Efudex vs. Picato for Actinic Keratosis: Important Differences and Potential Risks.

Key takeaways

Fluorouracil (Efudex) and ingenol mebutate (Picato) are both topical medications used to treat actinic keratosis, a skin condition caused by sun exposure. However, they differ in several ways. Fluorouracil is an antimetabolite available as a cream or solution, and it is also FDA-approved to treat basal cell carcinoma, a type of skin cancer. Ingenol mebutate (Picato), on the other hand, was a gel that has been discontinued in the United States due to its potential to increase the risk of skin cancer. Fluorouracil is applied twice daily for 2 to 6 weeks and can cause side effects like skin burning and irritation. Additionally, fluorouracil is not safe for use during pregnancy and requires careful application to avoid affecting healthy skin.

Fluorouracil

(Efudex)

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Picato

(ingenol mebutate)

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Summary for Efudex

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.

Indications for Efudex

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

Pros and Cons for Efudex

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

Common Side Effects for Efudex

Crusting of the skin
Stinging or burning feeling of the skin
Itchiness
Soreness on the skin
Scarring

Warnings for Efudex

Avoid sensitive skin areas
Don't cover skin areas after application
Sunburn
Harm to unborn baby
Rare toxicity reaction

Summary for Picato

Prescription only

Picato (ingenol mebutate) was a medication used for actinic keratosis. It was a gel that was applied directly on the skin. It has been discontinued in the United States because it's linked to higher a risk of skin cancer.