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Imiquimod Cream

(im-ih-kwim-odd)

Trade/other name(s): Aldara, Zyclara

Why would this drug be used?

Imiquimod is used to treat certain skin growths or tumors. These include pre-cancerous flat, scaly skin growths called actinic keratoses, often seen on the face or scalp. Imiquimod is also used to treat superficial basal cell carcinoma (cancer of the top layers of the skin) on the trunk, neck, arms, and legs. This is usually reserved for people who can't have surgery, and the person treated must be able to come in for follow-up exams. Imiquimod cream is also commonly used to treat warts on the genital area (called condyloma acuminata) in adults or teens.

There are now 2 creams that contain imiquimod, but they have slightly different concentrations of the drug (5% and 3.75%). The more-concentrated cream (5%) is used for cancer, genital warts, and actinic keratoses. The less-concentrated drug (3.75%) is used only for actinic keratoses. The 2 creams are used at different time intervals, but all the other information is very much alike.

How does this drug work?

Imiquimod cream changes the immune response. It helps to kill abnormal cells or stop their growth, but it is not a cure. In the case of genital warts, it is used to control them after they start to grow but it will not stop new ones from growing.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have chronic graft versus host disease. This drug can worsen it.
  • If you have any immune problems, including autoimmune diseases such as psoriasis. Your doctor may want to watch you more closely during your treatment with imiquimod cream.
  • If you work outside or cannot avoid sun exposure. This cream cannot be used on sunburned skin, and people who are using it may get sunburns more quickly than usual.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy.
  • If you are breast-feeding. Small amounts of this drug may pass into breast milk and affect the baby.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Talk with your doctor, nurse, or pharmacist before you use any other creams, lotions, or medicines on the area that is being treated with imiquimod cream.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Imiquimod cream should be applied to clean, intact skin. Wash the affected area with mild soap and water and let your skin dry completely for about 10 minutes before you put on the cream. With clean hands, apply a thin layer directly to the tumor, keratosis, or wart, and rub it in until it disappears. Avoid contact with the lips, mouth, nostrils, or eyes.

Leave the area open if you can, or cover it with a light cover such as cotton gauze or cotton underwear. Wash your hands after you apply the cream.

How often and how long you use it depends on the condition being treated and which cream you use. The cream is for use on the skin only. Avoid contact with the eyes and mucous membranes (nose, mouth, lips, rectum, urethra, or vagina.)

For actinic keratoses:

If you are using 5% cream (Aldara) apply a thin layer of the cream from one packet to the affected skin of the face or scalp at bedtime. Leave on the skin for 8 hours, and then wash with mild soap and water. Do this twice a week for 16 weeks unless your doctor tells you differently. Leave at least 3 days between treatments; for example, treat Tuesday and Friday nights or Monday and Thursday nights each week.

If you are using 3.75% cream (Zyclara) for actinic keratoses, apply a thin layer of the cream from one packet to the affected skin of the face or scalp at bedtime. Leave on the skin for 8 hours, and then wash with mild soap and water. The 3.75% cream is usually applied every day for 2 weeks, then left off for a week before restarting another 2 weeks. Check with your doctor to be sure of the schedule and when to stop.

For superficial basal cell carcinoma, you will apply a thin layer of the cream from one packet at bedtime. Be sure to include about half an inch around the tumor, and leave on the skin for 8 hours. Wash with mild soap and water 8 hours after applying. The cream is usually used 5 times a week for 6 weeks. Most people apply it Monday through Friday nights with weekends off.

For external genital warts, apply a thin layer of the cream from one packet to the affected area 3 times a week, before bedtime. Leave on the skin for 6-10 hours, then wash off with mild soap and water. Use it 3 nights a week for a maximum of 16 weeks. The schedule should allow at least a day between treatments. Avoid sex while the cream is on genital warts. Also, the cream can weaken latex condoms and diaphragms so that they split or break. Talk with your doctor about safer sex practices.

Throw away partly-used packets of cream out of the reach of children or pets. Be sure to wash hands before and after applying cream. Do not cover the site with a closed bandage. It is OK to use cotton gauze to protect the area if needed, or wear cotton underwear.

Use this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you. Store the unused patches in their original child-resistant wrapping, out of the reach of children and pets.

Precautions

Imiquimod cream might irritate the skin. Avoid sunlight, tanning beds, or sunlamps as a bad sunburn may result. Wear a hat, and be sure to cover your arms and trunk when outside during the day. If you get a sunburn in the area being treated, stop using the imiquimod cream and wait until the skin is completely healed.

Your skin may become lighter or darker in color where the cream is applied and on the skin around it. This change could be permanent.

You may have severe skin reactions to the cream that require you to stop treatment until the skin heals. If you have severe burning or itching, if you get blisters, ulcers, weeping or draining of the treated skin, or if you cannot do your usual activities due to skin problems, wash off the cream and call your doctor or nurse. Do not use the cream again until you talk with your doctor.

Women who use this cream in the genital area may notice swelling of the vulva. If this becomes severe, it can make it impossible to empty the bladder. Call your doctor if you have swelling or if you notice trouble emptying your bladder.

If you are being treated for superficial basal cell cancer, your doctor will want to see you after your treatment is complete and until any skin problems have improved. Keep all follow-up appointments.

If you have trouble breathing or swelling of the face, mouth, or throat, get emergency help.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • redness of skin
  • drying, flaking and scaling of skin
  • scabbing and crusting on the skin where the cream is applied
  • sunburns on treated areas*

Less common

  • itching and burning of the skin where the cream is applied
  • skin color changes (may be permanent)*
  • skin swelling, blisters, erosions and ulcers (sores)*
  • headache

Rare

  • weeping of skin with exudates (wet drainage)*
  • infection of the skin being treated
  • swelling severe enough to block the flow of urine (in women)*
  • headache
  • fatigue
  • flu-like symptoms such as fever and aches
  • allergic reaction with trouble breathing or swallowing, or swelling of the face, mouth, or throat*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1997.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 02/11/2010
Last Revised: 11/19/2010