What is Imiquimod cream used for?

If you're dealing with skin conditions like actinic keratosis, superficial basal cell carcinoma, or genital warts, Imiquimod may be the treatment option you've been looking for.

Imiquimod is a prescription cream used to treat certain skin conditions, including:

• Actinic keratosis: Precancerous skin lesions caused by sun damage.
• Superficial basal cell carcinoma: A type of skin cancer.
• External genital warts: Warts caused by the human papillomavirus (HPV).

• Drug class: Topical immune response modifier
• Brands:
  Aldara
  Zyclara

How It Works

Imiquimod works by stimulating your immune system to target and eliminate abnormal cells. This unique approach makes it an effective treatment for various skin conditions. When applied to the skin, Imiquimod activates immune cells to produce cytokines, such as interferon-alpha. These cytokines enhance your body's ability to identify and attack abnormal or infected cells.

This immune response is particularly effective against precancerous lesions like actinic keratosis and superficial basal cell carcinoma; and viral infections such as genital warts caused by HPV. By boosting your body's natural defenses, Imiquimod helps clear abnormal cells or infections without harming healthy tissue.

Aldara (Imiquimod 5% Cream)

• Genital and Perianal Warts: Approved for external genital and perianal warts in patients 12 years and older.
• Actinic Keratosis: Used on the face or scalp to treat actinic keratosis in adults 18 years and older.
• Superficial Basal Cell Carcinoma: Approved for treating biopsy-confirmed superficial basal cell carcinoma in adults 18 years and older when surgical methods are less appropriate.

Zyclara (Imiquimod 3.75% Cream)

• Actinic Keratosis: Approved for the treatment of actinic keratosis on the full face or scalp in adults 18 years and older.
• Genital and Perianal Warts: Approved for use in patients 12 years and older to treat external genital and perianal warts.

Contraindications

Imiquimod has several contraindications that should be considered before use:

• Allergy to Imiquimod: Individuals with a known allergy or hypersensitivity to Imiquimod or any of its ingredients should avoid using the cream.
• Open Wounds or Broken Skin: Imiquimod should not be applied to damaged skin, including open wounds, sores, or cuts.
• Internal Mucosal Areas: The cream is contraindicated for use on internal mucosal areas like the vagina, anus, or urethra due to the risk of increased irritation and absorption.
• Immunocompromised Patients: While not an absolute contraindication, Imiquimod should be used with caution in immunocompromised individuals. Their reduced immune response may affect the effectiveness of the treatment or increase the risk of side effects.

Course of Treatment

The duration of treatment with Imiquimod can vary depending on the specific condition and the product being used. Here's a general overview:

Genital and Perianal Warts

• Aldara (5% cream): Apply 3 times per week before bedtime. Continue treatment until the warts clear or for up to 16 weeks.
• Zyclara (3.75% cream): Apply once daily before bedtime. Continue treatment for up to 8 weeks, or until the warts clear.

Actinic Keratosis

• Aldara (5% cream): Apply 2 times per week before bedtime. Continue treatment for 16 weeks on the face or scalp.
• Zyclara (3.75% cream): Apply once daily before bedtime to the affected area. Treatment typically lasts 2 weeks, followed by a 2-week break, and then another 2 weeks of treatment (if needed).

Superficial Basal Cell Carcinoma

• Aldara (5% cream): Apply once daily, 5 times per week before bedtime. Continue treatment for 6 weeks.

Important Considerations

• Complete the Full Course: Even if the skin looks clear before the treatment period ends, it's crucial to complete the full course of treatment unless directed otherwise by your healthcare provider.
• Regular Follow-Ups: Schedule regular follow-up appointments with your healthcare provider to assess the effectiveness of the treatment and monitor for any potential side effects.

Application Instructions

Before using imiquimod, thoroughly wash the affected area(s) with soap and water, and allow it to dry completely for at least 10 minutes. It is important to wash your hands before starting this process.

Apply imiquimod right before bedtime, gently rubbing it into the affected area(s) until fully absorbed. Use only enough to cover the affected area, applying a thin layer, and avoid excessive amounts. Leave the medication on for approximately 8 hours, or between 6 to 10 hours if you're using Aldara for warts. Afterward, wash the area with soap and water to remove the medication.

Once you have applied Imiquimod, wash your hands thoroughly to avoid spreading the cream to other parts of your body. Keep the medication away from your eyes, lips, and nostrils. If it accidentally gets into these areas, rinse immediately with water.

Safety and Side Effects

Common side effects:

Local skin reactions:

• Redness
• Itching
• Burning sensation
• Bleeding
• Swelling
• Dryness
• Crusting or scabbing
• Flaking or peeling
• Discoloration of the skin (which may continue after treatment ends)

Common cold symptoms:

• Fatigue
• Fever
• Headache
• Muscle aches
• Chills

Other common reactions:

• Pain at the application site
• Rash
• Nausea
• Diarrhea
• Hair loss

Serious side effects:

Severe skin reactions:

• Intense burning or stinging sensation
• Severe blistering or ulceration
• Significant swelling, especially around the eyes or lips
• Open sores that do not heal
• Having issues urinating because of genital swelling

Other reactions:

• Chest pain
• Difficulty breathing
• Severe fatigue or dizziness

Allergic reactions (rare but serious):

• Hives
• Swelling of the face, throat, tongue
• Trouble breathing
• Severe rash or itching

What to Do:

Mild reactions: Some skin irritation is expected, but if the symptoms are bothersome, you can speak with your healthcare provider to possibly adjust the frequency of use or pause treatment.

Severe reactions: If serious side effects such as extreme skin reactions or signs of allergic reactions occur, discontinue use immediately and get immediate medical attention.

Since Imiquimod can cause local skin reactions, it is important to keep in mind that it is common for the treated area to look worse before it looks better as the immune response is stimulated. However, serious side effects should be reported to your healthcare provider right away.

Consult Your Doctor

Before starting treatment with imiquimod, it’s important to discuss with your doctor any pre- existing skin conditions, allergies, or sensitivities you may have, as well as any other medications or treatments you are using, including OTC products or herbal supplements.

Let your doctor know if you are pregnant, planning to become pregnant, or breastfeeding, as imiquimod may not be recommended in these cases.

Additionally, if you notice any unusual side effects such as flu-like symptoms, muscle aches, or fever, bring this to your doctor’s attention.

If your condition does not improve or worsens after the recommended treatment duration, you should also speak with your doctor to determine whether adjustments to your treatment plan are necessary.