Efudex with calcipotriol for pre-cancers on scalp

I have not used the combination therapy. If you have recurring stubborn
AKs it is worth inquiring about niacinamide supplements for prevention.

@seniormed
Thank you so much for this information! I recently heard about the 500mg nicotinamide supplement twice a day. Are you getting good results and where do you purchase the supplement?
Also, at what frequency do you use EFUDEX or PDT blue light therapy on your face and scalp to control the AK?
Thank you so much for this excellent information. It sounds like you have a very knowledgeable dermatologist assisting you.

@seniormed when you take 500mg nicotinamide for stubborn AK, does it effect your Tacrolimis blood level?
I am currently taking Envarsus XR and Cellcept fir my kidney transplant so I am curious if this supplement changed your absorption levels or no adjustments in immune suppression meds dosage was needed?
Many thanks!!

Hi- I haven't tried that but my dermatologist prescribed Fluoricil topical cream and that has quickly taken care of the Aktinic Kerstosis quite nicely so far.

@m1rmiller
Thank you so much for jumping in!
How often do you use the Flourucil topical cream on your face and scalp to keep the AK away?
My dermatologist is suggesting I use the topical cream once a week FOREVER, but I am concerned that there will not be any "crusting" to actually resiove the AK if I use it once a week.
(I think the idea of once a week is to keep the AK weak so it doesn't turn into squamous).
Have you ever tried PDT blue light therapy on your face? My doctor is offering me PDT for my face in March if I would like to try it, I am not sure what's best.
According to the internet, I would use the Efudex on my face for 10 days and the Efudex on my scalp for 4 to 6 weeks. The once a week idea concerns me.
Did you use the cream only one time for 4 weeks or did you do a repeat treatment at some time?
I assume you never changed your immune suppression to sirolimus since you had such a nice result with the cream.
Please let me know what your on-going treatment is going to be. It sounds like you are getting a great result and have an excellent dermatologist. Unfortunately, I keep having MOHS surgery.

@hello1234 Hi- I had already changed to Sirolimus because it had a malignant melanoma on my chest from a few months before. For the top of my head I was prescribed Fluoricil cream daily for 4 weeks and that completely got rid of it and it hasn't recurred anywhere else. I get a dermatologist full body exam every 3 months now. I am not using anything for skin right now. I've a few biopsys for new stuff but none of them turned out to be cacerous and just went away on their own. Never tried blue light therapy. My face hasn't been an issue yet ( other than how much I'm showing my ever advancing age, but that's not surprising as I stare at 80th birthday coming up). My dermatologist has a dermatological surgeon in her office and she did and an excellent job leaving no residual. She told me that melanomas can't be done with MOHS so we had a full on surgery.

@m1rmiller
Thank you so much for the details! Since I have had multiple MOHS for squamous carcinoma situ and basal carcinoma each year on my scalp and face, my transplant team and dermatologist are on the fence on whether I should switch to sirolimus now.
Are you a kidney transplant patient?
Did the Sirolimus replace your Cellcept (MMF) or the Tacrolimis? Did you have any issues or side effects switching to sirolimus or smooth sailing?
Thanks a million for all your hand-holding. I really appreciate all your help with this! My on-going skin cancers are my main concern right now.

@hello1234 Got my kidney transplant 3 years ago from a deceased donor. Initially I was started on Cellcept and Tacro both. then they cut me back to just Tacro. When the malignant melanoma appear we switched to Sirolimus and Prednisone. Basically all of that went pretty smoothly with no debilitating side effects so far. Basically the most troublesome thing that's happened was when I was hit by an electric delivery bike who was running a red light while I was crossing the street. That left me with a cut that got infected with a drug resisstent strain. I'm ok now, but that was not my idea of fun. Finally got rid of that. BTW- I've read that some folks are using Sirolimus off-label because there is some evidence that it prolongs your life even if you don't have a transplant.

@m1rmiller
THANK YOU again for all the excellent information!
All of your skin cancer information is incredibly helpful to me.
It gives me hope that my skin cancer situation will improve.
Your electric bike accident sounds awful. What a terrible thing to happen.
Did they have to lower your immune suppression meds to fight the bad infection? Which antibiotic did they finally use to resolve your drug resistant strain?
It sounds like you had an outstanding Infectious Disease doctor that finally resolved it. There are not many drugs that can resolve the drug resistant infections.
Unfortunately, I have been seeing more and more teenagers in our area driving very fast electric bikes and scooters on the sidewalk.
It's dangerous because they are so fast (and not under good control).
I am so very grateful that you are okay now, but I am sorry that you had such an ordeal to go through. You are strong!

@hello1234 I also have scans every 3-4 months due to many problem areas on my skin-it always results in several items being frozen off. I have had 3 Moh’s surgeries as well. I go to a local derm and also see one at Mayo annually. The Mayo Dr recommended Niacinamide. I could only find it on Amazon. I have been taking it for 2 years. I don’t know if it’s helped or not, as a fair skinned, red head on tacrolimus I have a lot of things working against me from the skin side. But it’s not hurting anything to take it, just 2 more pills to take!