End of this Round

My cheek is finally finished peeling, almost three weeks after I stopped the 4-week application of Efudex. This was a much longer and stronger reaction than when I only used the Efudex for two weeks, and I think it is more likely to have been effective. Here is what the final week looked like:

12 days after stopping Efudex

13 days after stopping Efudex

16 days after stopping Efudex. All clear except faint redness.

This will be the final entry for this round. I have another appointment with my dermatologist at the end of June and might start another "Efudex experiment" on my cheek after that.

Four weeks and done

I kept applying the Efudex to my cheek twice per day for four weeks, which ended a week ago. When I did it 4 months ago, I only applied it for two weeks, which didn't seem to be long enough. This time, I got about the same reaction in the first two weeks -- the skin turned very red and peeled in a few places. There wasn't as much additional change in the second two weeks as I expected, although there were a few spots that started to ooze blood, especially an area right below my eye, and there was extensive peeling. During the week since I stopped the Efudex, the bleeding areas have scabbed over and the the other areas have continued peeling. The peeling is much more extensive than when I only used the Efudex for two weeks, and it is easier to picture that it is actually shedding the layers of sun-damaged skin cells.

18 days of Efudex

4 weeks - Last day of Efudex

One week after stopping Efudex

This second application on my cheek seems to have achieved the reaction that most people describe. I think my dermatologist is just too conservative when she recommends only two weeks and says that it is done when it turns red. Other users, and even the official web site for the Efudex product, talk about a treatment of 3 to 4 weeks and a "destruction" phase when the skin ulcerates and peels. In any case, I will probably do another "Efudex experiment" after my next derm appointment at the end of June to see if the cheek reacts to a third application. If the sun damage is really removed, it shouldn't react so strongly the next time!

On my own for this experiment

I sent the email with the picture from the previous post to my dermatologist last Sunday, called on Tuesday, and finally got hold of her on Friday. So it had been almost two weeks since I started the "Efudex experiment," and I wanted some professional advice. The area on my scalp continued to have only a mild reaction, which makes sense if the previous Efudex treatment had removed most of the sun-damaged cells. But the area on my left cheek had continued its strong reaction, and was burning to the extent that I had started to apply vaseline over it to ease the burning.

I was a little surprised by what she said. Apparently she had just returned from a conference at which she had discussed my experiment with  a few of her colleagues. And whereas at our last appointment she had agreed that reapplying Efudex to an area that had recently been treated should not yield a significant reaction, her colleagues had convinced her that it would probably react even if the previous treatment had been effective. Well this makes no sense to me. In the original treatment, some areas reacted, presumably because those areas contained rapidly-dividing, sun-damaged cells. And other "normal" areas didn't react. So if the previous Efudex treatment really removed most of the rapidly-dividing, sun-damaged cells the treated skin should now be "normal" and there shouldn't be a strong reaction to a subsequent efudex treatment. Right? But she said that nobody has ever done such an experiment! Why not? Because 1) most people don't like to use the Efudex again, 2) if the skin looks smoother after the Efudex treatment, it must have worked, and 3) the condition is not life threatening anyway.

So she didn't see any point in continuing the Efudex on my cheek. It was previously treated for two weeks to the point that it turned red, it looks smooth on the outside, so it's fine. And even if it's not fine, it wouldn't be life-threatening anyway. On the other hand, I think that the strong reaction this time must indicate that there is still significant sun damage and that I might as well treat it for a while longer to try to remove that sun damage. She warned me not to go too long since it could become a mess and get infected, and we said goodbye.

So it appears that I am on my own for the rest of this experiment. I've stopped applying Efudex to the area on my scalp, since that area did not react. But I will continue for a while longer on my cheek. But perhaps not too much longer since it has already reacted more than the first time, with a few spots starting to ooze. Perhaps one more week? We'll see how it progresses.

Did the Efudex work? An Efudex experiment

I'm trying an "Efudex experiment" in which I reapply Efudex to a few small areas that were treated a few months ago to see if they react. My dermatologist agreed that if the first treatment really removed most of the sun-damaged cells, then the skin should not "light up" in response to a second treatment. So a week ago I started applying Efudex twice a day to my left cheek and to a small area (about two square inches) on my scalp.

What happened? The area on my scalp only had a small reaction. But my cheek lit up just as fast and intensely as during the original Efudex treatment. I can also feel it starting to burn like the first time.

What does this imply? Clearly, whatever property of the skin on my cheek made it react to the Efudex was not changed by the first Efudex treatment. In other words, if the reaction is due to sun damaged cells, then there are still a lot of sun-damaged cells there.

What to do next?  I sent an email to my dermatologist with this picture to see what she advises. I proposed to keep applying the Efudex, but go longer than last time -- perhaps 3-4 weeks instead of just two.

Day 86 (Recovery Day 72)

It's been over 10 weeks since I stopped the Efudex. Here's what I look like now:

Red area still present on left cheek at site of AK, but has sprouted no new keratin pillars

I'm surprised that the Efudex-treated areas are still a little redder than the untreated skin. This is mainly visible around the eyes, where whiter skin adjacent to the eye is surrounded by redder skin -- kind of a raccoon effect. 

Did it work? Well, the red area on my left cheek is still red, although no new keratin pillars have appeared in that area. And I do have a new keratosis on my forehead within the treated area. It doesn't seem that a new keratosis should appear so soon in an area where the sun damage has supposedly been removed. But it still seems that the best test will be to reapply the Efudex in some areas and see if they light up again. My next dermatology appointment isn't until March 8, so I might email the doc to see what she thinks about testing a few areas ahead of the appointment.