5-FU Combination

Hi friends! I wanted to share one of my most recent treatments with you. As you know, my face has a lot of sun damage and a few months ago, the spot on my left upper lip started "acting up" again. By that I mean a dry, flaky, non healing, mostly just annoying, pencil eraser sized area. I did exfoliation, steroids, lotions, ointments, voodoo, witchcraft, and finally it was decided that it needed to be treated as an AK, or pre-cancerous lesion, as it was examined but not biopsied. There were several other AK's on my face so we opted to do another full face treatment.

 I used a treatment which I had not previously tried or even heard of, a combination of Fluorouracil (5-FU) and Calcipotriol. I have used Fluorouracil previously on my lip and documented that in a previous post. That treatment lasted 6 weeks. This combination treatment was a better option for me this time since it would be treating my entire face and 5-FU alone can be fairly harsh. Calcipotriol, also known as calcipotriene, is a synthetic derivative of calcitrol, a form of vitamin D. The addition of synthetic vitamin D with 5-FU has shown less severe side effects, can be used for a much shorter duration, still providing similar if not better outcomes. I work with the public as a nurse and cannot take time off for treatments, so the less side effects, the better in that regard.

The directions for the treatment were simply to apply to my entire face twice a day for five days. I didn't really have much of a reaction during those five days. Days four and five my face felt a little itchy and irritated. My eyes were also red, dry and irritated. I was surprised that I hadn't reacted more and was hoping it had worked at all. 

This was my first short duration treatment, so the delayed and ongoing reaction kind of caught me off guard. I continued reacting for weeks after I had stopped using the cream. For me, that is the scariest part of the topical treatments. I've already taken the medicine, there's no turning back and I have no idea how severe the reaction will be. Every day I wake up hoping that the previous day was the "peak" day and that today is the beginning of healing. For every day that you wake up worse, it can take a toll on you not only physically, but very much so emotionally. It's a waiting game and I'm generally not the most patient person. 

Day 4 of treatment.

I could feel a little dryness, but overall not a lot was happening. I thought the treatment may not be successful. 

Day 5 of treatment.

This was day 5, the last day of treatment. I apologize for the horrible photo, with a filter...it's the only photo I took this day. This was the first day I really felt any reaction. My skin felt tender and itchy, my eyes were red and irritated. I was just generally uncomfortable.

3 days post treatment.

The two photos above were taken 3 days post treatment, meaning 3 days after the fifth and final day using the cream. My entire face was irritated, red and felt tight. I could feel my lips getting dryer and tighter as well. The corners of my mouth were very dry and tender so I was very careful opening my mouth, hoping to avoid cracking. Specific areas on my cheek and jawline were reacting strongly at this point. 

Five days post treatment. 

These photos were taken the same day. This is the first day that my lips were truly painful. Both corners of my mouth had cracked open and both lips were tender and swelling. I actually had a birthday party to attend, so I put makeup on (which I try to avoid during treatments). My lips hurt so bad that I put lidocaine on them so I could enjoy my nephews party. My shiny "lip gloss" in the first photo is actually the lidocaine. The second is when I finally got home and washed my face. I was pretty miserable and I could barely open my mouth without causing the corners to crack more, so my diet was restricted at this point.

Six days post treatment.

My lips were very swollen and tender, and I was trying to be as careful as possible to avoid moving my mouth or touching anything to it...so naturally, I got injured. My son and I had a little trouble getting him into his PJ's and he accidentally kneed me (very hard) in the mouth. This was the result.

1 week post treatment. 

I had so many areas reacting by now. I was reapplying aquaphor frequently to keep things from scabbing or cracking. My face was extremely itchy, and my eyes were irritated and red. 

9 days post treatment.

 My lips were still reacting, they were scabbing and crusting, but I did keep them moist to prevent them from cracking. I had to debride my lower lip frequently during this stage. Parts of my upper lip were starting to get better. My lower lip stayed like this, not getting worse but also not getting better for a few more days.

I skipped a few days of photos from here...for good reason. My son was diagnosed with the flu, and right when he started to feel better I got a horrible stomach virus that had me down for three days.

13 days post treatment.

I received some questions regarding me being on the beach right at the end of my treatment. I had a trip to South Carolina booked for my son's (first) Spring Break well before I was told that I needed this treatment. I finished treatment almost two week before I left but I was not fully healed. I wore sunscreen, hats, long sleeves, all the things to protect myself during the trip, and I did have a spray tan. I was there for a week and when I returned home, 19 days post treatment, there was only a small scab left on my lower lip. My lip was completely healed and scab free on day 21 post treatment. 

I am now about six weeks out of treatment. So far, everything on my lips looks good. The white spot on my upper lip is there to stay. That is loss of pigment from a previous treatment. There is a stubborn lesion on my left cheek, so I will be following up with my dermatologist in the next couple of weeks to check on that. Overall I am very pleased with this treatment. The duration of treatment and severity of side effects are huge factors to consider for me, as I have to work full time and I work one on one with patients. I would certainly be willing to use this again in the future, if needed.

Please let me know if there is anything specific you would like me to address regarding any of my treatments, signs, symptoms, or anything else! Thanks so much for following along and a special thanks for the well wishes and prayers.



  1. good to see u healing Tawny..i also did the four day mixed treatment..and because nothing seemed to happen i kept going for another week ..i then got hit big time as i was doing my whole face..i am now three days in to the post treatment and its all incredibly itchy and sore but i feel it is also positive and working well... I may have left the treatment at five days if i had read your report first but hey...you get that.. Thanks for reporting your story and good luck with the healing. Kol

  2. Hi there! I stumbled across your blog while googling the "5-U combo" treatment that my dermatologist recently prescribed for treatment of actinic cheilitis. I wanted to say "thank you!!" for putting this information out there and sharing your experience. It's been incredibly helpful to see what to expect and to read about the process. I'm honestly terrified to start it but it seems like it's worth it in the long run. I've been very fortunate that all of my skin cancer checks have turned up negative, but I've been struggling with constantly dry, chapped, flaking and tight lips for the last two years. My lips have become extremely sensitive to any and everything I put on or near them and lip balms only make things better for an hour or two at most. My doctors initially thought it was an allergic reaction or contact dermatitis but I've eliminated just about everything that could case any sort of reaction and have seen no relief over the last year or more. I did have a terrible sunburn on my lips a number of years ago and they've never been the same since, so the doctor recommended I start this treatment. I'm curious to know what your lip symptoms were like before you started treatment - were they always dry/flaking/tight? Were you happy with the overall results once everything was healed? Thanks again for sharing your story, I really appreciate the insight into your experience.

  3. Is the January 24th skin cancer selfie after use of these two creams?
    Was your skin healed by 3 weeks?


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