5% 5-fluorouracil cream (5-FU) and calcipotriol ointment - combination treatment

What are 5% 5-fluorouracil cream and calcipotriol ointment, and how do they work?    

5% 5-fluorouracil cream (5-FU) is a treatment that targets sun-damaged skin cells known as actinic keratoses, whilst leaving healthy skin cells alone. Actinic keratoses can be recognised as small flat lesions on sun-damaged skin that have a rough scaly surface. Calcipotriol ointment is normally used to treat psoriasis, an inflammatory skin condition; however, when used with 5% 5-fluorouracil cream it has been found to significantly reduce the length of treatment needed for actinic keratoses from around 4 weeks to 4-10 days.

How do I use the creams?

• Follow your healthcare professional's instructions on where, and when, to apply the combination treatment
   
• The combination treatment is normally applied at the same time in the morning and evening. The length of treatment is between 4 to 6 days for the face and scalp, and 6 to 10 days for the arms and legs, your healthcare professional will advise on this
   
• Wash your hands thoroughly before and after applying the treatment
   
• Apply the 5% 5-fluorouracil cream first, spreading a thin layer on to the area of skin identified by your healthcare professional - if the sun damage is widespread you may be advised to treat small sections at a time
   
• Wait 5 minutes and then apply the same quantity of calcipotriol ointment as a thin layer. The two creams should then be rubbed together in to the skin
   
• The affected areas can be washed or cleaned as normal prior to each treatment 
   
• Warning - do not apply to your eyelids or lips and avoid contact with your eyes and mouth. Do not use if you are pregnant or breastfeeding, or if you are allergic to any of the ingredients. Keep the medication away from children and pets. Harm or death to pets may occur from licking treated areas on patients. If the medication is swallowed by an adult or child, please contact the Accident and Emergency (A&E) department at your local hospital

What to expect during the course of treatment

• Timing - if you have something important coming up, such as a holiday or a special social occasion, it is sensible to start treatment on your return/afterwards
   
• Expect inflammation in the skin leading to redness, soreness, oozing and scabs, sometimes areas of untreated skin close by may also be affected - please continue to apply the creams if this occurs, the more sun-damaged the skin, the stronger the reaction will be. The images below show how the skin may look before, during, and several weeks after the treatment has finished 
   
• Sun protection is very important during treatment as the 5% 5-fluorouracil cream makes your skin more sensitive to sunlight which can make the reaction to the treatment more severe. Limit sun exposure during and after treatment, until the skin has healed. Use a broad-spectrum sunscreen (SPF 30 or above) and protect the treatment area with a hat or clothing
   

• The skin reaction may continue for up to 10 days, even after you have stopped using the creams following which your skin may peel. Usually, the skin will be back to normal within two weeks, which may be helped by the regular use of an emollient cream
   

• If the reaction is very severe, painful or more than you can tolerate, please stop the creams and contact a relevant healthcare professional who may recommend applying a steroid cream to settle the reaction. There is a small risk of developing permanent scarring or changes in skin colour following a severe reaction to treatment

The upper images show a typical reaction to treatment. The lower image shows the skin 3 months after the treatment had finished (click on the images to enlarge).

Will the treatment cure my skin condition?

Actinic keratoses are a marker of the amount of sun that your skin has been exposed to, and to its susceptibility to sun-related change.

The creams will reduce the number of actinic keratoses, which in turn will reduce your risk of skin cancer.

Over time more actinic keratoses will develop, meaning that the treatment needs to be repeated. Rather than treating each actinic keratosis as it arises, it may be preferable to wait until you get a crop of new lesions (e.g. 5-10) before repeating the treatment. 

You must not use the creams to treat any skin lesion that you do not recognise as either normal or an actinic keratosis, instead you must seek advice from a healthcare professional at the first possible opportunity.