Guest guest Posted May 9, 2002 Report Share Posted May 9, 2002 Buzz, Efudex is an anticancer drug, fluorouracil (5-FU). I'm familiar with 5-FU because it's one of the most common intravenous chemotherapy agents used to treat various types of cancer. From checking pharmacology resources it appears that, as a cream, it is primarily used to treat a sun-induced pre-cancerous condition, actinic (solar) keratosis. By treating the skin in this way, it is hoped to prevent the lesions from turning into cancer. As you described, it sounds like it works well for this condition. From what I've seen of actinic keratosis it doesn't look like rosacea, but I know that bad skin can look like bad skin. Appearances aside, though, the two are completely different conditions. The descriptions I've read of topical 5-FU treatment sound as dramatic as you describe -- even worse! Plus, 5-FU has tons of side effects, as you can imagine from a chemotherapy agent. I have no clinical experience with this so I can't know, but it's hard for me to fathom a use for this maximally irritating agent in rosaceans. Quite the contrary, I would think it would significantly damage rosacean's sensitive skin. Actinic keratosis is the opposite of sensitive -- its lesions are composed of lots of dead cells piled up on top of each other, a consequence of the area's newly acquired abnormality in skin turnover. Plus, on multiple pre-cancerous lesions that appear on otherwise normal skin (with an intact protective barrier) Efudex will be minimally absorbed. But the same medication on pathologically abnormal skin like rosacea, with its fragmented barrier, would be maximally absorbed, and that would make for potentially dangerous systemic effects. After reading how irritating Efudex can be, my face hurts. Marjorie Marjorie Lazoff, MD > Dear Group.........since I have made myself a human guiniea pig I try > just about anything that comes down the pike but before I try this > has anyone tried or have a comment on Efudex cream 5%..It is applied > 2x a day for 2 weeks...It basically fries off damaged skin and > smooths out the complexion by leaving a fresh layer of skin with no > damage..I have seen the results on two individuals and they were > awesome......The catch, both people were diagnosed with sun damaged > skin not rosacea although to me the look is very similar...at least > for me......by > the way its an ugly 2 weeks but for these individuals but it was well > worth it. Any rosaceans out there that have tried it? thanks in > advance.......Marjorie I know you post alot but I would especially > like to hear from you if you have the time buzz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2002 Report Share Posted May 10, 2002 Hi! My father was diagnosed with rosacea and his derm prescribed Efudex 5% cream. He said that it was " a radical approach " and to be prepared for some unsightly redness. Well, needless to say, his face was covered in large pus-filled blisters and was VERY red and swollen. He was then prescribed Fluocinonide to help with the healing process, which turns out is actually a steroid cream!! The blisters and swelling have gone down and he is now seeing another derm. Pam --- emarjency emarjency@...> wrote: > Buzz, Efudex is an anticancer drug, fluorouracil > (5-FU). I'm familiar > with 5-FU because it's one of the most common > intravenous > chemotherapy agents used to treat various types of > cancer. From > checking pharmacology resources it appears that, as > a cream, it is > primarily used to treat a sun-induced pre-cancerous > condition, > actinic (solar) keratosis. By treating the skin in > this way, it is > hoped to prevent the lesions from turning into > cancer. As you > described, it sounds like it works well for this > condition. > > From what I've seen of actinic keratosis it doesn't > look like > rosacea, but I know that bad skin can look like bad > skin. Appearances > aside, though, the two are completely different > conditions. > > The descriptions I've read of topical 5-FU treatment > sound as > dramatic as you describe -- even worse! Plus, 5-FU > has tons of side > effects, as you can imagine from a chemotherapy > agent. > > I have no clinical experience with this so I can't > know, but it's > hard for me to fathom a use for this maximally > irritating agent in > rosaceans. Quite the contrary, I would think it > would significantly > damage rosacean's sensitive skin. Actinic keratosis > is the opposite > of sensitive -- its lesions are composed of lots of > dead cells piled > up on top of each other, a consequence of the area's > newly acquired > abnormality in skin turnover. > > Plus, on multiple pre-cancerous lesions that appear > on otherwise > normal skin (with an intact protective barrier) > Efudex will be > minimally absorbed. But the same medication on > pathologically > abnormal skin like rosacea, with its fragmented > barrier, would be > maximally absorbed, and that would make for > potentially dangerous > systemic effects. > > After reading how irritating Efudex can be, my face > hurts. > > Marjorie > > Marjorie Lazoff, MD > > > > > > > Dear Group.........since I have made myself a > human guiniea pig I > try > > just about anything that comes down the pike but > before I try this > > has anyone tried or have a comment on Efudex cream > 5%..It is > applied > > 2x a day for 2 weeks...It basically fries off > damaged skin and > > smooths out the complexion by leaving a fresh > layer of skin with no > > damage..I have seen the results on two individuals > and they were > > awesome......The catch, both people were diagnosed > with sun damaged > > skin not rosacea although to me the look is very > similar...at least > > for me......by > > the way its an ugly 2 weeks but for these > individuals but it was > well > > worth it. Any rosaceans out there that have tried > it? thanks in > > advance.......Marjorie I know you post alot but I > would especially > > like to hear from you if you have the time buzz > > > > -- > Please read the list highlights before posting to > the whole group (http://rosacea.ii.net/toc.html). > Your post will be delayed if you don't give a > meaningful subject or trim your reply text. You must > change the subject when replying to a digest ! > > See http://www.drnase.com for info on his recently > published book. > > To leave the list send an email to > rosacea-support-unsubscribe > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2002 Report Share Posted May 10, 2002 Pam, I may be missing something, but there's nothing in Medline about it. I can't even fathom a hypothesis that would justify trying Efudex on rosacea. Your poor dad. Did the second dermatologist offer any explanation regarding the first dermatologists' " radical approach? " Marjorie Marjorie Lazoff, MD > Hi! My father was diagnosed with rosacea and his derm prescribed Efudex 5% cream. He said that it was " a radical approach " and to be prepared for some unsightly redness. Well, needless to say, his face was covered in large pus-filled blisters and was VERY red and swollen. He was then prescribed Fluocinonide to help with the healing process, which turns out is actually a steroid cream!! The blisters and swelling have gone down and he is now seeing another derm. Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2002 Report Share Posted May 10, 2002 Pam, I may be missing something, but there's nothing in Medline about it. I can't even fathom a hypothesis that would justify trying Efudex on rosacea. Your poor dad. Did the second dermatologist offer any explanation regarding the first dermatologists' " radical approach? " Marjorie Marjorie Lazoff, MD > Hi! My father was diagnosed with rosacea and his derm prescribed Efudex 5% cream. He said that it was " a radical approach " and to be prepared for some unsightly redness. Well, needless to say, his face was covered in large pus-filled blisters and was VERY red and swollen. He was then prescribed Fluocinonide to help with the healing process, which turns out is actually a steroid cream!! The blisters and swelling have gone down and he is now seeing another derm. Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2002 Report Share Posted May 10, 2002 Pam, I may be missing something, but there's nothing in Medline about it. I can't even fathom a hypothesis that would justify trying Efudex on rosacea. Your poor dad. Did the second dermatologist offer any explanation regarding the first dermatologists' " radical approach? " Marjorie Marjorie Lazoff, MD > Hi! My father was diagnosed with rosacea and his derm prescribed Efudex 5% cream. He said that it was " a radical approach " and to be prepared for some unsightly redness. Well, needless to say, his face was covered in large pus-filled blisters and was VERY red and swollen. He was then prescribed Fluocinonide to help with the healing process, which turns out is actually a steroid cream!! The blisters and swelling have gone down and he is now seeing another derm. Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2002 Report Share Posted May 11, 2002 Perhaps it was theorized that 5-FU would impart some sort of immunosupressive effect on the rosacea zone. More likely he got it because he asked his dermatologist if he could try it. Stranger discoveries have happened by just trying something out. > > Pam, I may be missing something, but there's nothing in Medline about > it. I can't even fathom a hypothesis that would justify trying Efudex > on rosacea. > > Your poor dad. Did the second dermatologist offer any explanation > regarding the first dermatologists' " radical approach? " > > Marjorie > > Marjorie Lazoff, MD > > > > Hi! My father was diagnosed with rosacea and his derm > prescribed Efudex 5% cream. He said that it was " a > radical approach " and to be prepared for some > unsightly redness. Well, needless to say, his face was > covered in large pus-filled blisters and was VERY red > and swollen. He was then prescribed Fluocinonide to > help with the healing process, which turns out is > actually a steroid cream!! The blisters and swelling > have gone down and he is now seeing another derm. > > Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2002 Report Share Posted May 11, 2002 Perhaps it was theorized that 5-FU would impart some sort of immunosupressive effect on the rosacea zone. More likely he got it because he asked his dermatologist if he could try it. Stranger discoveries have happened by just trying something out. > > Pam, I may be missing something, but there's nothing in Medline about > it. I can't even fathom a hypothesis that would justify trying Efudex > on rosacea. > > Your poor dad. Did the second dermatologist offer any explanation > regarding the first dermatologists' " radical approach? " > > Marjorie > > Marjorie Lazoff, MD > > > > Hi! My father was diagnosed with rosacea and his derm > prescribed Efudex 5% cream. He said that it was " a > radical approach " and to be prepared for some > unsightly redness. Well, needless to say, his face was > covered in large pus-filled blisters and was VERY red > and swollen. He was then prescribed Fluocinonide to > help with the healing process, which turns out is > actually a steroid cream!! The blisters and swelling > have gone down and he is now seeing another derm. > > Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2002 Report Share Posted May 13, 2002 Pam, I don't understand what your dad's second doctor is saying. Neither a penicillin allergy nor taking Lanoxin (Digoxin) should interfere with any rosacea treatment I can think of. In managing difficult/challenging conditions, I usually refer to the closest, most well-respected university medical center. Marjorie Marjorie Lazoff, MD > > > > > > Pam, I may be missing something, but there's > > nothing in Medline > > about > > > it. I can't even fathom a hypothesis that would > > justify trying > > Efudex > > > on rosacea. > > > > > > Your poor dad. Did the second dermatologist offer > > any explanation > > > regarding the first dermatologists' " radical > > approach? " > > > > > > Marjorie > > > > > > Marjorie Lazoff, MD > > > > > > > > > > Hi! My father was diagnosed with rosacea and his > > derm > > > prescribed Efudex 5% cream. He said that it was " a > > > radical approach " and to be prepared for some > > > unsightly redness. Well, needless to say, his face > > was > > > covered in large pus-filled blisters and was VERY > > red > > > and swollen. He was then prescribed Fluocinonide > > to > > > help with the healing process, which turns out is > > > actually a steroid cream!! The blisters and > > swelling > > > have gone down and he is now seeing another derm. > > > > > > Pam > > > > > > > > -- > > Please read the list highlights before posting to > > the whole group (http://rosacea.ii.net/toc.html). > > Your post will be delayed if you don't give a > > meaningful subject or trim your reply text. You must > > change the subject when replying to a digest ! > > > > See http://www.drnase.com for info on his recently > > published book. > > > > To leave the list send an email to > > rosacea-support-unsubscribe@y... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2002 Report Share Posted May 13, 2002 Pam, I don't understand what your dad's second doctor is saying. Neither a penicillin allergy nor taking Lanoxin (Digoxin) should interfere with any rosacea treatment I can think of. In managing difficult/challenging conditions, I usually refer to the closest, most well-respected university medical center. Marjorie Marjorie Lazoff, MD > > > > > > Pam, I may be missing something, but there's > > nothing in Medline > > about > > > it. I can't even fathom a hypothesis that would > > justify trying > > Efudex > > > on rosacea. > > > > > > Your poor dad. Did the second dermatologist offer > > any explanation > > > regarding the first dermatologists' " radical > > approach? " > > > > > > Marjorie > > > > > > Marjorie Lazoff, MD > > > > > > > > > > Hi! My father was diagnosed with rosacea and his > > derm > > > prescribed Efudex 5% cream. He said that it was " a > > > radical approach " and to be prepared for some > > > unsightly redness. Well, needless to say, his face > > was > > > covered in large pus-filled blisters and was VERY > > red > > > and swollen. He was then prescribed Fluocinonide > > to > > > help with the healing process, which turns out is > > > actually a steroid cream!! The blisters and > > swelling > > > have gone down and he is now seeing another derm. > > > > > > Pam > > > > > > > > -- > > Please read the list highlights before posting to > > the whole group (http://rosacea.ii.net/toc.html). > > Your post will be delayed if you don't give a > > meaningful subject or trim your reply text. You must > > change the subject when replying to a digest ! > > > > See http://www.drnase.com for info on his recently > > published book. > > > > To leave the list send an email to > > rosacea-support-unsubscribe@y... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2002 Report Share Posted May 14, 2002 the only way possiblly a pcn allergy could complicate rosacea treatment is that one would generally opt for minocycine instead of zithromax due to wanting to preserve the usefulness of zithromax for respiratory infections. also another reason to due low dose accutane > > > > > > > > Pam, I may be missing something, but there's > > > nothing in Medline > > > about > > > > it. I can't even fathom a hypothesis that would > > > justify trying > > > Efudex > > > > on rosacea. > > > > > > > > Your poor dad. Did the second dermatologist offer > > > any explanation > > > > regarding the first dermatologists' " radical > > > approach? " > > > > > > > > Marjorie > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > Hi! My father was diagnosed with rosacea and his > > > derm > > > > prescribed Efudex 5% cream. He said that it was " a > > > > radical approach " and to be prepared for some > > > > unsightly redness. Well, needless to say, his face > > > was > > > > covered in large pus-filled blisters and was VERY > > > red > > > > and swollen. He was then prescribed Fluocinonide > > > to > > > > help with the healing process, which turns out is > > > > actually a steroid cream!! The blisters and > > > swelling > > > > have gone down and he is now seeing another derm. > > > > > > > > Pam > > > > > > > > > > > > -- > > > Please read the list highlights before posting to > > > the whole group (http://rosacea.ii.net/toc.html). > > > Your post will be delayed if you don't give a > > > meaningful subject or trim your reply text. You must > > > change the subject when replying to a digest ! > > > > > > See http://www.drnase.com for info on his recently > > > published book. > > > > > > To leave the list send an email to > > > rosacea-support-unsubscribe@y... > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2002 Report Share Posted May 15, 2002 Hi' For what it's worth, I'm allergic to penicillin--which was confirmed by an allergist about 10 years ago. I have taken tetracycline with no problem--but it didn't really help my rosacea. I've been taking doxycycline which has helped my rosacea. The only thing is with the doxy, if I take on an empty stomach, I have felt nausea, so now I usually take with some crackers or pretzels. I've taken Zithromax for strep in the past with no adverse (allergic) reactions. I'm not aware of the other drug that Pam's dad is taking, and how that affects rosacea meds. Michele --- doubleoh7_mi6 ciz@...> wrote: > the only way possiblly a pcn allergy could > complicate rosacea > treatment is that one would generally opt for > minocycine instead of > zithromax due to wanting to preserve the usefulness > of zithromax for > respiratory infections. also another reason to due > low dose accutane > > > > > > > > > > > > > Pam, I may be missing something, but there's > > > > nothing in Medline > > > > about > > > > > it. I can't even fathom a hypothesis that > would > > > > justify trying > > > > Efudex > > > > > on rosacea. > > > > > > > > > > Your poor dad. Did the second dermatologist > offer > > > > any explanation > > > > > regarding the first dermatologists' " radical > > > > approach? " > > > > > > > > > > Marjorie > > > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > > Hi! My father was diagnosed with rosacea > and his > > > > derm > > > > > prescribed Efudex 5% cream. He said that it > was " a > > > > > radical approach " and to be prepared for > some > > > > > unsightly redness. Well, needless to say, > his face > > > > was > > > > > covered in large pus-filled blisters and was > VERY > > > > red > > > > > and swollen. He was then prescribed > Fluocinonide > > > > to > > > > > help with the healing process, which turns > out is > > > > > actually a steroid cream!! The blisters and > > > > swelling > > > > > have gone down and he is now seeing another > derm. > > > > > > > > > > Pam > > > > > > > > > > > > > > > > -- > > > > Please read the list highlights before posting > to > > > > the whole group > (http://rosacea.ii.net/toc.html). > > > > Your post will be delayed if you don't give a > > > > meaningful subject or trim your reply text. > You must > > > > change the subject when replying to a digest ! > > > > > > > > See http://www.drnase.com for info on his > recently > > > > published book. > > > > > > > > To leave the list send an email to > > > > rosacea-support-unsubscribe@y... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2002 Report Share Posted May 15, 2002 I can't know, but if I were to guess what the second physician treating Pam's father were concerned about, it's this: digoxin has a relatively narrow therapeutic range -- a bit too low and the medication doesn't do what it's suppose to, a bit too high and side effects ensue. Many, many drugs affect the metabolism of digoxin, so adding a new medication to a patient already on digoxin can be tricky, as the level of digoxin in the blood goes up or down in response to the new medication. The antibiotics most commonly used to treat rosacea -- the tetracyclines (includ doxy and mino) and the erythromycins (includ zithro) -- are well known to interfere with the metabolism of digoxin. A dermatologist wouldn't be used to managing patients on digoxin as would be most internists, cardiologists, and even general practitioners. I don't know why the dermatologist threw in the pen allergy though the penicillins, while not to my knowledge used to treat rosacea, are one of the medications that I believe do not interfere with digoxin. A penicillin allergy has no cross reactivity with tetracyclines or erthyromycins, so that wouldn't have anything to do with the dermatologist's statement. Alternatively the dermatologist may think Pam's father is a candidate for laser surgery, having nothing to do with his penicillin allergy or use of other medication. Some aspects of rosacea, such as telangiectasia or phyma, and some types of flushing without any evidence of inflammation, simply have no good medical treatment, and that may be the dermatologist's assessment of Pam's father's condition. Marjorie Marjorie Lazoff, MD > > > > > > > > > > > > Pam, I may be missing something, but there's > > > > > nothing in Medline > > > > > about > > > > > > it. I can't even fathom a hypothesis that > > would > > > > > justify trying > > > > > Efudex > > > > > > on rosacea. > > > > > > > > > > > > Your poor dad. Did the second dermatologist > > offer > > > > > any explanation > > > > > > regarding the first dermatologists' " radical > > > > > approach? " > > > > > > > > > > > > Marjorie > > > > > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > > > > > Hi! My father was diagnosed with rosacea > > and his > > > > > derm > > > > > > prescribed Efudex 5% cream. He said that it > > was " a > > > > > > radical approach " and to be prepared for > > some > > > > > > unsightly redness. Well, needless to say, > > his face > > > > > was > > > > > > covered in large pus-filled blisters and was > > VERY > > > > > red > > > > > > and swollen. He was then prescribed > > Fluocinonide > > > > > to > > > > > > help with the healing process, which turns > > out is > > > > > > actually a steroid cream!! The blisters and > > > > > swelling > > > > > > have gone down and he is now seeing another > > derm. > > > > > > > > > > > > Pam > > > > > > > > > > > > > > > > > > > > -- > > > > > Please read the list highlights before posting > > to > > > > > the whole group > > (http://rosacea.ii.net/toc.html). > > > > > Your post will be delayed if you don't give a > > > > > meaningful subject or trim your reply text. > > You must > > > > > change the subject when replying to a digest ! > > > > > > > > > > See http://www.drnase.com for info on his > > recently > > > > > published book. > > > > > > > > > > To leave the list send an email to > > > > > rosacea-support-unsubscribe@y... > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2002 Report Share Posted May 15, 2002 I can't know, but if I were to guess what the second physician treating Pam's father were concerned about, it's this: digoxin has a relatively narrow therapeutic range -- a bit too low and the medication doesn't do what it's suppose to, a bit too high and side effects ensue. Many, many drugs affect the metabolism of digoxin, so adding a new medication to a patient already on digoxin can be tricky, as the level of digoxin in the blood goes up or down in response to the new medication. The antibiotics most commonly used to treat rosacea -- the tetracyclines (includ doxy and mino) and the erythromycins (includ zithro) -- are well known to interfere with the metabolism of digoxin. A dermatologist wouldn't be used to managing patients on digoxin as would be most internists, cardiologists, and even general practitioners. I don't know why the dermatologist threw in the pen allergy though the penicillins, while not to my knowledge used to treat rosacea, are one of the medications that I believe do not interfere with digoxin. A penicillin allergy has no cross reactivity with tetracyclines or erthyromycins, so that wouldn't have anything to do with the dermatologist's statement. Alternatively the dermatologist may think Pam's father is a candidate for laser surgery, having nothing to do with his penicillin allergy or use of other medication. Some aspects of rosacea, such as telangiectasia or phyma, and some types of flushing without any evidence of inflammation, simply have no good medical treatment, and that may be the dermatologist's assessment of Pam's father's condition. Marjorie Marjorie Lazoff, MD > > > > > > > > > > > > Pam, I may be missing something, but there's > > > > > nothing in Medline > > > > > about > > > > > > it. I can't even fathom a hypothesis that > > would > > > > > justify trying > > > > > Efudex > > > > > > on rosacea. > > > > > > > > > > > > Your poor dad. Did the second dermatologist > > offer > > > > > any explanation > > > > > > regarding the first dermatologists' " radical > > > > > approach? " > > > > > > > > > > > > Marjorie > > > > > > > > > > > > Marjorie Lazoff, MD > > > > > > > > > > > > > > > > > > > Hi! My father was diagnosed with rosacea > > and his > > > > > derm > > > > > > prescribed Efudex 5% cream. He said that it > > was " a > > > > > > radical approach " and to be prepared for > > some > > > > > > unsightly redness. Well, needless to say, > > his face > > > > > was > > > > > > covered in large pus-filled blisters and was > > VERY > > > > > red > > > > > > and swollen. He was then prescribed > > Fluocinonide > > > > > to > > > > > > help with the healing process, which turns > > out is > > > > > > actually a steroid cream!! The blisters and > > > > > swelling > > > > > > have gone down and he is now seeing another > > derm. > > > > > > > > > > > > Pam > > > > > > > > > > > > > > > > > > > > -- > > > > > Please read the list highlights before posting > > to > > > > > the whole group > > (http://rosacea.ii.net/toc.html). > > > > > Your post will be delayed if you don't give a > > > > > meaningful subject or trim your reply text. > > You must > > > > > change the subject when replying to a digest ! > > > > > > > > > > See http://www.drnase.com for info on his > > recently > > > > > published book. > > > > > > > > > > To leave the list send an email to > > > > > rosacea-support-unsubscribe@y... > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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