My Efudix Diary

by Audrey Thomas

I love a sunburnt country …

Growing up under the Australian Sun

Since I was in junior primary school my family has lived in the driest state in the driest continent on earth. Cool fact.

But hot, dangerous summers.

Living in South Australia, I was an active, outdoorsy kid and spent much of my childhood and teen years outside - I loved Little Athletics, sailing, bike-riding, skateboarding and swimming in our backyard pool. Having emigrated to Australia at the age of five, with my pale skin, blue eyes and strawberry blonde hair I was destined for a lifetime of sunscreen and slip-slop-slap vigilance under the fiery Australian sun. And my parents were sunblock vigilantes! To my juvenile embarrassment, my sister and I were the kids who always wore zinc cream and hats long before the ‘no hat, no play’ mantra became the norm.

While my friends - with the beautiful tanned skin that I so wanted instead of my freckled, ruddy complexion - could wear bikinis and cool bathers (swimsuits, for those of you not from Adelaide), I had to wear a t-shirt over my one-piece. These were the days before funky rashies and long, skin-protecting board shorts were in vogue. Along with my oversized swimming tee, I remember from October to March being coated in a layer of thick, white sunscreen that rubbed off on my clothes and made me look like I was greased-up and ready to swim the English Channel!

Yet, despite my parent’s best efforts, from time to time I came home sunburned and inevitably sore. Three occasions stand out, for all the wrong reasons, all of which resulted in potentially prize-winning ginormous blisters on various parts of my young body. Just to be clear, I have never been a beach-loving sun worshipper; rather someone who has been a little lackadaisical in the day-to-day sun-protection regime that I know is not an optional activity (despite our family doctor forewarning me at 16 that I “would burn in the moonlight”).

Fast forward a few decades and I'm acutely aware of the dangers of long-term sun damage to our precious skin.

In 2014 I had Mohs surgery on my nose to remove a BCC (Basal Cell Carcinoma). While my wonderful surgeon was removing that skin cancer, she happened upon a potentially more dangerous SCC (Squamous Cell Carcinoma) right next to it - an incredibly lucky find! You’ll see from the pics below that the surgery was quite invasive and I had many stitches covering the full length of my nose, right up to between my eyebrows.

Mohs surgery to remove an SCC and BCC's

Use sunscreen. Wear sunglasses and a hat. Be sun-safe.

Here's the alternative ... along with undergoing anti-cancer chemotherapy treatment such as Efudix.

Your choice.

It was scary - I was scared.

If those cancerous nasties were lurking beneath the surface, then chances are there are more.

A couple of years later I noticed a small pinkish mark (barely visible to other people) on my forehead - right on my hairline. I attended a regular check up with my skin doctor and within a couple of weeks I had a biopsy and further Mohs surgery to remove what was confirmed as another skin cancer (BCC). With all the stitches, I was starting to feel like Frankenstein’s Bride!

I count my lucky stars for the truly caring and skilled professionals who are helping me to deal with the damage to my skin and minimise the risks of more sinister skin cancers.

Take your 15 minutes now ...

When Emma and I launched My 15 Minutes in September 2013, one of the activities we included in the program was taking 15 minutes to book in all of your regular and recurring health checks for the year ahead; mammogram, eye test, hearing, pap test and skin checks etc. Having recently been through my first round of Mohs surgery I was already committed to regular skin checks and we wanted to ensure our program members used the My 15 Minutes approach to keep on track with their health and self-care.

What we didn’t anticipate at the time were the number of people who have completed the 15-minute task and discovered a serious and lurking health issue, including melanoma and other potentially life-threatening conditions. Seriously. If you haven't already, please take 15 minutes right now to book in those health checks - you are so worth it.

What is Efudix?

Efudix (called Efudex in some countries) is a topical cream used to treat skin growths caused by sun damage, including solar keratosis (aka Actinic Keratosis) and some simple skin cancers. The active ingredient fluorouracil, belongs to a group of anticancer (chemotherapy) medicines and has been used for many years to effectively treat cancer.

Efudix destroys cancerous and precancerous cells, while having little effect on normal cells.

My decision to go ahead with Efudix Treatment

I have been considering this type of treatment for a couple of years and decided to commit to going ahead with it in July 2017. My skin doctor recommended undergoing the treatment in the depths of winter to ensure exposure to damaging UV was kept to a minimum. My decision to capture my experience with Efudix through a daily diary post and photos was a bit of a no-brainer for me. While I have gone in search of other people’s experiences and really appreciate those who have shared their stories, many of them were from the US and Canada and there were few from very recent times.

I also have a history of skin cancer in my family. We lost my Granma to melanoma, which was not discovered early enough and later metastasised and spread through her body. As a later-in-life emigrant from the UK, she loved the sun and embraced Australian summers, but years of wearing low or no SPF protection sadly took their toll. Having had less serious skin cancers already removed from my face, I certainly don't want to play Russian Roulette with other potential nasties and Efudix makes sense to me.

I was discussing my imminent hibernation from social and work life during the Efudix treatment, with one of my lovely clients, and mentioned that I thought I would blog about the treatment and show daily photos. Her response was one I hadn’t considered until that moment “I’m not particularly vain, but I’m not sure I could do that”. Hmm, vanity hadn’t occurred to me until then (but maybe it should!?).

However, for me it's not about vanity (or rather lack of) at all. My key motivation is to document this experience and through that, possibly help other people make the decision whether or not it’s right for them. I’ve barely started the treatment and yet I know it is right for me. I want to show my sons, who are 10 and 12 years old, that this treatment is potentially what happens when you don’t take sun protection seriously enough in this beautiful land of ours. When the cumulative effect of mild sunburn over the years results in needing to choose between chemically removing your skin (through Efudix or similar treatment) or having parts of your precious body removed to eradicate cancerous cells. Neither of these are pretty options. It may be tough love to be so brutally honest with my tender young children but I can’t bear to imagine their tender faces being cut, cauterised, ‘melted away’ and scarred.

Our children need vigilante parents.

One last thing before I get started ...

** Warning - Graphic content and photos **

For anyone who is squeamish or doesn’t fancy looking at what I suspect will be fairly yucky pics (that’s a technical term) over the next few weeks, perhaps now is the time to close this browser and watch a funny video on Facebook instead.

For those of you who want to follow along as the process unfolds, then thank you for sharing this experience with me. Please understand that while I hope to offer some encouragement and my perspective of undertaking this treatment, I’m in no way offering medical advice or recommendations for your own treatment. Take the time to find a doctor who will be a good fit for you and listen to their advice specific to your circumstances.

At this stage, I'll be applying the Efudix for up to 28 days, and capturing these diary posts until I've finished the healing stage. Apparently I may even look younger by the end of this - we'll see!

All the best

Audrey x

PS  The more obvious changes in my skin, as a result of the Efudix treatment, starts to kick in from about Day 8, with a bigger shift on Day 12.


Day 1 - Here we go ...

1 July 2017

This morning I woke with a feeling of resigned apprehension. Knowing, for many good reasons, that I have to go ahead with this treatment, yet looking forward to it with as much trepidation as someone about to have a root canal procedure without anaesthesia.

Procrastination kicked in pretty early and by late morning I'd found loads of other things to do before I finally sloped off to the bathroom for my first encounter with Efudix. My doctor had given me clear instructions about applying the cream very sparingly. At $61 for a 20g tube, I'm happy to oblige. The cream is easy to apply, at this stage at least, and I very carefully followed the facial map my doctor drew for me showing where to apply the cream and where to avoid.

I'm treating all of my face except for my chin and the areas close around my eyes, mouth and nostrils. I suspect that where I have applied the Efudix will become glaringly obvious in the next couple of weeks, if I ‘light up like a beacon’ as my doctor expects.


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Day 2 - Routine, routine, routine

2 July 2017

OK, so with 4 applications done and dusted, there's nothing to see here.

I'm being super-careful about washing my hands and ensuring I don't touch anything or rub off the applied cream.

My skin is already feeling dry and a bit tight and even though I’d love to apply some of my regular BB Cream or tinted moisturiser, I’m following the recommendations not to use any other product on my face throughout the Efudix application phase.


Day 3 - All quiet here ...

3 July 2017

Strange that I'm feeling a little impatient and just wanting to get the party started (that sounds much more fun than I’m guessing it's going to be). My face is still feeling tight and in need of a generous layer of my usual moisturiser but no inflammation or ‘hot spots’ appearing yet.

I'm already missing the closeness of kisses from my 2 boys and my husband, Daf. Having read the scary warnings on the Efudix instructions, there's no way I want to risk getting any of the cream on their faces.


Day 4 - Pesky headache

4 July 2017

The headache is stronger today, which is a side effect I hadn’t expected and it's annoying but not a biggie in the scheme of things. Taken some paracetamol but it’s hasn’t done much at all.

Nothing much to see in terms of change on my face, which is both good and bad, I suppose.

When I had a shower, I realised that although normally I love that the showerhead in our ensuite delivers brilliant water pressure with a strong needle-like spray, I suspect it’s going to become a bit painful in the coming weeks. Hmm, such a cheery thought to have in the shower, especially as I’m generally an eternal optimist.


Day 5 - Still quiet

5 July 2017

Are we there yet? Nope, apparently not.

While I’m feeling like I have mild sunburn today, to other people, there are still no really obvious signs that the Efudix is kicking-in (I know this because I polled everyone I have seen face-to-face today).

I think my nose is a little more pink than usual and my cheeks look and feel a bit flushed. I’ve felt physically low today though - tired and a bit irritable, and I woke up with a splitting headache, which is worse than yesterday. Since late this afternoon I’ve also had some nausea and could quite happily curl up in a corner and sleep. Would be a great plan except for the fact that I have some pressing work to do while the boys and Daf are at hockey practice and the house is peaceful. Maybe tomorrow …


Day 6 - School holiday juggling

6 July 2017

Very little change and not really noticeable to anyone other than me.

Had nausea and splitting headache again today and I’m feeling really flat. Much as I’d prefer to post just cheery, uplifting updates here, I’m keen to share with you the changes in me, both physically and emotionally, over the course of the treatment.

I had to drop our 12 year old, Fin, at a friend’s house this morning and decided that Will, our 10 year old, and I would go and do some grocery shopping. It’s cold, overcast and a bit miserable today so I thought heading out would be a good option before coming home to do some work this afternoon. After a couple of hours of wandering around the supermarket and taking care of a few shopping centre errands, I came home feeling very tired. Not sure if it’s related to the Efudix but I feel like I’ve been running around for days without stopping (which I definitely haven’t). So I’m listening to my body and not pushing myself to work on through the tiredness.

Self-care 1: Work 0.


Day 7 - First signs of Efudix taking effect on my face

7 July 2017

I swear I have never looked at myself in the mirror as much as I have done this week! It’s so weirdly compelling to check for tell-tale signs that the treatment is starting to work. Before bed last night I noticed a reddish spot on my right temple and this morning it’s definitely more defined - confirmed by other people too so I’m sure I’m not imagining it today.

I had an early start this morning and the headache I’ve been waking up to for a few days is dull rather than throbbing - that’s progress - yay! We have my 6 year old nephew with us today and he’s keeping to a safe distance from me as he’s nervous about what’s going to happen to my face. He relaxed a little after I explained that I’m not contagious and he can’t catch skin cancer or sun-damaged cells from me (or anyone else).

I’m not shying away from explaining this to the children around us, especially my own. The earlier we can instill the need to always be sun-safe, the better. If my face flares up to a horrible mass of reds, pinks and weeping nasties, then that’s OK. I’m hoping it will leave an ineradicable impression on them and their friends. Skin cancer is preventable and the cure sometimes doesn’t work or the damage spreads to other organs and secondary cancer takes hold. I intend for my kids to be as aware about the dangers of sun exposure as they are about smoking (they’ve been known to be embarrassingly lacking in diplomacy when they’ve encountered smokers, loudly declaring “Eeewww, mummy, why would anyone smoke - it’s disgusting!”.

A couple of hours after getting up I snuggled up on the sofa with the boys to watch a kid’s movie … and promptly fell asleep! I’m not someone who easily naps during the day so I was surprised when I woke again to the dulcet tones of the 3 kids yelling at each other. Hmm, perhaps school holidays was not the best time to do this after all.

Due to my ‘nanna nap’, I was a bit late in taking a shower, cleaning my face (just with water and a soft cloth in the shower) and applying the Efudix this morning. It’s recommended that you ensure your face is completely dry after washing and before applying the cream. Apparently the side effects of the treatment (redness and soreness) are exacerbated when using the cream on wet/damp skin. Glad I read that early in the process as I find that straight after washing my face it becomes very dry and taut, and really needs to be moisturised. I now wait for at least 15 minutes and then apply the cream. Efudix leaves my skin a bit greasy so I’m not sure if the small bumps on my forehead are the result of my sensitive skin reacting to this new pore-blocking cream or if it’s actually an intended reaction to the Efudix. Time will tell.


Day 8 - The silver lining

8 July 2017

One aspect of good news and bad news of this treatment for me is that I'm self-employed. It's great to have flexibility in terms of scheduling my work around this possible effects of the Efudix but not-so-great in that if I'm not available to work with clients, I can't generate income. I'm always on the lookout for the silver lining though so here's today's ... a positive of blocking out my calendar for all of July in anticipation of having a face not fit to take out in public is that we can have PJ days on as many days as we want! Yippee!

It's a slow day today and not much to report on any front - face or otherwise. Thankfully the ever-present headache has diminished to barely there and the nausea is completely gone. Back to reading my book …

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Day 9 - Zzzzzzzz ...

9 July 2017

A day of rest as it's all much the same as yesterday …

Still smiling 🙂


Day 10 - If you look closely ...

10 July 2017

Although it's not as noticeable first thing in the morning, after my shower and the day's first Efudix application you can see a number of small raised spots on my forehead. They looked pink initially but a few hours later you can really only see them if you're looking for them (which of course I am). Same goes for a couple of other spots on my left cheek and above my top lip.

At this stage, it seems that the really nasty ‘lighting up like a beacon’ reaction may not hit my whole face and I may be lucky enough to have only a few spots. Fingers crossed! I'm struggling to understand the logic of that though. Given that I've had 3 cancerous spots already surgically removed from my nose and forehead it seems unlikely that there isn't more widespread sun-damaged cells across my face. Perhaps I'm just a late-bloomer 😉

If this is a case of delayed reaction, then I wish it would hurry up (not that I want it to react but you know what I mean). I have booked in some face-to-face client work and a speaking gig for the first and second weeks in August and I'm concerned about whether I'll be healed enough by then.


Day 11 - Minimising side-effects

11 July 2017

A few more spots today and the existing ones are more obvious too, but not enough for anyone to give me a second glance. It just looks like my skin has broken out in a couple of places and definitely not like some of the ‘day 11 examples’ I’ve seen on other blogs.

I’m still being careful to follow the instructions, and avoid doing anything which will heighten the reaction. For example, I am:

  • Washing my face thoroughly before each application of the cream
  • Allowing at least 10mins (I’ve been waiting 15-20mins) after drying my face before applying the Efudix
  • Avoiding being out in the sun. Right now in Adelaide, the daytime UV rating is a maximum of 2.0 every day and the SunSmart smartphone app recommends that ‘sun protection is not required’. Regardless of the rating, I’m being extra sunsafe (I could be a vampire!)
  • Avoiding all creams, lotions, makeup and other facial products, including soap and cleansers. Washing my face with just water and a soft cloth and it’s doing the job well

Day 12 - A beautiful day

12 July 2017

A beautiful, bright, sunny winter’s day here but I’m staying indoors and getting some work done. My mum has taken the boys down to Port Adelaide for a tour of the Clipper ship, City of Adelaide. According to the Cancer Council app, the UV is currently 1.6 but the kids' faces are covered in SPF 50+ #sunsafevigilante

After my shower this morning, I noticed my face felt very dry and was ‘tingly’ all over - hard to describe but almost like a low-level static across my skin. Weird.

Today is the first time that the cream itself caused stinging on my face - until now it has been like applying a thin layer of greasy hand cream., which has taken away the dryness but with no other sensation. The best comparison would be using a facial toner (or other astringent) on sunburnt skin. Not painful but definitely noticeable.

You’ll see from the photos (after applying the cream) that there’s more redness in some areas, especially high on my cheeks. This covers a whole patch of skin rather than being isolated like the red spots scattered around my forehead, between my eyebrows and on my hairline.

Again, time will tell how this will play out but it seems that things are progressing more quickly now.

Nasty cells - precancerous or otherwise ... be gone!

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Day 13 - Visible hot spots

13 July 2017

Our 10yo, Will, just came in and said ‘Wow, it looks like you’ve been out at the beach all day with no sunscreen, mum!’. Yep, that pretty much sums it up in terms of how it looks and feels. Tight, red, sore and warm.

Sometime last week I wrote that the water from our mains-pressure shower hitting my face was likely to be a problem. And yes, it now is, as I discovered this morning. Ouch. Still, I’m very lucky that it’s been annoying but not a painful process so far.

The skin high on my cheeks, just under each eye, is probably the place that I've caught the sun the most over the past 4 decades (ok, nearly 5 decades). Although now I always have some form of sun protection as both my daily moisturiser and the light tinted moisturiser I wear before heading out each day have at least SPF 30+, that hasn't always been the case.

Sure, in summer I wouldn't venture out without sunscreen but I know that it's on those overcast, cooler days in the past that I would have spent a day out and come home with pinkish cheeks. It's those days that we let slide and don't think too much about that contribute to the risks of skin cancer and AK's. Damage is damage.

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Day 14 - Looks like a mug shot!

14 July 2017

I’ve been out and about shopping today, rather than being cooped-up in self-imposed home detention, avoiding the sun. It’s just been easier to avoid heading out during daylight hours; and downtime over the school holidays has made that even easier than normal. I have been going out late afternoon/evening for shopping etc and to catch up with friends in the street so I’m not a complete recluse.

A bit more stinging today when applying the cream but other than that, the reaction on my face is not progressing much. Seem to be in a holding pattern (not complaining).

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Day 15 - Thank you!

15 July 2017

In the past few days, I have received some lovely comments of encouragement and gratitude for capturing this photo diary - thank you so much for your words! I am especially pleased to hear that a few people have taken my none-too-subtle hints and have made the decision to get their skin checked. Yay! As with any issue relating to your health and well-being, procrastination and avoidance are strategies which, sadly, can lead to a lack of options (and worse …). Early detection is often the key to stopping life-threatening conditions in their tracks; and skin cancer is no different. Getting into the habit of booking regular appointments helps a lot and I always book in my next check up while I’m at my skin doctor’s office. Easy peasy.

Nothing much has changed today except that my face has been considerably more red/flushed in the evenings over the last couple of days.

Tonight I was working and the popped downstairs to tell Daf something and he gave me a double-take. Apparently, it looked like I had fallen asleep with sunnies on and had some serious sunburn (well, yes, indeed).. ‘A red and white version of a panda’. Thanks for that ...

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Day 16 - Treading water ...

16 July 2017

Another cold and rainy day here and I’m in my cosy home office listening to the rain as I catch up on some work. Being self-employed, my work hours rarely look like a typical 9-5 day, so I generally work around the boys’ school drop offs and pick ups, and other family and sporting commitments.

Right now, while it’s school holidays, I often work well into the evening after they’ve gone to bed (it helps that I’m a night owl!), so I can spend time with them during the day if they’re at home. It also gives me loads of flexibility in terms of this treatment too. Not sure I’d fancy going into an office every day as this continues to develop, especially while avoiding using any other face products (I so miss my tinted moisturiser).

Nothing at all to report today in terms of changes to my face -  the past few days have felt like the Efudix equivalent of treading water.

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Day 17 - Hmm ...

17 July 2017

Something that has been intriguing me over the last few days has been the number of people who have referred to this as ‘brave’. I say I’m intrigued because I’m not sure whether it relates to undergoing the treatment itself or to sharing the experience on the Interwebs, for all and sundry to see.

From my perspective, bravery, or indeed courage, don’t come into it, on either front. Although I’ve felt apprehensive, the treatment is something I feel grateful to be able to undergo (and blessed to live in this lucky country with access to affordable preventative treatment options). I’m certainly not looking forward to any discomfort or facial ickiness yet to come, but as chemotherapy treatments go, this is about as DIY and simple as you can get (from my limited knowledge). The process itself doesn’t require a brave approach - but for me, the consequences of not taking action were far more fear-inducing.

I suspect though that ‘brave’ may have been used in the context of putting this out there every day with close-up photos of my face completely exposed - no makeup, hair scraped back, no filter, no photoshopping, lots of wrinkles, plenty of blemishes and looking every day of my 48 years (and more). Hmm. Perhaps I won’t ponder on that any longer ...

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Day 18 - 10 Days to go ...

18 July 2017

Just when I think that maybe the redness, and particularly the red spots, are not very noticeable to other people … I see tonight’s profile pic and realise I look like I’ve got a nasty skin condition (funny, that!).

The red sores that have come up on my cheek and under my nose are in fact, red and sore.

On day 18 of applying the cream and at this stage, it looks like I’ll go through with the full 28 days before the healing phase can begin.

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Day 19 - Some hot tips

19 July 2017

I just realised that I haven’t mentioned a couple of things I’ve been doing, which may help others. Here a some tips that have worked for me so far:

  • I’ve been washing my face twice a day using a soft cloth (fine microfibre) before applying the cream. As it’s quite a greasy cream, I’ve found that just splashing with water hasn’t been enough to clean my skin properly. As some of the spots are getting close to the ‘erosion’ stage, the skin is starting to get flakey and even this soft cloth makes it quite sore to clean. Gently does it.
  • Even our softest (fluffy) bath towels have felt too rough to dry my face (plus I haven’t wanted to risk transferring any Efudix anywhere else) so I’ve been using plain white, very absorbent paper towel to pat dry my face. It's gentle and hygienic, and hasn’t caused an issue so far.
  • Using a whiteboard marker, I have written a list of dates prominently on our bathroom mirror for the days of the treatment 1 to 28 (it’s a big mirror!). Each day I’ve marked with a tick the morning and night applications to ensure I’ve done each one. Great to see watch the days passing! I love completing a to-do list 🙂

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Day 20 - A worrying development

20 July 2017

Tonight my face is looking particularly ‘rosy’ in the photos and the redness is spreading a bit from the localised spots that have been most obvious to date. The spot between my eyebrows is also quite sore - it’s also where I have a fair bit of scar tissue from my Mohs surgery, and the corrective surgery done a few months after the initial op.

Over the last couple of days I’ve noticed there is a new spot on the end of my nose. This, of course, joins lots of other spots but my concern with this one specifically is that it’s appeared in exactly the same place I had an SCC removed a couple of years ago. Fingers crossed it’s not more of those nasty cells.

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Day 21 - 'Greasy gravel' ...

21 July 2017

The angry-looking spot high on my cheek started bleeding when I was gently washing my face with warm water and a soft-cloth tonight. I’m lucky that I’m still not in pain, as such, with this treatment, but it is getting more uncomfortable to wash my face thoroughly and to apply the cream.

Until recently, the Efudix was (almost) a welcome relief to apply to my very dry skin as it help to relieve the tightness and added some moisture. That seems to have changed now ... unfortunately it felt like I was rubbing fine (greasy) gravel over my whole face today. Better than having potentially cancerous nasties lurking on my face though.

In good news - it’s only a week left of applying the cream and then I can start ‘Operation Hydration!’

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Day 22 - A smiley photo today ...

22 July 2017

This afternoon I had to head out to pick up some shopping and popped on my hat and sunglasses - which is pretty much what I always do on the weekends or when I’m not working anyway. In one of the stores, I had to ask for some help from staff and for the first time since using the Efudix I was acutely aware that the two women behind the counter were looking at me a little warily. It took a few seconds to dawn on me that they were looking at my face (no eye contact) without trying to stare at me. Awkward.

I had heard from a friend recently about one of her colleagues who had trouble trying to buy codeine-based painkillers at the pharmacy while going through the treatment. Apparently her appearance raised some red flags with the staff - red, sore-ravaged skin much like skin of someone with a drug dependency.

Grateful that it’s only a temporary situation and thanking my lucky stars that I haven’t had a severe reaction to the treatment as I’ve seen other people (online) have experienced.


Day 23

23 July 2017

An interesting new patch of discolouration popped up on my jawline, near my chin at some stage today. My mum asked me if I had a bruise on my face, and on closer inspection, it looks like another cluster of spots, similar to the one on my left cheek is coming to the surface.

Never a dull moment around here, hey?

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