Imiquimod (cream)

Sounds like 'im-I-kwi-mod'

Easy-to-read medicine information about Imiquimod cream – what is it, how to use it safely and possible side effects.

Type of medicine Also called
  • Belongs to a group of medicines known as immune response modifiers or topical immuno-modulators (which means it activates your immune system)
  • Aldara®
  • Apo-imiquimod®
  • Imiquimod (Perrigo)®

What is imiquimod cream?

  • Imiquimod cream is used to treat skin conditions such as actinic keratoses (also called solar keratoses) and superficial basal cell carcinoma.
  • It belongs to a group of medicines known as immune response modifiers or topical immuno-modulators that work by helping to activate your immune system to fight these abnormal skin growths.
  • Imiquimod cream is also used to treat external genital warts.
Caution – before starting imiquimod cream
Tell your doctor if you are pregnant, if you become pregnant while using the cream or are planning a pregnancy. Imiquimod cream should not be used during pregnancy. Your doctor will recommend other treatments for you.

Dose

How often and for how long you should use imiquimod cream will depend on your skin condition. Imiquimod cream is not usually applied every day but rather a few times a week.

Skin condition Dose
Actinic keratoses
  • Apply the cream 2 times weekly for 6 weeks OR 3 times weekly for 4 weeks.
  • You may be asked to repeat the treatment after a break of 4 weeks.
  • If your lesions are very scaly, your doctor may freeze them with liquid nitrogen about 3 weeks before starting imiquimod.
Basal cell carcinoma
  • Apply the cream to the lesion on 5 days each week. Continue for 6 weeks.
Genital warts
  • Apply the cream 3 times a week (on alternate days followed by a 2-day treatment-free interval).
  • Continue until the warts have cleared or for up to 16 weeks.

How to use imiquimod cream

  • Wash your hands thoroughly before and after applying imiquimod cream.
  • Cut the top off the sachet or pierce the sachet with a needle and squeeze out a tiny amount of cream onto your fingertip. Apply this to the affected area and gently rub it in until the cream is absorbed into your skin.
  • Although the information on the packet states that the sachet is for single use, you could seal it using a paper clip or tape and store in a closed container to prevent the cream drying out.
  • Imiquimod cream should be left on the skin for about 8 hours, so it is best to apply imiquimod cream at night and wash it off in the morning.
  • If you have to apply the cream to a large area, treat a small area at a time. This will help make the treatment reaction more tolerable. Your doctor will provide further advice about this.
  • Always use your imiquimod cream exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much imiquimod cream to use, how often to use it and any special instructions.
  • If you forget to apply the cream on your usual day, use it on the next night and then continue with your regular schedule. Never apply the cream more than once a day.

Special instructions for actinic keratosis or basal cell carcinoma

  • After 20 minutes of applying imiquimod cream, you can apply moisturisers and/or make-up as part of your usual skin care routine.
  • When outdoors, you should protect yourself from the sun with clothing and sunscreen.
  • Do not apply apply imiquimod cream on broken or sunburnt skin.
  • Take care not to get the cream in your eyes and nostrils or on your lips.
  • Only cover imiquimod cream with a plaster if advised to do so by your doctor, otherwise leave the treated area uncovered. 
  • Make sure you put the used sachets into a rubbish bin that children cannot access.
  • You will need to see your doctor during treatment to see if imiquimod is working and if you have any reactions. Your doctor may change how often you use your cream, depending on your response.

Special instructions for genital warts

  • Be careful to apply the cream only to the wart. If the cream spreads on to normal skin it can cause skin reactions such as redness, swelling, flaking and irritation.
  • Sexual contact is not recommended while you are treating genital warts. It is best to wait until your warts have gone and your skin has healed.
  • If you do have sex, use a condom and wash the area first as the cream can damage latex condoms and diaphragms.
  • If you are a male and have not been circumcised wash the area under the foreskin daily.

Possible side effects

Like all medicines, imiquimod cream can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • Skin redness, itching and burning
  • Black scabs or ulcers on your skin
  • This is quite common when you first start using imiquimod cream.
  • Usually the area will look worse before it gets better.
  • Tell your doctor if this becomes very uncomfortable or very sore. You may need to take a break from treatment.
  • Flu-like symptoms such as fever, tiredness, muscle aches and pains
  • Feeling unwell
  • Headache

Learn more

The following links provide further information on imiquimod cream:

Aldara Medsafe Consumer Information
Imiquimod (Aldara) Patient Information Guide SafeRx, WDHB
Imiquimod DermNet NZ

References

  1. Imiquimod New Zealand Formulary
  2. Guidelines for the management of genital, anal and throat HPV infection in New Zealand 9 ed 2017
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 05 Jul 2018