Imiquimod

| 6 min read

About Imiquimod

Imiquimod (Brand name Aldara), is a topical cream used primarily for the treatment of superficial basal cell carcinoma, viral warts and lentigo maligna. It is not recommended for the treatment of other forms of basal cell carcinoma. It works by stimulating the body's immune system to eliminate precancerous or abnormal cells. It may take a period of time - several weeks or longer - to trigger the immune reaction and in some cases there is no reaction and the treatment is not effective.

If the cream stimulates a reaction there will be a local inflammatory reaction on the skin with redness, soreness, and peeling, which indicates that the medication is actively targeting abnormal cells. As treatment progresses, the affected area may also become swollen and crusty before eventually healing, Please click on the following button to review images of imiquimod reactions so that you know what to expect:-

Examples of imiquimod reactions

After completing the treatment course this reaction will settle over a few weeks.

You should apply imiquimod only to the areas advised by Dr Lynch. You may find that you experience inflammation in other areas even where you have not applied the cream to.

Rarely you may have a severe reaction or allergic reaction to the cream, this can cause ulceration, altered skin pigmentation and scarring. You can also experience flu-like symptoms, fevers or feel unwell in yourself. If you have concerns about the severity of the skin reaction you should contact Dr Lynch. As for any medication it is essential to read the information leaflet that comes within the packaging and contains a full list of all recognised side effects.

For how often/long should imiquimod be applied?

Dr Lynch will tell you exactly how long to use the treatment for. In most cases the following will apply:-

• For superficial basal cell carcinoma apply 5 days per week for 6 weeks
• For viral warts apply once daily for a minimum of 3 months
• For lentigo maligna apply for a total of 60 days. If you need to take a break due to the level of inflammation then add these days that were missed at the end of the course.

How to use imiquimod

• Imiquimod cream should be applied regularly according to the instructions provided by Dr Lynch (see above)
• It will induce inflammation in the skin. This will consist of redness, soreness, oozing, crusts and scabs.
• It should be applied once daily with a clean fingertip.
• The cream comes in sachets - although not officially recommended by the manufacturer, many dermatologists advise that an opened sachet can be kept in the fridge and used for 2-3 days if there is sufficient quantity within the sachet.
• If the skin becomes very sore stop using imiquimod for a couple of days and allow the inflammation to settle then restart.
• Every day, bathe the area with water, dab the skin dry and apply vaseline (petroleum jelly) daily. The vaseline that you apply should be newly opened and free from potential contamination from fingertips.

Risks of imiquimod

• Local skin reactions: Severe reactions can include blistering, peeling, and painful erosion of the skin at the treatment site.
• Flu-like symptoms such as fever, fatigue, muscle aches, and chills can occur.
• Severe skin reactions like blistering, severe pain, extensive redness or swelling, 0 and skin infections if the skin barrier is compromised.
• Systemic reactions such as swollen lymph nodes, swelling of the eyelids, face, lips, hands, or feet, and difficulty breathing (rare)
• Patients with a weakened immune system may experience more severe side effects or a different response to treatment.
• Infection: Open sores and skin breakdown could potentially lead to bacterial or viral (e.g. herpes virus) infection.
• Allergic reactions: Although rare, some individuals may develop allergic reactions, such as rash, itching, or swelling.
• Changes in skin color: Treated areas may experience changes in pigmentation, becoming lighter or darker. Usually this resolves with time but rarely it can be permanent.
• Scarring: Scarring is rare , but there is a very small risk that you develop a visible scar that may be raised/dipped/keloid or lumpy.
• Increased sensitivity to sunlight: Treated areas can become more sensitive to sunlight. You should be very careful with sun protection.