Imiquad Cream is a prescription-only topical immunomodulator indicated for the treatment of external genital and perianal warts/condylomata acuminata, superficial basal cell carcinoma, and actinic keratosis. It functions as a toll-like receptor 7 agonist, stimulating a localized immune response to target abnormal cells. This cream is formulated for dermatological application under medical supervision, offering a non-invasive therapeutic option with a well-established efficacy and safety profile. Appropriate patient selection and adherence to application guidelines are critical for optimal outcomes.

Features

• Contains 5% imiquimod as the active pharmaceutical ingredient
• Available in single-use sachets or multi-use packets (250 mg, 500 mg, 1 g)
• White-to-light yellow oil-in-water emulsion cream
• pH-balanced formulation for cutaneous compatibility
• Requires refrigeration between 2°C–8°C; may tolerate room temperature for limited periods
• Preservative-free single-dose packaging minimizes contamination risk

Benefits

• Induces localized cytokine production (e.g., interferon-α, TNF-α, IL-6) to enhance cell-mediated immunity
• Provides a non-surgical treatment alternative for certain premalignant and malignant skin lesions
• Demonstrates high clearance rates for external anogenital warts with reduced recurrence compared to destructive methods
• Allows self-application by patients under physician guidance, improving convenience and compliance
• Shows good cosmetic outcomes in treated areas when used as directed
• Supported by extensive clinical trial data and long-term post-marketing surveillance

Common use

Imiquad Cream is primarily indicated for:

• External genital and perianal warts in immunocompetent patients aged 12 years and older
• Superficial basal cell carcinoma (sBCC) with a maximum diameter of 2.0 cm located on the trunk, neck, or extremities (excluding hands and feet) in immunocompetent adults
• Actinic keratosis on the face or scalp in immunocompetent adults

Off-label uses may include treatment of molluscum contagiosum, lentigo maligna, and certain forms of Bowen’s disease, though these applications should only be pursued under specialist supervision with appropriate informed consent.

Dosage and direction

For external genital/perianal warts:

• Apply a thin layer to the wart area 3 times per week (e.g., Monday, Wednesday, Friday)
• Leave on the skin for 6–10 hours, then wash off with mild soap and water
• Treatment duration: up to 16 weeks

For superficial basal cell carcinoma:

• Apply 5 times per week for 6 weeks
• Leave on the skin for approximately 8 hours before washing
• A rest period of several days is recommended if intense local reactions occur

For actinic keratosis:

• Apply 2 times per week for 16 weeks
• Treatment area should not exceed 25 cm² per session

Always wash hands before and after application. Use sufficient cream to cover the treatment area, but avoid excessive application. Do not occlude unless directed by a physician.

Precautions

• For external use only; avoid contact with eyes, lips, nostrils, and mucosal surfaces
• Sexual contact should be avoided while the cream is on the skin
• May weaken condoms and diaphragms; avoid contact during treatment
• Not recommended for internal genital warts (urethral, vaginal, cervical, or intra-anal)
• Use with caution in patients with autoimmune disorders or those on immunosuppressive therapy
• Sun exposure should be minimized during treatment; use protective clothing and sunscreen
• May cause hypopigmentation or hyperpigmentation, particularly in patients with darker skin tones
• Not recommended for use during pregnancy unless potential benefit justifies potential risk

Contraindications

• Hypersensitivity to imiquimod or any component of the formulation
• Application on broken skin or open wounds
• Use in children under 12 years (except for external genital warts in patients ≥12 years)
• Patients with congenital or acquired immunodeficiencies (for certain indications)
• Concurrent use with other topical medications on the same treatment area

Possible side effects

Very common (≥1/10):

• Application site reactions: erythema, edema, erosion, flaking/scaling, itching, burning
• Influenza-like symptoms (headache, fatigue, fever, myalgia)
• Local pain or tenderness

Common (≥1/100 to <1/10):

• Application site ulceration, weeping, crusting, induration
• Nausea, diarrhea
• Local infection (bacterial, viral, or fungal)

Uncommon (≥1/1000 to <1/100):

• Regional lymph node enlargement
• Hypopigmentation or hyperpigmentation
• Allergic contact dermatitis

Rare (<1/1000):

• Severe skin reactions (e.g., ulceration requiring discontinuation)
• Autoimmune disorders exacerbation (e.g., psoriasis, vitiligo)
• Systemic allergic reactions

Drug interaction

• No formal drug interaction studies have been conducted
• Theoretical potential for increased systemic absorption when used with occlusive dressings
• Possible enhanced inflammatory response when used concurrently with other topical irritants (e.g., retinoids, benzoyl peroxide, salicylic acid)
• Caution advised with concomitant immunosuppressive therapies
• No known interactions with systemically administered medications

Missed dose

• Apply as soon as remembered if within a few hours of scheduled time
• If close to next application time, skip missed dose and resume regular schedule
• Do not apply extra cream to compensate for missed dose
• Maintain at least 48 hours between applications for genital warts and actinic keratosis regimens

Overdose

• Excessive application may intensify local skin reactions
• Systemic absorption is minimal with recommended use, but excessive application over large areas could theoretically lead to increased systemic exposure
• Symptoms may include severe local reactions, flu-like symptoms, or lymph node enlargement
• Treatment: discontinue therapy, remove cream by washing, and provide supportive care
• No specific antidote exists; manage symptoms appropriately

Storage

• Store in original container between 2°C–8°C (36°F–46°F)
• May be kept at room temperature (up to 25°C/77°F) for single periods of up to 2 months
• Do not freeze
• Keep out of reach of children and pets
• Discard any unused cream 1 month after opening a multi-use packet
• Single-use sachets should be used immediately after opening

Disclaimer

This information is intended for healthcare professionals and should not replace comprehensive clinical judgment. Prescribers should consult full prescribing information and current clinical guidelines before initiating therapy. Patients should receive thorough education on proper application technique, expected local skin reactions, and when to seek medical attention. Treatment decisions should consider individual patient factors, including immunological status, lesion characteristics, and treatment history. Report suspected adverse reactions to the appropriate regulatory authority.

Reviews

Clinical evidence summary: Multiple randomized controlled trials demonstrate complete clearance rates of 50-85% for external genital warts after 8-16 weeks of treatment, with sustained clearance rates of 70-85% at 3-month follow-up. For superficial basal cell carcinoma, histological clearance rates of 80-90% have been reported at 12-week post-treatment follow-up. Actinic keratosis studies show complete clearance in approximately 55-75% of patients after 16 weeks of treatment.

Expert consensus: Dermatological associations recognize imiquimod cream as a valuable treatment option for selected patients, particularly those preferring non-invasive therapy or with lesions in cosmetically sensitive areas. The immunomodulatory mechanism offers theoretical advantages for preventing recurrence compared to purely destructive methods.

Practical considerations: Patients should be counseled that local skin reactions are expected and indicate immune activation rather than treatment failure. Management of reactions may include temporary treatment interruption (2-3 days) or reduced frequency while maintaining overall treatment duration. Follow-up evaluations are essential to assess response and determine need for alternative therapies.