Imiquimod 5%

How it works

It is a toll-like receptor 7 agonist that stimulates local innate and cell-mediated immunity, increasing interferon-alpha and other cytokines to produce an antiviral and antitumour response.

Prescribing in practice

• Local skin reactions such as erythema, erosion, crusting and flaking are expected and reflect the intended immune response, but severe reactions warrant a treatment break.
• It weakens latex condoms and diaphragms, so alternative contraception should be advised when treating genital warts.
• Wash hands before and after application, apply to the lesion at night and wash off after the recommended period; treatment course and frequency differ by indication, so follow the SPC.

Monitoring

Review the treated area periodically for response and for severity of local skin reactions, adjusting or pausing therapy as needed.

Counselling the patient

• Some redness, soreness and scabbing of the treated area is expected and shows the cream is working.
• Apply at bedtime and wash the area in the morning; wash your hands afterwards.
• This cream can weaken condoms and diaphragms, so use another form of contraception.

Evidence & guidelines

Imiquimod is recommended in NICE and dermatology guidance as a treatment option for superficial basal cell carcinoma, actinic keratoses and external genital warts.