Monday, November 15, 2010

Sun damaged (a Carac experience)

Leopard skin
Having grown up in Kimberley, South Africa, I was exposed to the dry heat and sun for most of my youth.  I spent many blissful sunny days at the Karen Muir Public swimming pool (named after the 12 year old Kimberley girl who set the still unbroken world backstroke record at a junior national event in the UK in 1965) with my childhood friend and his brothers soaking up the sun.   We were of course always out and about on bicycles or walking with our faces exposed to the sun - I think that Kimberley had something like 350 sunny days a year!  Unlike the USA, there was no culture of children wearing the almost ubiquitous baseball cap so we had tanned faces almost all year round.

Sun screen had been around when I was young and I do remember the Coppertone Girl billboards when I was a teenager - but even so, I had managed to get myself burned badly enough to blister several times in my life.  We certainly didn't know about the connection between sunburn and cancer until much later.  I think the sun products were all about how to get even tans and how to avoid the acute sunburn experience rather than long term protection.

A couple of years ago this all caught up with me when a squamous cell carcinoma was discovered high on my forehead.  This cancer is not dangerous if discovered early and is the second most common form of skin cancer.  It shouldn't be treated lightly though - it is a cancer and there is concern if it isn't treated in good time.  Fatalities are tied to not treating these early and the pictures that you see on the Internet can be quite disturbing.  Mine was very small and unassuming but gave me a bit of a wake up call to pay attention to the marks on my skin.


As a follow up, this year I scheduled an appointment with a dermatologist.  In America (or perhaps just in this part of the US) these things require planning and patience.  You need a referral and have to wait several months for an opening for the screening which basically involves inspecting you from head to toe for signs of growths or moles that might be problematic.

The condition that I have, caused by sun-damaged skin, is called Actinic Keratosis and is essentially scaly rough patches that you get on your face as you age.  These are fairly easy to spot in the "before" photograph of me in the series below - slightly darker than the rest of my skin.

The presence of these are evidence of sustained sun damage and the likelihood of developing any of the skin cancers (including the very aggressive melanoma) is greatly increased by this condition.  In fact many believe that actinic keratosis is an early stage of squamous cell carcinoma.  Apparently about 10% of these patches are likely to develop into cancer.

One suggested preventative treatment is to use a cream that attacks the cells on the skin that have the potential to develop into cancer.  The cream is made from a chemotherapy drug called fluorouracil which is most quickly absorbed into cells that are dividing rapidly and inhibits their ability to synthesize DNA which essentially kills the cell.

The cream apparently affects people differently and the treatment time can vary from two to four weeks.  I was told that I'd have to use the cream for about two weeks and was warned that I would be astonished at how much of my face would react to the cream and that it would end up being increasingly irritated and red as the treatment progressed.

After a few days of use, I was not showing too many signs of redness - perhaps just enough to prompt me to create an image in black and white using the red filter in Lightroom to accentuate all the red places.  I called the image Leopard Face because of how it made me look.

The truth is, that my face was beginning to look pretty grim.  The raised spots were not quite painful, but certainly noticeable - I guess a little like how you feel a few days after you have had a bad graze, the tight not-quite-itchy slightly painful feeling you get as you are recovering.

I had to apply the cream once a day - I did it before going to bed each night - and after a few days of treatment I had a borderline headache by the end of the day and was pretty aware of all the irritated areas around my face.  It was entirely bearable, but fairly unpleasant.


As you can see from the second picture, the irritated area was enough to be noticeable but not that obvious - my colleagues at work told me that I was being over-sensitive to how obvious it was.

So here is a collage of my face before, after a few days and after 2 weeks to show how the effect increased over time.   You can click on these pictures to see them in closer detail.  Because there were areas in my beard that began to react to the cream I ended up shaving my beard  - much to the alarm of the rest of my family - to give me better access to those areas.  The dermatologist had said that I didn't have to shave, but I felt more comfortable treating the skin with the beard off.

On the last day of the two week treatment I was told to use Vaseline to help the healing process.  Like a glaze, it makes the red areas appear even worse than before.  I was quite fortunate to be able to work from home during this process, because the bright red patches on my face are very distracting and it takes some getting used to.

I am told that it will take several days for the redness to back off and all of the dead skin will have to peel off my face.  Apparently after two weeks I will look at least like I did before the treatment and four weeks after the treatment my skin will be markedly better than it has been.  There may be a few persistent patches of actinic keratosis that will still have to be treated separately.

Most people who have this condition are able to treat each developing lesion by burning them off individually with liquid nitrogen.  This was an option that the dermatologist suggested to me as an alternative.  Considering though, how much of my face proved to be susceptible to this cream I am pleased to have used this more aggressive treatment despite the unpleasant view that I treated my family to as my face deteriorated over the course of the treatment.

Don't underestimate the importance of your appearance to people's impression of you.  It is an interesting experience going out looking like this.  I think that strangers assume that you have some facial pigmentation like port wine stains so you do get some looks - but mostly people ignore it.  We went out to lunch and had the waitress focus all of her attention on my wife for taking the order and checking on how we were enjoying the meal.  It is hard to ignore if you are face to face with a colleague or a customer so I would really recommend figuring out how to work from home if you can during the 2nd and 3rd weeks of treatment.

I have read on some of the forums for cancer treatment (I was prescribed Carac) that an option often exercised is to treat different parts of the face at different times.  Since some people end up having to have this treatment over 4 weeks it is hard to imagine avoiding going to work for that long.  From what I read these are for severe cases and also where the skin doesn't react as quickly as mine did.  I suppose fair people burn more easily and respond more readily to this treatment.  Either way, the longer treatments might only get unsightly after a much longer period.

A week on (6 nights after I stopped the treatment) my skin is looking a lot less angry.  My face is showing some peeling and the vaseline that I have to use to help the healing does make it look more pronounced but it is bearable.  I assume that I'll have a lot less to show for this in another week.

After 4 weeks there is still some evidence of the red below my eyes and some of the darker spots that were more inflamed than others, but overall I think that the skin on my face is quite a bit better than it was before I even started the treatment.  I have to say that I haven't noticed peeling excepting in some of the very badly affected areas.  I suspect that the peeling has not been very noticeable on my forehead for example where the skin looks very much better.








---- Feb 2012 update
I have been asked to add a photograph as an update 15 months later.  I am a little overdue for a checkup on my skin.  There are still a few noticeable sun damaged spots on the top of my forehead but as I said before these will be treated when they begin to transform.   Other than that, just more white in my beard :-)


Nov 2012 Update
One of the people who followed this Blog sent images of how he looked at the end of treatment.  Hopefully we'll also see an image in a few weeks as your skin returns to normal.  Thanks, Jim!


One week later...

106 comments:

  1. thanks for your input...I'm on day 12 and longing for the end, but it's fix it now or pay dearly for it later...cheers, Ged

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  2. I'm on day 21 of a 30 day treatment and my face is killing me. Luckily I work from home, as I really wouldn't want to be out in public. I have been combing the web to see pictures of others experiences, so I know I'm not alone. Thanks for sharing!

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  3. im on day 10 of 2 week treatment, your site was a blessing as it is helping me understand what is going on and what to expect. thanks for writing this it is a big help for many of us going thru this!

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  4. Thanks for the pictures and the narrative. I will be going through this this coming summer (ugh! - fun summer). Since I'm a teacher, I don't have much choice. Your ending picture looks great! I am pretty apprehensive about the whole thing!

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    1. I teach high school! My doctor told me to wait until winter to undergo treatment because the sun might cause bleached spots. I'm on day 14 of a three week treatment and a walking public service announcement to my students. No working from home in this profession. I think I have the advantage that I live in a small town and via facebook, my students, and local gossip, everyone knows that I'm doing the treatment and they're not too shocked when they see me. Thanks for the blog post so that we know we are not alone.

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  5. Thank you for the comments. Some months later my skin is clear and in good shape. I am encouraged at the treatment. Good luck with your treatment and recovery!

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  6. Thank you for sharing your experience. I am on day 11 of a 21 day treatment for my face, hands and arms. I have had 4 BCC and 1 SCC removed from my legs. This is a very unpleasant experience as my skin was badly sun damaged and was diagnosed with Actinic Keratosis. Far too many places to freeze this time. Hang in there to all who are going through this. I PROMISE TO WEAR SUNSCREEN AT ALL TIMES!!!

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  7. I am on my 5 day after completing a 2 week twice a day treatment on my forehead. I will have mohs surgery in April on my ear. It is the fifth surgry - 1 forhead -1 nose (forhead flap) - 1 lower leg - 1 upper arm. Anyone that reads this, make sure you use sunscreen and your children and grandchildren. Especialy if they are very active in summer sports. My daughter played softball and at 35 she needed surgery on her nose for bascil cell.

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  8. Tim,
    Would you say that the photo of you in the nay blue shirt was about as bad as it got?

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  9. That should have said "navy blue"

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  10. Yes, I'd say that was the worst it got. I was surprised that it took days after I stopped before it started to look any better.

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  11. Hi Tim,
    Did you actually have to go back, as you mentioned, and have any spots treated separately after the carac treatment was over? If so, how did they treat them?

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  12. I had to go back 4 weeks after the treatment stopped to be examined. There was one spot that was still red that she said was fine and another place in my hairline that I honestly think was from a scratch that she burned with liquid nitrogen ("just to be sure").


    She said that this would take care of a great deal of the damaged skin and make it possible to more readily deal with any isolated actinic keratosis that might come to light later. I have to go back once a year to be examined.

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  13. Thanks, Tim. I think your pattern of skin damage looks very similar to mine (mostly around the nose). I hope I make out as well as you did!

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  14. Hi, I'm 45 and on day two of the cream application. Ironically, my 77 year old father is on day 14 of the same treatment. I find myself obsessively researching it. I have read and seen enough and know what to expect, but my fears are still there. It is comforting to see people make it through to the end. I fear some sort of bad reaction internally. However, I believe that is rare. I have a 10 yr old son and need to be here :)

    Anyway, each journal I read, helps. Thanks for posting. Yours is the most current one I have read. I too was a sun worshiper and MOHS 9 yrs ago for my first skin issue a BCC. Now with the Ak's and two different docs I decided to go ahead with the Efudex/fluorourcil. Wish me luck....as all our fellow treatment goers wish! Thanks again,
    Caroline from TX

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  15. Tim, Thanks for the great personal account. Cuts through the BS... So much better than a Mayo Clinic-type description for letting friends know what I'm going through -- and why. (And I don't have to scare them with my own photos, ha ha... better you than me).
    Cheers.
    Bradley

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  16. Claire checking in. I'm on Day 12 and look very much like you Tim, except nothing on my forehead. It's very red under my eyes and on my nose. I'm hoping the doctor will say I'm done when I see him in 2 days. thanks, Tim.

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  17. Good to hear from you Claire and others! I hope so too - I really think that it is worthwhile. There may still be recurrences of skin cancer but this clears the decks so that they can be treated in isolation. So far no sign of anything on me but I remain vigilant and will see a dermatologist at least once a year for inspection.

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  18. @Bradley - ha ha, that is funny, using my leopard face images to "suggest" to others what you might look like. Clever.

    Best of luck.

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  19. As more people get prescribed this the general public will become aware and get used to seeing people who are undergoing this treatment. I work in a public library on the front counter so if its any consolation to anyone who is scared to appear in public sporting the red spots let me tell you there is nothing to worry about. Most people scarcely give me a second look and if they ask they are sympathetic. I also lost a front tooth at around the same time so I looked an absolute fright. Cured me of any stirrings of vanity! Ha ha

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  20. I am on day 17, and return to the dr tomorrow to see how much longer... How do you tell when the bad cells are destroyed? Is the flaking skin a sign that it's time to stop applying?

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  21. From what I could tell, some people's skin doesn't react as quickly as others do. In most cases very fair skin reacts quicker. My dermatologist had me put Vaseline on the skin so I didn't notice much flaking of skin, just very red and dry. I think the redness is a good sign that the treatment is being effective but I don't know that how they tell when it has done enough.

    Good luck with your appointment tomorrow!

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  22. Thanks Tim, the appt went well. My derm was happy that I decided to treat my whole face even though she only told me to do my forehead. Half of my face is a week behind the rest now, but some spots were showing up that I wasn't aware of so thought there were probably more. (there are)
    Anyway, I guess what she looks for is the brownish crusty appearance... that means it's done its thing.
    I have a question regarding what to use after the treatment is complete to help the healing. The Dr gave me Cutivate, a type of hydrocortizone lotion I think. I have read some negative reviews and don't need to start it until Sat, so wanted to get your opinion. Thanks for keeping up your blog, it's really helpful!

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  23. I'm on day 13 of a 3 week treatment. Your pictures really helped me prepare for what I would be going through. So it really only took a week after you stopped the treatments for most of the redness to go away? Do you have any other tips for speeding the recovery process?

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  24. Well on the start of that week I put Vaseline on my face which actually made it look worse for a couple of days. You can see in the picture that it was probably close to what it looked like at the end of week one. Good luck!

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  25. Hey Tim,
    Thanks very much for your well documented experience with using this creme ,Fluorouracil (Carac is one of the brand names for this drug) to treat sun damaged skin. I was prescribed this and given minimal information as to what to expect in terms of the timing of things. Your account, which mirrors mine, has removed the uncertainty about what I was experiencing. Both your pictures and the writings about the timing of your facial changes from the treatment have been helpful. The one thing I personally am still unsure of is the difference in treatment periods... some people have been told to use the creme for 3-4 weeks and some have been told only 2 weeks. If anyone else can maybe explain what an appropriate timeline for treatment should be, that would be helpful. Obviously, I assume it depends on the specific case...
    Anyway thanks again for your helpful and informative blog.

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  26. Best I could understand from what my dermatologist said was that much like our skins react differently to sun, it reacts differently to the effect of the creme. I suspect that fairer skin probably reacts more readily hence the shorter period. (But I am not a doctor - it would be interesting to hear if others have a more scientific explanation).

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  27. Tim, Thanks so much for your very informative overview. I am only on my second day, and as a freelance illustrator have the latitude to work at my home studio and out of public view. I am a little concerned about the declarations from the Flourouracil makers to stay out of direct sunlight. I am a flyfisherman, and hope I won't have to radically change my pursuit of the sport after completing the process. Other than liberal use of sunscreen, do you have any thoughts on life after Carac?

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  28. That's interesting. I understood that it was only during and directly after treatment that the skin is very sensitive to sun.

    You should check, but it might be ok after your treatment.

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  29. Thanks for your comments and pictures during treatment.. I am a 63 year old guy, of Irish German ancestry, on day 13 of my treatment.. forehead, temple area, below sideburns, cheek bone area, and one side of my neck gets a full coating, 2x a day of Fluorouracil 5%. I live in the south, have been exposed for years to the sun from running long distances outside, and beach time.. I was told its better to do this in fall/winter months.. I am glad I waited.. I have been running marathons etc for years, and have trained wearing only a visor and sunglasses, with sun block on my face in the early am hours.. still get a lot of sun on some 1-3+ hours training runs.. I am 63, and have had patches "frozen" off before.. my entire face is red,"hot" and tight like a very bad sunburn.. 3 more days to go.. the I will stop the Flurouracil.. its a comfort to see the "war stories" of folks like you who have been through this, and are kind enough to share your experience.. wish I could "advance the clock" a month, but am sure I will be thankful I did this.. Thanks again, Tim!

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  30. Thanks, Tim and all. Day 14 here. Decided for business reasons not to do my entire AK affected areas and just do the bald spot on my head, which is badly sun damaged. If this goes well, I'll do my forehead next year. So far, so good. Just some blotchiness and relatively minor sensitivity. Weird, since the AK developed 6-8 years ago, all the AK areas feel sensitive anyhow, so it's not big change as of yet. (I've had to tell my hair cutter to go easy on the top of my head with the clippers...). Hopefully, we'll be the last generation to have to deal with this. My very Irish-American kids are pretty sensible about sunscreen and avoiding bad sunburns. They've heard their father's stories about too much time on Long Island beaches growing up, with no protection. Anyhow, hope you've all survived your Carac journey and I wish you well. You've done a great service, Tim. Cheers.

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  31. Thank you!

    I thought after the treatment whether a phased approach would have been better. In retrospect I am glad it was all over at once but then I was able to work from home for the worst part of the treatment.

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  32. Thanks for this blog Tim! I am on Day 8 and not quite sure when to stop. It is starting to look real bad and I was worrying about my decision to do this. I am already cancelling plans to watch the Super Bowl at a friends house just cause I do not want people to be uncomfortable thinking I have a spreadable disease of sorts! I also have a baby girl being born in 3 weeks and now worry I am going to terrify her with this look. If I stop after 2 weeks, will I be markedly better 2 weeks later? I know its different for each person but in your experience is what I am wondering. Thanks!

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    1. I think you will be pleased once the treatment is over. Not so much fun watching the Superbowl without friends, though - mine had a good time teasing me about my face and I'd guess they'd give up soon enough once the game started.

      Congratulations on your daughter! I think babies only really start making sense of faces after about 5 or six weeks - everything is blurry and key much more on sounds at first.

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    2. Wow! Great response time! The funny thing about this is it is somewhat a voluntary decision to 'disfigure' yourself like this. I think that is what makes this scary as heck. The Super Bowl party is at a friends per say but I would not know the rest of the people so that is the daunting part! Thanks for the encouragement and the blog. It is helpful to know you can come out of it when you have doubts like this.

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    3. Yes - I think that I mentioned that my wife felt guilty because she didn't really like me very much at the time. Good luck with the next few weeks.

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    4. Hi. Thought I would check in with you. I am at two weeks treatment now. The odd thing is while the center of my face is red and getting brown crusty in spots, other areas, like my forehead, still seem to be coming in. I did not get the healthy all around attack it seems you got. It seems to be centered around nose with slowly coming in areas. Did you have any areas like this? I cannot get to a doc so I got to make the end call on my own. Appreciate any advice. Thanks!

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    5. Yes there were a few patches around my forehead that didn't flare up - it seemed to attach the damaged skin but not healthy skin. I think that the area around the nose - the tops of the cheek are most sensitive to this.

      Not sure about making the call - I didn't want to go through the process again so I did want the doctor to check it out before I stopped. Good luck!

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  33. This comment has been removed by the author.

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  34. I am in day 11 of a 14 day, twice a day Flouracil treatment. I can not tell you how much I value your blog here. This is the best one I have found. Especially all the comments and responses. My face is on fire. Well, that is a little to dramatic. But the forhead, nose and both high cheek areas full red, dry, scalely, etc. It is good to see that there is an end in sight. The manufacturer's right up says there are 4 phases - preinflammatory, inflammatory, tumor disintegration and healing. I hope I get to the healing soon. I do have a question. I was told that if I must go out in the sun during treatment to use sun block. But, I was also told when complaining about the dry feeling that I should not use moisturizer until end of application period then use vaseline. Is it true we should not use any moisturizer during treatment application period? Why would that be if it is ok to use sun block. Seems like a contradiction to me. Thanks so much for your blog. I too send this to people who I am explaining why I am hiding out at home.

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    1. I have to say that I can't remember clearly whether I was able to use something on my skin other than the fluorouracil.

      I did find this article: http://www.drugs.com/mtm/efudex.html. It says that you can put a moisturizer on you skin from 2 hours after applying the treatment and you can use SP15 if you are out in the sun (I wore a hat).

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  35. Thank's Tim. For other's reading this, thought I would share the following. My doc had originally said come in mid application period for a check in. When I set the appt the nurse said, no come in 2 weeks after application cessation. Well I decided to force the issue because my face is extremely red here on day 12. I went in. She said that I was experiencing a perfectly appropriate response and that I could stop now. Wow. I am glad I forced the issue. My face is really red and raw down the center corridor from forehead nose, high cheeks around the nose and chin. She said stop treatment there, but keep going on the perimeter where the reaction is spotty. She wanted me to go 5 or 6 more days on that, but I told her I need to get back to work soon. She said fine. see it through on the perimeter of the face only now until total 2 weeks is up. If we have to freeze something down the road we will just do it. I also asked about ointment for moisturizing during application. They said they just prefer you not have layers of flouracil and moisturizer on your skin, so better without, but not a big problem to do so. But, since I am stopping they prescribed me Mupirocin, an antibacterial type of ointment she said would keep infection away, and moisturize. Problem is, my face stings more with it on. But, hoping that won't last long. I had other questions like why do some go 2 weeks and some 4, and it just came down to different skin types. I also asked about whether I can wash face with soap and she said yes, and suggested I use Cetaphil (soft). I asked if I was using too much flouracil given how intense my reaction was. My tube (40 grams) is about 40% used after 23 applications (11 full days * 2 per day and half of 12th day down = 23. Full face applications). So, my intense reaction was not due to my overdoing it. I asked if shaving with shaving cream and water was ok. She said not a problem as long as your skin can handle the razor.

    Probably too long of a post here, but people seem to value the information based on the other posts. It sure has helped me a lot. Thanks for the forum. I am only Anonymous because my email has my company name in it. Sorry for being impersonal. Name is Glenn

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    1. Thanks Glen (and no worries). I wrote the blog originally because there were only one or two published out that. They showed the worst but didn't show the recovery afterwards.

      It was funny to hear that I have been used as an illustrative example of why someone else is hiding out :-)

      Good to hear that you have been able to stop treatment too. I am probably due for an annual follow-up soon and my face is in pretty good shape.

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  36. Thanks, Tim, for this service. Have read these entries with interest. I am 58 years old with many years of sun exposure on the beautiful beaches of Long Island and New Jersey. My doc prescribed Carac for forehead, sides of my face, into my scalp and on my bald spot. I could not be out of work action for 4-6 weeks, so I confined initial treatment to my bald spot, which is about 3 inches in diameter. The treatment has gone very well. I have had no real discomfort. I can already see the healing taking place. I am going to do other sections of my face as time allows, stretching treatment out over a year. We'll see how that goes. Good luck to everyone.

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  37. Glenn here. I last wrote when the doc told me I could stop the center of my face after 11.5 days, but had to keep going on the outside perimeter of the face for the next few days. I did that. My face was really red and raw, then the peeling came in heavily. Anyway, last Saturday was my last treatment and I am almost completely back to normal. I was pretty hideous just a few days ago, but it works. Anyone going through this, here is how it worked for me. Started on Sunday morning January 29. 2 treatments a day. No real sign of anything on Friday February 3. Light signs of readness Saturday the 4th. Self conscience on the 5th, and definitely needed to work from home the week of the 6th and 13th. LIke a sunburn and measles at once. But, by the end of this week (here on Saturday the 18th), all fine. Could have worked from office on Thursday / Friday. Tim - thanks for this forum. Hope my story helps people. Oh, by the way, when it itches (the peeling and what not), I just put a towell on my face and light press, not rub, the spot and it gives relief. I slept fine with a glass of cognac before bed too. Best of luck everyone.

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    1. Thanks Glenn - I like the idea of the glass of cognac. I was thinking about it the other day - not sure that I'd do it again, but glad that I did it once.

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  38. hy!
    could you please post a picture to see what your face looks like after all this time.
    Thanks in advance,
    Vito

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    1. Sure thing, Vito.

      I'll add a little note at the end of the post.

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  39. Hello. I just completed 3 weeks of once a day Carac. Five years ago, I did 2 weeks of twice a day Efudex and this latest round of Carac was as grim as the first round of Efudex. Both times, I look like I'd been dragged across rocky, rough pavement on my face - I am so self-conscious and miserable, but going into the office anyway (wearing a big hat). Today is day 3 of "recovery" and I have Aquafor all over my face. It feels better but still looks like hell. Somebody out there please tell me when this will clear up completely. I just never realized how embarassed and uncomfortable I would feel with my face totally beaten up. I won't do a total-face application ever again.

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    1. It is miserable. I remember that it took the best part of a week for me to feel that my face was passable again. I realized that I was super-sensitive to how it looked but after a week people were not noticing it any more.

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  40. Tim ran into your blog when searching carac cream. This blog has been comforting in that I'm now on day 18 of a 21 treatment schedule. It was nice to be able to read other accounts from people going through the same treatment. I'm 60 years old and grew up on Lake Erie so I was at the lake constantly. Who knew back then the damage we were doing to ourselves. I've been treating skin issues for several years. I've had spots cut off my face, arms, legs and chest. My Doc finally said let's try carac. It's been all that everyone describes painful, burning, itching and more but seeing this blog makes me realize it's what needs to be done. Thanks to everyone!

    Seeing your home blog I see that you are a hiker Tim. I go on a 10 day backpacking trip every year generally in the western US Wind River Range (Wyoming), Utah, Montanna.... This May heading to Vancouver to hike in the Canadian Rockies. Hopefully my face will accomodate my trip.

    Also Tim my condolences on the passing of your mother in January.

    Thanks again for everything you do!!!

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    1. Thanks Tom. I have to figure out how to get out west to do some hiking. Wyoming, and the Rockies are on my list :-).

      Thank you also for your condolences. She was a good woman and we will miss her.

      Best of luck with this treatment too - I have to schedule an annual checkup for my remaining spots.

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  41. I found these posts very interesting. I did this over my entire face. I can relate to what everyone is saying. My sister also did this treatment. Someone told her to use cocoa butter so I did use it some. It helped. Has anyone else heard of using cocoa butter? My doctor wants me to do it again but do it in sections. I'm having trouble deciding if I want to do the whole thing or deal with this over such a long period of time. I started it yesterday on my forehead and a small section of my cheek that looks like it may have some precancer cells. I've been told it isn't as bad the second time. Can anyone confirm that?

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    1. Thanks for the post. I suppose that since the cream reacts to sun-damaged skin it might be have a less pronounced effect the second time around. I will be interesting to hear how you progress.

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  42. I just finished a two week treatment yesterday. Thank you so much for posting your experience. Anyone having to go through this, my doctor prescribed Desonate cream, a topical steroid, once I finished the treatment. Just one application later (today), my skin is noticeably better. I cannot believe that doctors have advised using vaseline. I know it has been used in the past for all sorts of ailments but this topical cream has helped heal the swelling most of all but also the size of the affected areas. Good luck to everyone!

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  43. Hi Tim (and others). I wanted to check back in post treatment and let you all know how things are going with me. I was one of the people who wrote you Tim in the beginning of February. Scott is my name btw. I stopped treatment 2 months ago. I will say that it is amazing how quickly the face rebounds from this treatment! One week after I stopped I went from looking like I had a mutant virus to a slight sunburn! It was liberating to walk in public without fear of people staring. Now to my concern area. I am still red in a few areas. Too much so for my tastes. My hardest hit areas, around nose, eye bag lines, and between eyebrows still have a pink tint to them. The area around the eye bag lines makes me always look swollen and tired all the time. When did 'all' the redness go away for you Tim? I see above you had some still after one month. Thanks again for this great web site again.

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    1. Thank you for the update, Scott. It is strange that I think I was so relieved that I was looking "normal" again that I didn't pay attention to how long the remaining redness took to go down.

      I feel sure that it will. Perhaps you can let us know?

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    2. I certainly will. It probably would not bother me as much except I am getting ready to look for a new job and had hoped to be back to 'normal' looking by now. I am glad to be out of the contagious looking stage but the lingering effects are surprisingly hanging in there. I will keep you posted. -Scott.

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  44. Hi, Tim. Thank you for this blog. I am experiencing my third carac treatment. My first two treatments did not include my nose, only a few spots on my cheeks and forehead became sores. This third treatment, however, has been very difficult. My whole face was treated and after only 4 days, my nose was very red. I am now on day 11 and my face burns, the skin is peeling in parts, scabbing up in some parts, and just red and inflamed in the rest of the parts. I look horrible. I am a teacher and have used this experience to warn my 7th graders about the dangers of too much sun exposure...I think they have taken the warnings to heart after looking at my face.lol.I really want to stop before the three weeks is up as I am bleeding in some parts and tend to be a little cranky. I will stick with, though, in the hopes I won't have to go through this again in the recent future.
    Lori

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  45. Thanks Lori. It is not an easy treatment but worth completing. I feel for you as a teacher going through this. Good luck in the final phases! Perhaps you can see if you can get an earlier appointment for your doctor if you are reacting this well to the treatment?

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  46. I am starting with it Fluoroacil now and your blog is a lot better than every doctor´s recomendation. i thank you so much. Sorry my english i am from Argentina. REGARDS

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  47. Good luck with your treatment - please keep us posted if you have anything new to share!

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  48. Just read your blog and got more information from you than I got from the doctor. I have been on a 3-week once-a-day regimen and was told to stop application yesterday,let it heal and do another 3-weeks of the cream. I was told my nose would turn red and peel Well, it didn't. It is slightly blotchy and there is one little "bubble" where the squamous cell cancer was detected but no peeling and no real redness. I don't know what is supposed to heal but I will wait a few days and call my doctor before starting the next 3-week regimen. My next appointment is June 28th unless he wants to see me sooner. You look great now but stay out of the sun. Thank you for all the good information. Ms. Lee

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    1. Thank you. It is interesting how some skin does not react to this treatment as quickly. Apparently it attacks the cells most prone to cancer so perhaps it makes sense that it would be active where you had the squamous cell cut out.

      Good luck with the rest of your treatment.

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  49. I am so glad that I found this website. My husband is going through this now, and the doctor told him nothing about what to expect, other than, "You're going to start looking really scary". (and he is). It's good to know that an end is in sight.

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    1. Glad to hear it. My wife didn't like me for a period during the treatment and felt bad about it... I suppose if it was permanent she would have got used to it, but I am very glad it was only a few weeks (so is she :-))

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  50. I'm on day 6 of a 14 day treatment of my face.. I did my bald spot about six months ago. I must admit my face is much more sensitive than the top of my head. Having been thru this once before eliminates the "uncharted waters" aspect of the treatment. The bald spot took three weeks. Two weeks I can manage.

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  51. Tim, wanted to say thanks! I went into this blind of expectations, and your blog helped me understand what to expect. Have just finished the treatment, and wish I could send you a picture as I think my face actually looks worse! :-) Hope you realize that your willingness to share this episode in your life has made a difference for a bunch of us.

    Now it's healing time! For all of you going through this treatment, keep it up. It is absolutely worth the time, pain, frustration, etc.
    Jim Taylor jtaylor36@austin.rr.com

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    1. That really is saying something, Jim - I went up for an annual checkup at my dermatologist last week and had a few pre-cancerous spots (a few persistent ones remained) burned off. It reminded me, though about the treatment. I agree that it is worthwhile to do because it is like this big reset on your skin but it would be tough to do it again.

      I'm glad this entry has helped so many people! Thanks for the encouragement.

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  52. Tim,
    It is now March 2013, and I'm on day 12 of 21 for my forehead. I did the left side of my face first and thought THAT was horrible. I am fair skinned with very fine, thin blonde hair. My cheek was a piece of cake compared to my forehead. And my forehead includes my eyebrows, my temples, and into my hair (past my hairline). If I knew then what I know now, I would have worn hats and tons of sunscreen!!

    Thanks for this blog. You can see you've helped so many people going through the same thing, and thanks, also, to all of you who have posted.
    Just wanted to say one thing a little different that I have done this go around. My forehead is quite red and "angry". It hurts alot. I have actually used a product called Recticare on it. Recticare is basically 5% lidocaine and REALLY helps with any stinging and itching. I am in no way recommending it to anyone. Just saying that I use it. My dermatologist said I can put cover-up on my skin about 10 minutes after applying the flourouracil, so I'm not as embarrassed by my appearance. My kids, though, get the full blown look when I take my makeup off. They cringe! Can't wait until this is all done!!!
    I am a walking advertisement for Sunscreen, and I promote it all the time. I carry a small tube in my purse at all times for myself and to share with anyone and everyone!!
    Thanks again for your blog and pictures. It was good for me to know that I am not alone in going through this and looking like this!!
    Carol

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    1. Thank you for this! Very brave of you to do it in stages. I think it must be harder to start each new stage after going through the first experience.

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    2. It is absolutely amazing what 2 days can do during this treatment. I couldn't make it to day 21. My dr did say I could stop at 14, but 21 was better. At this time I just want to immerse my forehead in a vat of frozen vaseline! Even makeup isn't able to cover the redness (almost purple now) that's going on. I can't imagine going through this on my entire face all at one time. And I still have to go to work every day. I can't wait for my forehead to heal!!!

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    3. Luckily we and the people we subjected to our red faces forget quickly. I was looking back at the pictures - it is a pity we can't live in black and white because that at least looks interesting ;-)

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  53. What amazing me is how great your skin looks in the after picture!

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  54. Thanks so much for posting this - and the other pictures. My dermatologist prescribed 3 x per week for 6 weeks but I am on week 6 now!!! It is truly amazing what the Carac does and it is miserable. If I was very vain, I would have a problem but most people have been pretty nice about it saying it just looks like a bad sunburn (that was 2 weeks ago so and it's now ickier). Not sure if it's better to do multiple applications per day for a shorter term or spread it out like I did. The other thing I found that helped a little bit was to put the cream on and then wash it off after 2-3 hours and then cream (aquaphor/cetaphil)...lots and lots of cream.
    Shannon

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  55. I'm 40 and applying this to one, small actinic keratosis. I have one next to my nose, near my eye, that they've tried to freeze off five times with no success--so now the flourouracil. I think I'm getting one on the other side of my nose as well, so I suspect more treatments may be in my future. No redness yet, but I've only applied twice so far. Since the area is very limited, I'm thinking of trying to apply a gauze bandage once things get ugly. I understand a light piece of gauze with tape is okay...just nothing that really impedes air flow. Thanks so much, Tim, for giving me some idea of what to expect--even just in this small area.

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    1. Good luck! I am due for another annual checkup for a couple of spots that have appeared. Last time they were diagnosed as Seborrhoeic dermatitis

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  56. Hi there,
    I am really glad I came upon this sight. I am day 3 of the treatment and don't have any redness yet but I am very nauseous. Did anyone else feel this?
    Thank you,
    JJ

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    1. All of my symptoms were topical. Skin felt like it had been sand-papered. I didn't feel nauseous from the treatment.

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    2. A couple days after I started treatment on my face, legs, arms and chest 2x a day, I developed severe nausea and ended up throwing up all night. I was told it was a reaction to the medicine. I guess some people react different than others...

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  57. Thank you for replying, Tim. I think this nausea is a separate issue!

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  58. I am on day 14 of 21 and really want to be done! I am doing full face and chest 2xs per day (ouch!). It is very difficult to eat or smile, as my worst facial areas are around my nose and mouth. I am a Holistic Health Counselor and totally believe in preventative care, so I am using my face as a public billboard to increase awareness of skin cancer. I read a lot of posts about "hiding out" and I understand the desire to do so, but being out in the community, telling people about what I'm doing and why I'm doing it, might save lives!!
    Thanks,
    Sally Buchanan

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    1. Wow - this is the first I've heard of application other than on the face. It must be very uncomfortable. Good luck with the last week of this!

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  59. Hi, i am Laurie. The beginning of August I am doing the treatment on my face, arms, neck and chest. Yikes! I am 54, and yes, of the time when we used baby oil and iodine while laying in the sun! I have has 4 MOHS surgeries. I also think its a bit hereditary, my Mom is always having things cut off. To avoid that, I am doing this. So....I will post regularly. Also, I have used Retin-A on my face for about 6 years, will be interested to see of that has any impact at all. Wish me luck! And thanks to everyone for your posts.

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    1. Good luck Laurie - that is quite a large area that you are treating. Let us know how it goes!

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    2. Day 1 finished! All is well (lol). I will post as things progress....

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    3. Have to say the cream is wierd, it kind of turns into a powder like consistency as you put it on, it's not greasy or anything. So far, no reaction yet anywhere.

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    4. Interesting. I think it did take a couple of days for it to kick in. I did hear that some people's skin doesn't react as well to the treatment... keep us updated.

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    5. Checking back in, 16 or so days in. No reaction on my face, and I mean none! So as of today I stopped using it there. I guess the last 7 years or Retin-a, lasers and sunscreen have helped a lot, although 2 years ago I has a basal cell MOHs right above the left eye...
      However, my chest has lit up. Took about a week, I now look like I have chicken Liz, dark purple spots all over where the V or U of a shirt is. Itches, for sure, just like everyone says, and skin feels tight. I'm not using any aquaphor yet, don't feel like I have to. No oozing yet either. So....onward! Laurie

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    6. Haha....chicken POX. Love auto correct!

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  60. Hullo there!
    Thank you so much for starting and keeping up with this blog! The lack of information (my dermatologist is a great scientist, but lacks in bedside manner... and as a newbie to skin care I just didn't know what questions to ask) from my doctor and from the internet has been really disheartening, combined with the emotional toil of the physical changes in my face. I am two weeks into a three week treatment all over my face (but my forehead is not reacting at all- I guess because I wear caps and have bangs). The rest of my face is reacting as expected from a 40-year old life of beach-combing, surfing, and sailing in Texas. I am using Aquaphor (like Vaseline, but thinner and less sticky) for itch and tightness relief, and am counting the days until this is over. I am a biology teacher and do not want to scare my students off when school starts in a few weeks, but I am taking pics to show them when we get to our cancer unit. I am actually grateful for the experience of having a face that is difficult to look at- I have always been sort of a "natural beauty" but now I can empathize rather than sympathize with students with skin problems. Plus, I am very grateful that this experience will hopefully prevent much more severe problems. The memory of the pain and difficulty will stay with me, and makes me a much more vocal advocate of SPF, for sure!
    I thank you for your time to manage this blog for all of us, offering us hope and a sounding board for our concerns. You must be a very generous person, and I am thankful for you! -Sam

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    1. Thank you Sam
      It is tough convincing teenagers that something like this can be very bad for them later in life so having pictures of someone they know will b really drive it home. I am coming up for my third year since taking this and have to get an appointment for an examination sometime soon. So far, so good though.

      Good luck with the recovery!

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  61. Thank you for sharing your thoughts and experience I will be using this cream on my upper chest. I, too, will will chronicle my experience.

    Roxanne

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    1. If you publish this, feel free to forward me a link so that I can let people who visit this page know about your experience too!

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  62. Tim, Thank you for your outstanding blog. I am 9 days into a 14 day treatment, and have some encouraging news for folks. This is my second treatment. About 2 years ago, after two bouts of basel cell carcinoma surgery, I ask my dermatologist if there was anything we could do to reduce the risk of a reoccurrence. He prescribed Carac. As most folks have experienced, my northern-European-face-exposed-to-constant-sunlight-as-child lit up like fireworks on the 4th of July. Everything healed up nicely.

    Now, two years later I'm seeing little spots of Actinic Keratosis emerge again. The good news... my reaction is positive, but much more subdued. While I have the itchy, scaly, burning, soreness, it is localized to the top of one ear and nose. Bottom line ... the treatment 2 years ago really helped, and my experience the second time around is much easier to tolerate.

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    1. That is very encouraging news. It is good that they caught that early and even better to hear that your subsequent treatment is more tolerable!

      Good luck with the next week!

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  64. I am 5 days into the treatment and I notice that the cream doesn't all absorb into the skin. It looks like a film and it can be rubbed off. Is this normal? Also has anyone experienced any nausea?

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  65. Great thanks for sharing this post. I was looking for something like this. Your blog have inspires me a lot.Thanks.


    Treatment For Sun Damage

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  66. Thank you. I can identify a lot with your experience as this is my second time through it (first time was predominantly my forehead, second time three years later was my entire face). I am almost halfway through the second time experience. Will need to habitually use sunscreen from now on even though I live in an area of the country that doesn't see as much sun as others ( Michigan- the Great Lakes contribute to much cloud cover). Glad also to see Hugh Jackman drawing attention to this. I'm guessing this post has helped a lot of people. I am also a fair skinned white male and wife and family have been supportive but it freaks out people at work and in public. God bless.

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  67. Thank you. I can identify a lot with your experience as this is my second time through it (first time was predominantly my forehead, second time three years later was my entire face). I am almost halfway through the second time experience. Will need to habitually use sunscreen from now on even though I live in an area of the country that doesn't see as much sun as others ( Michigan- the Great Lakes contribute to much cloud cover). Glad also to see Hugh Jackman drawing attention to this. I'm guessing this post has helped a lot of people. I am also a fair skinned white male and wife and family have been supportive but it freaks out people at work and in public. God bless.

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  68. Greetings Tim and all. I am a veteran fluorouracil user, having undergone multiple treatments for pretty severe solar keratosis (a side effect of being Irish, loving sports and the outdoors, and having grown up near the beach on Long Island...). I have previously used Carac and Efudex. Carac has the benefit of being just once a day, so you can apply in the morning and shower it off at night, without fear of leaving traces on your pillow, bedding. The delivery mechanism is also "creamier" and penetrates the skin better when you reach the drying stage. I am currently on day 14 of a planned 28 day Rx with a new fluorouracil product -- brand name Tolak. It is a 4% solution, which accelerates the process significantly. I am hoping to be done by Week 3, as much of my face is already brownish and crusty. Fortunately, I can work mostly at home, so the social discomfort is diminished. Anyhow, for all you fluorouracil patients out there, go the distance. It's worth it, even if you, like me, are chronic sufferers. It does work, but there's no guarantee that you will not have to revisit the need for Rx periodically. Having seen -- and admired -- close family members undergo REAL chemotherapy, I have an appreciation for what REAL pain and discomfort is like. This is not it ! Good luck

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