Imiquimod cream by Ray Sahelian, M.D. Imiquimod cream treatment benefit and side effects
Imiquimod is used topically to treat warts on the skin of the genital and anal areas. Imiquimod does not cure warts, and new warts may appear during treatment. Imiquimod is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
How should Imiquimod medicine be used?
Imiquimod comes as a topical cream in unit-of-use packages. It is important to
wash your hands before and after applying imiquimod to your skin. One packet of
imiquimod is used to apply a thin layer of cream to the wart area three times
per week, just before going to sleep. A schedule of Monday, Wednesday, Friday or
Tuesday, Thursday, Saturday is suggested. Rub the imiquimod cream into the skin until no
more cream is visible. Do not put any covering on the area. Imiquimod should be
left on the skin for 6 to 10 hours. Upon waking, wash the area with mild soap
and water to remove excess cream. Use imiquimod as directed. Do not use more or less of it
or use it more often than prescribed by your doctor.
Imiquimod cream
Imiquimod cream is indicated for the topical treatment of external genital and perianal warts (condyloma acuminata) in adult patients. Imiquimod cream is available as a 5% cream in single use sachets. Imiquimod cream should be applied 3 times per week to the cleaned wart area, prior to sleeping and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until there is clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.
Imiquimod cream for hemangioma
Imiquimod cream may help accelerate the resolution of superficial
hemangiomas in infants. These "strawberry" birthmarks are benign skin lesions
consisting of dense, usually elevated masses of dilated blood vessels. Dr. Nhung
T. C. Ho and colleagues at the University of Toronto reviewed the outcomes of 16
girls and 2 boys, median age 18 weeks, with a total of 22 hemangiomas, most of
which were on the head. The immune response modifier imiquimod was initially
used three times weekly in all patients but was increased to five times weekly
in eight patients. Imiquimod cream was applied for periods ranging from 7 to 46
weeks. All 12 superficial hemangiomas showed improvement and complete clearance
was achieved in 4. There was little improvement in the 3 mixed and 3 deep
hemangiomas. There were no apparent internal imiquimod side effects, and
irritation and crusting were the most common skin-related side effects. Journal
of the American Academy of Dermatology, January 2007.
Skin Cancer
Imiquimod has been successfully used for treatment of various epithelial cutaneous neoplasms. Imiquimod 5% cream has been tested as treatment of Bowen's disease and invasive squamous cell carcinoma (SCC) in patients who were unsuitable candidates for surgery. Topical application of imiquimod 5% cream might represent an alternative topical treatment to surgery in selected cases of Bowen's disease and invasive SCC.
Imiquimod cream for basal cell skin cancer
5% imiquimod cream is a treatment option for superficial and nodular basal cell carcinomas, giving a clearance rate of 80 % at an average of 4 year follow up. Sometimes complications can occur, see below.
Invasive
squamous cell carcinoma after treatment of carcinoma in situ with 5% imiquimod
cream.
Australas J Dermatol. 2006 Aug;47(3):186-8. Goh MS. Department of
Dermatology, Austin Hospital, Heidelberg, Victoria, Australia.
Squamous cell carcinoma in situ has the potential to progress to invasive
squamous cell carcinoma. This report presents two cases of punch biopsy-proven
squamous cell carcinoma in situ, treated with once-daily application of 5%
imiquimod cream for 6 weeks. Both patients developed moderate local inflammatory
reactions during treatment. The first patient demonstrated clinical clearance of
the scalp lesion after treatment. Two months later, he re-presented with a
subcutaneous nodule at the same site. Histology was consistent with recurrent
squamous cell carcinoma. Five months following excision of the recurrent tumour,
he presented with metastatic squamous cell carcinoma to a cervical lymph node.
The second patient had low-grade chronic lymphocytic leukaemia and presented
with squamous cell carcinoma in situ of the leg that failed to clear clinically
after treatment with imiquimod. He presented 4 months later with a focus of
invasive squamous cell carcinoma within the lesion.
Two-year
interim results from a 5-year study evaluating clinical recurrence of
superficial basal cell carcinoma after treatment with imiquimod 5% cream daily
for 6 weeks.
Australas J Dermatol. 2006 Nov;47(4):258-65. Fremantle, Western Australia,
Australia.
Imiquimod 5% cream is approved in the USA, Europe and Australia to treat
superficial basal cell carcinoma, using a regimen of once daily, 5 times per
week for 6 weeks. Vehicle-controlled, phase III clinical trials show that
imiquimod is safe and effective for treating superficial basal cell carcinoma
with dosing 5 or 7 times per week for 6 weeks. This phase III, open-label study
evaluates the long-term (5 years) clinical efficacy and safety of dosing once
daily, for which this manuscript reports the 2-year time point in the follow-up
period. For the 169 enrolled subjects, the tumour selected for treatment was
assessed clinically to determine initial clearance at the 12-week post-treatment
visit. If clinically clear of superficial basal cell carcinoma, subjects entered
a 5-year, long-term follow-up period. Subjects were evaluated for recurrence at
the 3-, 6-, 12- and 24-month follow-up visits. The initial clearance rate at 12
weeks post treatment was 94.1%. The proportion of subjects who were clinically
clear at the 2-year follow-up visit was estimated to be 82.0%. Imiquimod was
tolerated when applied daily, with erythema reported for all subjects
participating in the study. The recurrence rate observed suggests that once
daily dosing and 5x/week dosing yield similar clearance rates, but daily dosing
increases local skin reactions.
Erythroplasia
of Queyrat treated with imiquimod 5% cream.
J Am Acad Dermatol. 2006 Nov;55(5):901-3. Dermatology Clinic, University of
Catania, Catania, Italy
Imiquimod is an immune response-modifying agent with potent antiviral and
antitumor activity effective in the treatment of various skin disorders,
including in situ carcinoma of the skin (Bowen's disease). The case of a
64-year-old man affected by an in situ carcinoma of the glans mucosa, namely
erythroplasia of Queyrat, successfully treated with imiquimod 5% cream is
described. Because the results of tests for human papillomavirus infection were
negative in this case, we suggest that imiquimod may have acted through an
antitumor effect mediated by cytokine activation. This compound may represent an
alternative treatment in patients with erythroplasia of Queyrat, although the
dosing schedule and treatment duration require further evaluation.
Imiquimod for Paget's Diesease
Treatment of
mammary and extramammary Paget's skin disease with topical imiquimod.
J Dermatolog Treat. 2006;17(3):167-71.
Paget's disease is an uncommon epidermal cancer, affecting all skin regions
wherever apocrine glands are present. It is divided into extramammary (EMPD) and
mammary Paget's disease (MPD). It can be confined to the epithelium or may be
associated with an underlying adenocarcinoma. The diagnosis is confirmed by skin
biopsy and the treatment depends on characteristics of the underlying cancer.
Surgery is the first-line treatment. Imiquimod, a topical immunomodulator,
approved its efficiency in several skin neoplasms and has been shown as a safe
treatment for EMPD. However, it has never been reported for the treatment of MPD.
Observations: We report on two cases of EMPD and MPD successfully treated with
imiquimod 5% cream. Conclusion: This non-surgical method may be considered as a
primary treatment when Paget's disease is not associated with an underlying
malignancy. The good prognosis with a long-term survival, the anatomic
localization and the poor general condition of elderly people may favor
imiquimod as an alternative treatment. On the other hand, it will reduce the
extent of excision when it anticipates surgery.
Safety of imiquimod 5% cream in the treatment of molluscum
contagiosum in children
Imiquimod cream 5%, a toll-like receptor 7 agonist, induces alpha-interferon
upon topical application, prompting off-label usage to treat children with
molluscum contagiosum. Systemic drug levels were low after single and multiple
doses of imiquimod 5% cream in children. Imiquimod cream appears to be safe for
use in children for brief periods.
Imiquimod medications questions
Q. My father has been recently diagnosed with early stage EMPD Extramammary
Paget's disease. He has been referred to a Radiologist to explore PDT
photodynamic therapy possibilities. I’m wondering why Imiquimod cream 5% was not
prescribed to begin immediate treatment before exploring PDT or surgical
excision. Should he have been given a script for this alternative treatment to
surgery and other treatments? He is a very healthy 64 year old prostate cancer
survivor. No other malignancies were found following full evaluation / CT scan,
etc. Was Imiquimod cream not prescribed due to radical prostectomy 2 years ago?
A. This is not my area of expertise, hence I don't have an opinion.
Imiquimod cream