Fluorouracil/Calcipotriol Cream for Solar Keratoses

Note: This information is not intended to replace the knowledge and professional judgement of your healthcare provider. Alternate instructions from your healthcare professional always supersedes any information that may be conflicting. Always consult your healthcare provider for any questions or concerns about a medical condition or treatment

What are Solar Keratoses?

Solar keratoses, also known as actinic keratoses, are rough, scaly patches on the skin caused by extensive exposure to the sun's harmful ultraviolet (UV) rays. They typically occur on areas of the skin that have been frequently exposed to the sun, such as the face, neck, and hands. Solar keratoses are considered precancerous and if left untreated, can potentially develop into a type of skin cancer known as squamous cell carcinoma. Hence, early detection and treatment is important.

How are solar keratoses treated?

Treatment options for solar keratoses include topical medications such as 5-fluorouracil, photodynamic therapy, cryotherapy, and minor surgical procedures. Efudix (the common brand name of 5-fluorouracil) kills precancerous and superficial cancerous cells directly whilst sparing normal cells and skin.  Topical medications allow for treatment of ‘fields’ of sun-damage, similar to how a targeted weed-killer can kill a specific type of weed.

What is Fluorouracil/Calcipotriol Cream?

Fluorouracil/Calcipotriol is a combination drug used to treat solar keratoses and some forms of superficial skin cancer. The cream contains two key components;

5-Fluorouracil (5-FU): This compound kills superficial cells that are cancerous or precancerous.

Calcipotriol: A derivative of vitamin D, calcipotriol (or calcipotriene) boosts the immune system's ability to combat cancerous and precancerous cells.  Calcipotriol was previously available as ‘Daivonex Cream’ in Australia.

The combination cream appears to be as effective as Fluorouracil alone (Efudix), but only needs to be applied for a few days rather than several weeks. The combination of these two ingredients offers significant advantages over the use of fluorouracil alone, including; 

1. Shorter treatment courses, and;
2. Reduced inflammation and irritation.

The combination cream is often referred to as ‘Efucal’ or ‘FU/Cal’ in Australia, and is not commercially available. The cream must be compounded at a reputable compounding pharmacy.

How to Use

1. The treatment area should be washed with a soap-free cleanser and dried gently with a soft towel.
2. Apply and gently rub-in a thin layer of cream to the affected area twice a day, or as directed by your doctor, for the time advised by your doctor. The application time can vary between 2 and 10 days, but is typically a 4-day treatment for the face.
3. Use your finger to apply the cream, ensuring you wash your hands thoroughly after application. 
4. Do not cover the treated area with dressings unless advised by your doctor.
5. Sunscreen can be applied 10 minutes following application of the combination cream in the mornings.
6. Makeup and concealers can be used after a further 10 minutes.  Ensure that concealers are washed off thoroughly before the next application of the combination cream.
7. Night time application should be performed at least 20 minutes before bed to allow for adequate absorption before contact with pillows and bedding.

What to Expect

Fluorouracil/Calcipotriol will irritate your skin, often in a patchy manner.  This is an indication that the cream is working to destroy precancerous skin cells.  The irritation should be mild or moderate and you should not expect to experience significant pain or discomfort.  Over the following week, your skin will gradually return to normal appearance, with a reduction in the number of solar keratoses and smoother skin.

Occasionally, redness, scaling and peeling can be more significant.  In such circumstances, use of an over-the-counter cortisone ointment such as Cortic twice daily for a maximum of 3 days can help settle the inflammation. Consult your doctor immediately if, in the extremely unlikely event, you experience significant weeping and bleeding.

Aftercare

You can moisturise your skin with a fragrance-free gentle moisturiser at any point after 10 minutes of application of the combination cream. Ensure that you adhere to strict sun-protection measures at all times.

Precautions

Fluorouracil/Calcipotriol should not be used in the setting of pregnancy, family planning (in females) or while breastfeeding. Inadvertent exposure by touch of newly applied cream to the skin should be strictly avoided by pregnant women, children and pets.  Avoid direct sun exposure to the treated area during treatment and while the skin is irritated and inflamed after treatment.

Storage

Keep out of reach of children and pets. Keep the cream stored in a cool and dry place.

Protect from heat. 

Purpose of this information

The information presented on this website and in this article is for general information and example purposes only, does not contain health advice specific for users and must not be relied on for that purpose.  Please see your GP, dermatologist or other health care professional for specific advice.