Combination cream containing a skin cancer drug and an immune booster. Fewer side effects and a shorter treatment course than other treatments.
Fluorouracil/calcipotriol is a combination drug for treating solar keratoses and some forms of skin cancer (Cunningham 2017).
It is as effective as existing creams, but it needs to be applied for a few days rather than several weeks.
After treatment, the area is less likely to develop squamous cell carcinoma—a potentially serious form of skin cancer—for three years (Rosenberg 2019).
Fluorouracil (commercially available as Efudix) has been used successfully for solar keratoses for many years. The combination of fluorouracil and calcipotriol is not commercially available and must be compounded specially.
For convenience, the Spot Check Clinic team refers to the combination as “Efucal” or "FU/Cal". This is not an official name.
Solar keratoses (also called actinic keratoses or “sunspots”) are patches or crusts on the skin, usually in areas with long term sun exposure. They can appear as single spots or as a group covering an area such as the face, forearms or chest.
If untreated, most solar keratoses are harmless, but a small percentage can progress to squamous cell carcinoma (SCC) which can spread to other parts of the body, causing serious illness and sometimes death.
Also known as Bowen’s disease or squamous cell carcinoma in situ. This is a mild and slow-growing form of skin cancer which often appears as a scaly patch of skin. If untreated, it can potentially progress to squamous cell carcinoma.
Many options are available for treating solar keratoses or Bowen’s disease.
Individual solar keratoses can be treated by methods such as:
Large numbers or areas of solar keratoses usually need field treatment, which treat the whole area (not just the visible solar keratoses) by applying a cream, sometimes with a light to activate it. These treatments work well, but have drawbacks which can make it difficult to complete a course of treatment:
"FU/Cal" contains two main ingredients:
In combination, this treatment has significant advantages over 5-fluorouracil alone:
Note that the duration of treatment many need to be varied depending on clinical response or side effects.
Apply in the morning and then again in the late afternoon or early evening. Do not apply the cream immediately before going to bed. Apply at least 1.5 - 2 hours before bedtime to enable complete absorption and prevent wiping off on to pillowcases and sheets. Contact with pillowcases or sheets may cause spreading of the cream to normal skin that does not need treatment.
The total area of skin treated with at any time should not exceed 500 cm² (approx.23 x 23cm). Treat larger areas a section at a time.
Fluorouracil/calcipotriol must not be used during pregnancy or while breastfeeding.
During the treatment course and while the skin is inflamed or ulcerated following treatment, don’t use cosmetics, moisturisers or other medications unless your doctor has advised you to.
Avoid sun exposure to the treated area both during treatment and while the skin is irritated and inflamed after treatment. Even untreated areas of the skin may be more sensitive to sunlight.
Fluorouracil/calcipotriol can be very irritating to the skin, although in most cases the irritation is mild.
The treated area while appear unsightly and may be uncomfortable during treatment and for up to 2 weeks after the course is completed.
Irritated skin may be itchy or painful. There may be a burning sensation, redness and ulcers or sores in the treated area. Sometimes these symptoms affect areas that did not previously have solar keratoses. This means that the ingredients are treating sun damaged skin that has not yet developed into solar keratoses or skin cancer.
If symptoms are severe, paraffin ointment/petroleum jelly (e.g. E45, Bepanthen, pawpaw ointment, Vaseline, Aquaphor or Infadolan) can provide relief.
Inflammation and redness usually settles in 2-3 weeks. it may be possible to reduce this time with a course of low-level light therapy., which works well to settle inflammation and redness following surgical procedures and skin injuries such as burns (Min 2013). This treatment is available at Spot Check Clinic.
Do not use antiseptics such as Betadine, as they tend to dry the skin and make irritation and pain worse. If you suspect that the skin has become infected, notify your doctor.
In unusual cases, more general side effects can occur. These include fever, dizziness, abdominal pain and cramps, diarrhoea and vomiting. If you experience any of these symptoms, stop using the medication and notify your doctor.
Keep the cream stored in the fridge, between 2-8°C.Protect from heat. Fluorouracil/calcipotriol can be stored outside of the fridge at room temperature for up to 48 hours.
Keep all medicine out of the reach of children.
Do not flush unused medications or pour down a sink or drain. Return any unused fluorouracil/calcipotriol to Spot Check Clinic or a pharmacy, especially if it is past the expiry date.
We prescribe fluorouracil/calcipotriol only to patients who attend Spot Check Clinic in person and have a face-to-face consultation with our specialist skin cancer doctor.
It's important for an experienced skin cancer doctor (preferably accredited by the Skin Cancer College of Australasia) to examine your skin before prescribing this medication. Because of the risk of side effects, you must be able to return to the prescribing doctor's clinic at short notice.
We don't send fluorouracil/calcipotriol or prescriptions for fluorouracil/calcipotriol to people who have not attended Spot Check Clinic.
The Skin Cancer College maintains a list of accredited doctors with demonstrated competence in the management of skin cancer.
This medication must be dispensed by a specialist compounding pharmacist. If we decide that it's a suitable treatment for your condition, we send a prescription directly to the compounding pharmacy, who will later contact you to arrange delivery and payment.
Route of administration:
1. Wash the skin to be treated using lukewarm water only.
2. Pat dry the affected area. Allow your skin to completely dry.
3. Apply a thin layer of cream to the affected area(s)twice a day, without a dressing, for the time advised by your doctor. Do not continue further unless advised by your doctor.
4. Use a non-metal applicator, cotton bud or a rubber glove to apply a thin film of cream to your affected skin. Use the smallest amount that can cover the treatment area.
5. Don’t allow the cream to come into contact with mucous membranes, such as eyes, eyelids, nostrils and lips, unless your doctor has advised you to treat these areas.
6. Do not apply to broken skin or open cuts as it may be absorbed into the bloodstream and may cause side effects.
7. Wash your hands carefully and thoroughly immediately after using the cream.
8. Do not cover the treated area unless your doctor tells you to.
Other drugs for skin cancer and sun damage, drugs which make the skin more sensitive to sunlight
The most effective topical treatment for solar keratoses ("sun spots") now takes four days instead of four weeks.
Some early skin cancers affect only the top layers of the skin. Although they can be removed surgically, there are other methods of treatment which may offer advantages such as less scarring or expense.