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Compare Efudex vs. Aldara

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Fluorouracil (Efudex) and Imiquimod (Aldara, Zyclara) are both topical treatments used for skin conditions, but they work differently and treat different issues. Fluorouracil is an antimetabolite that interferes with the DNA of pre-cancerous and cancerous cells, making it effective for actinic keratosis and basal cell carcinoma. It is applied twice daily and can cause skin burning, crusting, and irritation. Imiquimod, on the other hand, activates the immune system to fight off abnormal skin cells and is used for actinic keratosis, genital/anal warts, and superficial basal cell carcinoma. It has a more varied dosing schedule depending on the condition and can cause skin reactions, flu-like symptoms, and fatigue. Unlike Fluorouracil, Imiquimod is not considered a form of chemotherapy. Both medications require careful application and have specific instructions to avoid side effects, but Imiquimod also requires you to wash it off after a certain period, while Fluorouracil does not.

Fluorouracil (Efudex) topical
Imiquimod
Fluorouracil (Efudex) topical
Imiquimod

Summary of Efudex vs. Aldara

Summary for Antimetabolite
Prescription only

Fluorouracil (Efudex) topical is an antimetabolite. It's available as 5% topical cream and solution, and as 2% solution. Both strengths can treat actinic keratosis, a precancerous skin condition caused by exposure to ultraviolet (UV) light over time. But only fluorouracil 5% is approved to treat basal cell carcinoma, a type of skin cancer. Fluorouracil (Efudex) topical is applied directly on the affected area(s) twice daily for 2 to 6 weeks, depending on what condition you're being treated for. Side effects of this medication can include skin burning, crusting, and irritation.

Summary for Topical skin product
Prescription only

Imiquimod is a topical cream that works well for various skin conditions, including certain skin cancers and genital/anal warts. It takes a long time to work and often causes irritation. The instructions on how often you use the medication also depends on your skin condition and the strength of cream you're using.

Indications of Efudex vs. Aldara

Indications for
•Actinic (or solar) keratosis (scaly pre-cancerous spot or growth on the skin) in adults
•Basal cell carcinoma (certain type of skin cancer) in adults
Indications for
•Face or scalp actinic keratosis (scaly precancerous spot or growth on the skin) in adults - all brands and strengths
•Genital and anal warts in adults and children 12 years and older - Zyclara 3.75% and Aldara 5% only
•Superficial basal cell carcinoma (a type of skin cancer) in adults - Aldara 5% only

Pros and Cons of Efudex vs. Aldara

Pros and Const for Antimetabolite
Pros
•Preferred treatment option for actinic keratoses
•Up to a 90% cure rate for people with basal cell carcinoma
•Treatment might last as short as 2-3 weeks, depending on your condition
Cons
•Can cause uncomfortable skin reactions
•Need to use twice daily
•Hasn't been studied in children
•Not safe to use during pregnancy
Pros and Const for Topical skin product
Pros
•A first-choice treatment for genital and anal warts
•A good option if you prefer treating your condition privately at home rather than getting in-office procedures
•Available as a lower-cost, generic form
Cons
•Need to remember to wash off after the recommended amount of time (usually first thing in the morning)
•Doesn't work as fast as lasers or surgery
•Not the first-choice treatment for skin cancer
•Skin reactions and irritation are pretty common.

Common Side Effects of Efudex vs. Aldara

Common Side Effects for
•Crusting of the skin
•Stinging or burning feeling of the skin
•Itchiness
•Soreness on the skin
•Scarring
Common Side Effects for
•Skin reaction (33% total), including itching (20%), burning (6%), bleeding, stinging, and pain
•Common cold symptoms (15%)
•Sinus inflammation (7%)
•Headache (5%)

Warnings of Efudex vs. Aldara

Common Side Effects for
•Avoid sensitive skin areas
•Don't cover skin areas after application
•Sunburn
•Harm to unborn baby
•Rare toxicity reaction
Common Side Effects for
•Skin inflammation
•Flu-like symptoms
•Sunburn
•Caution with actinic keratosis (Aldara only)
•Not for other types of skin cancer (Aldara only)
•Not for HPV (Aldara only)
•Not for use with other imiquimod medications (Zyclara only)
•Caution in autoimmune disease (Zyclara only)

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