Chemotherapy Creams
The good, the bad and the ugly
It’s that time of year. The time when I encourage some of my patients to use a chemotherapy cream to help “erase” some of the sun-damage done to their skin over the years. Use of these creams is not for the faint of heart, but it can deliver great long-term results.
Chemotherapy creams are primarily used to treat Actinic Keratoses (AK) which are precancerous spots on the skin. Some are also used to treat superficial Squamous Cell Carcinoma (SCC) and superficial Basal Cell Carcinoma (BCC) as well. The creams work to seek, find, and destroy any abnormal cells.
The good part. These creams work extremely well, and they are very thorough. They give an excellent clearance of actinic keratoses. The end cosmetic outcome is great. While there is always a risk of pigmentation changes with any treatment regimen, discoloration is much less likely with the creams.
The bad part. These creams will find all the abnormal spots in the treated area. Each abnormal spot will get red, scabby, crusty, and uncomfortable during the treatment. Often a patient starts with a small area and the cream finds much more than we can see with our naked eye.
The ugly. All the abnormal spots will be red, scabby, and crusty for 4-6 weeks. It usually takes about 7 days for the reaction to get started. The cream is used for about 30 days. It usually takes about 7-14 days for the skin to recover back to pink skin after stopping the cream. Then, it can take a total of up to 3 months for everything to be perfect.
We use these blog posts as part of our patient education and instructional materials. The rest of this blog post will provide those for patients. If you think you would benefit from using these creams, discuss it with Dr Rosenberger at your next visit.
Instructions for patients. Although there are several different regimens that have been scientifically explored and researched, generally the patient applies the cream once or twice a day for one month. These creams are used to seek and conquer whatever is abnormal. DO NOT BE SURPRISED IF THE CREAMS HIGHLIGHT MORE AND LARGER LESIONS THAN WE CAN SEE WITH OUR NAKED EYE. If the skin gets red, scabby, and crusty, you are NOT having an adverse or allergic reaction. This is normal. If nothing happens after 14 days you can stop the cream. No reaction means there are no abnormal cells.
The treated skin will become uncomfortable. This is best alleviated by keeping the skin moist with Vaseline throughout the day. Other than Vaseline, please do not apply anything else to the skin. If you must be in the sun extensively, you can use a Zinc Oxide based sunscreen for protection. Do not use any other creams or sunscreens, except one containing Zinc Oxide. Tylenol can be taken for pain. VERY rarely a patient will develop flu-like symptom. If you develop flu-like symptoms call the office, take a picture of the treated area, and stop the cream until Dr Rosenberger can give you further instructions. Flu-like symptoms indicate an exuberant response to the cream, often enabling patients to stop the cream a little early.
You can and should wash the skin gently with a mild cleanser twice a day before applying the cream. Do not scrub too hard or the skin will bleed.
It is important that you not stop therapy. The more AKs and abnormal cells you have, the more redness and inflammation you can expect during treatment. Dr Rosenberger prefers to see you toward the end of the 30 days of treatment. After stopping the cream, you will be instructed to apply Vaseline only while it heals.
5-Fluorouracil (5-FU, Efudex, Carac, Tolak) is a chemotherapeutic topical cream that can be applied to the area once or twice a day for up to four weeks. 5FU inhibits a cell’s ability to reproduce. Cancerous and pre-cancerous cells grow faster than normal skin cells, which means that they absorb the medication faster than the surrounding healthy cells . Carac is applied once a day, while Efudex or generic 5FU needs to be applied twice a day. 5FU is used to treat actinic keratoses and SCC in Situ. Sometimes a Vitamin D cream can be applied along with this medication to accelerate the reaction.
Imiquimod (Aldara) was originally designed to treat warts, but studies quickly showed that this medication could induce our own immune system to fight off skin cancer cells. Side effects and the unsightly appearance during treatment is similar to 5FU. 5FU is approved to treat actinic keratosis and superficial BCC.
Chemotherapy creams are only one of many ways to treat actinic keratoses. Photodynamic therapy is another great option. To learn more about it see the video below.
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