cold sore (seriously, huge). Once this infection subsided, the dryness remained. My dermatologist and I decided to treat for AK or possible superficial basal cell carcinoma. We discussed several options, one of which being the Imiquimod cream I used previously on my face. Though I was happy with the results when I used it a few years ago, my life has changed dramatically since then. When I used Imiquimod I was a stay at home mom. I had many of the listed side effects but I was lucky to be able to stay home and rest (as much as you can rest taking care of a two year old) throughout treatment. I now do not have the option to stay home during treatment as I work full time. She suggested Fluorouracil (also known as 5FU, Effudex, Fluoroplex, Carac, Adrucil, and Tolak), a topical chemotherapy agent which I have not previously used but had heard of and read about. It does not have nearly the systemic or local side effects as Imiquimod so I opted to try it.

I used the cream every other day for six weeks. After only two applications I could tell the area was becoming very dry (more than usual) and felt "tight". I was happy to know the treatment was working. Throughout treatment the area would get extremely dry with a lot of flakiness, redness and  tenderness. If felt similar to windburn. On my off days of treatment, I slathered on the aquaphor. Aquaphor is amazing, it may be worthy of its own post. My bad days entailed dry, flaking and raw skin. On those days, I simply wore a surgical mask at work. I didn't want to distract my patients or make them feel like they were gonna catch something :D. I also wanted to make sure I kept the area free of bacteria, as I'd already acquired one secondary infection and I was not interested in the added care again.

Other than dryness and flaking skin, I experienced dry eyes as a side effect. This seemed kind of random and it took me a few weeks to realize there was a cause for my dry, red and itchy eyes which I'd never really experienced before. This was not extremely bothersome, I looked as if I had some serious seasonal allergies. As I said previously, treatment with Imiquimod in the past resulted in a lot of unpleasant systemic side effects (body aches, chills, vomiting, dizziness...) so the dry eyes affected me very little.

Post treatment I've noticed a bit more loss of pigmentation in the area, but the dryness and flakiness has subsided. I will continue to monitor for changes, but so far everything looks good and it appears that the treatment was successful. Here are some photos throughout the six weeks.

A few days before I began treatment. I exfoliated the area and ended up with a secondary infection resembling poison ivy or a cold sore (which I've never had before), or a little of each. This photo is horrible quality- I apologize.

 2 days into treatment. I had some blister like areas throughout from the exfoliation/infection. The treatment dried all of this up within days. I was previously unsuccessfully treating it for over a week.

 1 week in, redness expanding, blisters are gone.

2 weeks in. My eyes were very irritated this day and skin felt dry and burning.

3 weeks in- shedding.

4 weeks in- the flaky skin was very scaly, I could barely scratch it and it would come off but it also would take healthy skin with it very easily.

Just after removing some of the scales in the previous photo. One area of healthy skin came off and caused a bit of bleeding.

5 weeks into treatment- very raw, flaky and tender.

 2 weeks post treatment- makeup except on lips. The white spot is pretty obvious, I usually fill it with lip liner.

 1 month post treatment- no makeup. I have pinkish/redness on my nose and cheeks from Imiquimod treatment in 2015.

My eyes are visibly irritated in this photo. This is near the end of treatment, the area covered well with make-up.

3 months post treatment with makeup. The surface of my skin is still smooth after both Imiquimod and Fluorouracil. The only lasting effects seem to be discoloration/loss of pigmentation and some redness, all of which can be covered easily with makeup.  

Overall I'm very happy with these results, I do think I will use Fluorouracil in the future, if needed. Thank you for following along, please let me know if you have questions regarding this treatment.