Topical Chemotherapy — Cream: Not a Drip, Not an Injection
If your doctor has prescribed a chemotherapy cream, you may be expecting a drip or an injection. This is different. The cream is applied directly to the skin, stays mostly at the surface, and is used for conditions that systemic chemotherapy is not designed to reach.
Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026
- Applied to skin, not a vein — Topical chemotherapy is a cream you apply directly to the affected area of skin.
- For skin conditions specifically — It treats precancerous patches and some superficial skin cancers, not internal cancers.
- Minimal systemic absorption — Very little enters the bloodstream, so hair loss and nausea are not the typical experience.
- Local reaction is expected — Redness, flaking and crusting in the treated area mean the cream is working as intended.
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Topical chemotherapy cream is applied directly to the skin — not by drip or injection. It is used for precancerous patches and some superficial skin cancers. Very little is absorbed into the bloodstream, making the experience quite different from chemotherapy given through a vein.
Which conditions is topical chemotherapy cream used for?
The most common use is actinic keratosis — rough, scaly patches on sun-damaged skin that can become cancerous if not treated. These are pre-malignant, meaning treatment can prevent a skin cancer from forming.
It is also used for superficial basal cell carcinoma and Bowen's disease, which is squamous cell carcinoma limited to the skin surface. In both cases the cancer has not grown into deeper tissue, which is why a cream can reach it.
The medicine most commonly prescribed for these conditions is fluorouracil, also written as 5-fluorouracil or 5-FU. Your oncologist will explain whether the cream is the right approach for your specific lesion, or whether surgery or another treatment is more appropriate.
How is topical chemotherapy cream applied?
- Your doctor or nurse will show you exactly how and where to apply it before you take the prescription home.
- Apply a thin layer only to the area your team has marked — not to surrounding healthy skin.
- Wear a glove or use the applicator provided. Wash your hands before and after every application.
- Keep the cream away from your eyes, nostrils, lips and the inside of your ears.
- Do not cover the area with a dressing unless your team specifically tells you to.
- Protect treated skin from sunlight — cover it with clothing or a hat when outdoors.
- Tell your team before applying any other cream, lotion or herbal preparation to the same area.
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Is the cream absorbed into the body? Will you get chemotherapy side effects?
A small amount is absorbed through the skin, but far less than with intravenous chemotherapy. For most people, the cream stays largely at the surface.
Hair loss, nausea and profound fatigue are not expected side effects of topical treatment. The effects are almost entirely local.
You will very likely notice redness, flaking and crusting in the treated area. This reaction is expected — it means the medicine is reaching the abnormal cells. The skin usually heals after the course ends and often looks clearer than before.
Absorption increases when the skin is already broken or inflamed, which is one reason your team monitors how the skin responds and why a reaction that feels extreme needs a call rather than home management.
Questions patients ask most
Will my skin look worse before it looks better?
Yes, and this is completely expected. The inflammatory phase — when the skin turns red, crusted and sometimes raw — is the treatment working. It can look alarming, especially on the face. After the course ends, the skin heals and usually looks clearer than before treatment, because the abnormal surface cells have been destroyed. Photographs taken at the start can help you see the improvement.
Can I use the cream on my face or near my eyes?
Fluorouracil is prescribed for sun-damaged areas including the face, but your treating doctor will mark exactly where to apply it. Keep the cream away from your eyes, nostrils, mouth and ears without exception. If it contacts those areas accidentally, rinse with water immediately and let your team know. Follow the boundary your doctor marks precisely — do not extend the area yourself.
What does a reaction that needs a phone call look like?
A normal reaction is redness, flaking, crusting and mild soreness, confined to the treated area. Call your team the same day if the redness spreads significantly beyond that area, the skin is oozing, you have severe pain, or you develop a fever. These signs may indicate a secondary skin infection or a reaction that needs review before your next appointment — do not wait.
What should I avoid during the course of treatment?
Avoid sun exposure on the treated skin — it is more sensitive to ultraviolet light during treatment, and sun can worsen the reaction. Do not apply other creams, lotions, make-up or herbal preparations to the same area without asking your team first, because some ingredients can increase absorption or change how the skin reacts. If you are of childbearing age, discuss contraception with your oncologist: fluorouracil is not safe in pregnancy even when applied to the skin.
Do I need to go to hospital for every application?
No. After your team has shown you how to apply the cream and confirmed you are comfortable, you do it at home yourself. Clinic appointments are for monitoring the skin response, not for the daily application. Keep those appointments — your oncologist needs to see how the skin is responding and should not be the last to know if something changes. Call the clinic between appointments if anything concerns you.
Can I use other medicines or traditional preparations at the same time?
Tell your treating team everything you apply to the skin, including herbal oils, turmeric pastes, ayurvedic preparations and moisturisers. Some ingredients can increase absorption or change how the skin reacts to the cream. This is not a judgement on what you use — it is safety information your team needs. The same applies to oral medicines and supplements, because some can affect how the skin handles topical treatment.
Did you know?
Actinic keratosis — the sun-damaged patches that fluorouracil cream is most often used to treat — are pre-malignant, not yet cancerous.
Treating them is one of the few situations in oncology where the aim is to prevent a cancer from forming at all, rather than to treat one that already has.
Source: ESMO clinical guidelines on non-melanoma skin cancers
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Frequently asked questions
Will using this cream give me the same side effects as chemotherapy by drip?
Very unlikely. The cream stays mostly on the skin surface rather than entering the bloodstream in significant amounts, so hair loss, nausea and systemic fatigue are not expected. What you will notice is a local skin reaction — redness, flaking and crusting in the treated area. This is expected and means the medicine is working. Call your team the same day if the reaction spreads beyond the treated zone, the skin is oozing, or you develop fever.
How long will I need to use the cream?
Your oncologist will prescribe a specific course length based on the condition being treated and how your skin responds. Do not stop early because the skin looks bad — that reaction is usually the treatment working at its peak. Do not extend beyond what was prescribed without speaking to your team. Your monitoring appointments are the right time to review whether any change is needed.
My skin looks terrible during treatment. Is this normal?
In most cases, yes. Redness, crusting and peeling can look alarming, particularly on the face, and the reaction often peaks before the course ends. After finishing, the skin heals and usually looks clearer than before, because the abnormal cells have been destroyed. Contact your team if the reaction spreads well beyond the treated area, the skin is oozing or extremely painful, or you develop a fever — those need same-day review.
Is fluorouracil cream safe during pregnancy or breastfeeding?
No. Fluorouracil is not safe in pregnancy even when applied to the skin, because some is absorbed into the bloodstream. Tell your oncologist before the prescription is written if you are pregnant, could become pregnant, or are breastfeeding. If you are of childbearing age, your team will discuss contraception. If you become pregnant while using the cream, stop immediately and contact your team and your obstetrician the same day.
Do I need to wear gloves every time I apply it?
Yes. A glove protects the skin on your hands from absorbing the medicine. If the cream contacts ungloved fingers, wash thoroughly with soap and water. Apply the glove before opening the tube, not after. Dispose of used gloves carefully and keep the cream out of reach of children and other household members, since incidental contact with healthy skin should be avoided.
What happens after I finish the course?
Your oncologist will review the treated area after the skin has had time to heal, to assess whether the abnormal cells were adequately treated. Some people need a repeat course or a different approach if the response is incomplete. Ongoing sun protection matters more after treatment than before — skin in that area has already shown it is vulnerable to sun damage, and consistent protection reduces the risk of new lesions developing.
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