To Buzz

May 10, 2002

Buzz, I am making your private email public because even putting

Efudex on one spot is potentially too dangerous to keep private.

Please, consult with a competent healthcare professional -- or at

least show my last post and this one to someone who loves you, so

they can talk you out of using this poison on your face.

Let me go into greater detail, so you can better understand my

concern. First, fluorouracil (5-FU), the active ingredient in Efudex,

is an anti-cancer drug, which means it kills living cells.

Precancerous conditions like actinic keratosis have cells that need

to be killed, but that's not rosacea.

In actinic keratosis, one single skin cell's DNA has been damaged (by

the sun) and as a result begins rapidly reproducing out of control,

and then each of these newly created cells, each with it's own copy

of the damaged DNA, continue to reproduce wildly (it's like a pyramid

scheme ). It's precancerous because while the DNA is damaged, the

cell functions normally (other than its reveed-up proliferation). The

problem, aside from the cosmetic pile-up of all these cells, is that

there's a great likelihood one of these trillions of rapidly created

cells will reproduce itself incorrectly in a critical way and not

only proliferate out of control, but start taking over the nutrition

of surrounding normal cells -- that's cancer.

Efudex is like rat poison to cells. Because they reproduce so

quickly, it kills off rapidly proliferating cells disproportionately

to normally reproducing cells. What theoretically remains after

treatment are only the normal cells that don't contain any of the

damaged DNA that started the problem in the first place. Even more

than you described, it's very rough treatment that requires

scrupulous medical attention, and it's a hell of a month...but in the

end it sounds like most patients do well.

But this has nothing to do with rosacea, which has normal skin cells,

reproducing normally. Even recurrent inflammatory lesions such as the

seven you describe take place among normal skin cells. Inflammatory

lesions are one common manifestion of rosacea and other skin

disorders that involve involve inflammed pores (a pore is that

portion of the otherwise buried sebaceous (oil) gland that opens onto

the skin's surface).

cea has a complicated pathophysiology, but it's not one that

Efudex can impact upon. The problem with rosacea lies below the skin

cell surface, below the epidermis, with the dilated leaky blood

vessels and surrounding dermis filled with inflammatory molecules.

Even when inflammatory lesions are due to acne vulgaris, the problem

is microbacterial in part, and in part glandular sludge that recurs

for a number of reasons, but reasons that have nothing to do with

rapidly prolifering skin cells. Best of all, inflammatory lesions

have their own treatments; the inflammatory component of rosacea can

be managed far more successfully than it sounds like you're

experiencing at present. There's lot of hope for you, buzz, you don't

need Efudex.

But there's more about Efudex you need to understand. A 5-FU

treatment given intravenously for cancer is always followed by

a " rescue " treatment, which is an intravenous anti-5-FU drug that

halts the damage of 5-FU on normal cells. I'm not familar with 5-FU

treatments on the skin, but in looking up Efudex in the pharm books I

recall seeing its own version of a topical 'rescue' that is given

during the second part of the treatment, first with the Efudex and

then continued on its own, to help the skin recover. So if the Efudex

doesn't hurt you, the rescue -- at least part of which includes high

dose corticosteroids -- certainly will.

So as damaging as Efudex treatment on rosacean skin can potentially

be, I have no concept what placing Efudex alone without its 'rescue'

counterpart could do. You obviously think that Efudex can be used

like a pimple cream, but it's actually part of a whole system of

care, with specific stages of treatment based on how the skin

responds. It's not used alone, it's not dabbed on lesions.

I hear your frustration with your seven spots, but do you really

intend to risk hurting yourself by self-medicating with an anti-

cancer drug? I know you don't want to hurt yourself, you want to help

yourself, all you want is those seven lesions to go away permanently.

But you risk permanently disfiguring yourself by using Efudex, and

you risk even worse than that if the Efudex is absorbed into your

bloodstream.

Instead, why not share what treatments you've already tried

unsuccessfully, or with only partial success. Maybe I or someone else

can help.

Marjorie

Marjorie Lazoff, MD

-=-=-=

Thank you SOOOO much for taking the time to reply. It's folks like

you that

will eventually find a treatment for this. I will try this on one

spot..just

to see but after reading your note I will NOT try it on the whole

face. I

have 7 spots on my face that go through 3-4 week cycles healed,red

bump.eruption,and healing.....this goes on over and over and has been

for

years....The same spots.....I even lance them through the same

pore.....I

know that's bad....however if I dont lance and release It just stays a

raised red bump and hurts....if left alone it will stay like that

indefinitly..go figure?...............again thanks for being a great

contributor buzz

May 11, 2002

Buzz,

I have a lot of experience prescribing Efudex and I agree with Dr. Lazoff's

wise advice. If your purpose to embark on this therapy is to clear up the

existing inflammatory lesions on your face and to attain the post-Efudex

baby-smooth skin your friends achieved, you may be in for a surprise. The

risk/reward factor is quite unfavorable to rosacea. I am not aware of any

published study on the use of 5FU to treat rosacea, granting that your

lesions are rosacea-related. Topical 5FU has a selective and specific action

on actinic keratosis (premalignant sun damage). Therefore, if your lesions

are not AKs, this treatment will not benefit you and may cause irritant

dermatitis thus exacerbating the condition further. If your lesions are AKs,

there are more conservative alternative treatments available which will not

cause harm to your rosacean skin. I urge you to see a dermatologist for more

hands-on diagnosis and treatment.

Marjorie, you are all heart!

Sy MD

Sy Skin Care

http://www.lindasy.com

Voice:Toll-free 877-sy (546-3279)

Outside U.S.:

FAX:

May 11, 2002