Imiquad Cream

Imiquad Cream (imiquimod 5%) is a prescription-only topical immunomodulator indicated for the treatment of external genital and perianal warts, superficial basal cell carcinoma, and actinic keratosis. It functions by stimulating local immune responses, specifically enhancing cytokine production and activating dendritic cells and macrophages. This targeted mechanism enables the body to recognize and eliminate abnormal skin cells and viral particles with precision. Appropriate patient selection and adherence to application protocols are critical for achieving optimal therapeutic outcomes while minimizing adverse effects.

Features

• Contains 5% imiquimod as the active pharmaceutical ingredient
• Available in single-use sachets or multi-use packets (250 mg each)
• White-to-light-yellow oil-in-water emulsion base
• pH-balanced formulation for cutaneous compatibility
• Requires refrigeration between 2°C–8°C (36°F–46°F)
• Preservative-free formulation in sealed packaging

Benefits

• Induces localized immune-mediated clearance of HPV-related lesions and pre-malignant skin changes
• Provides non-invasive treatment alternative to surgical procedures for eligible patients
• Demonstrates high complete clearance rates in compliant users across approved indications
• Reduces recurrence rates through immune memory establishment
• Enables patient-administered treatment with proper medical guidance
• Shows favorable cosmetic outcomes compared to ablative therapies

Common use

Imiquad Cream is primarily prescribed for three dermatological indications. For external genital and perianal warts (condylomata acuminata), it is applied to visible lesions in immunocompetent adults. In superficial basal cell carcinoma (sBCC), it is used for primary lesions smaller than 2 cm in diameter located on the neck, trunk, or extremities (excluding hands and feet) when surgical methods are less appropriate. For actinic keratosis, it is applied to typical lesions on the face or scalp in immunocompetent adults. Off-label uses exist but require careful risk-benefit assessment by prescribing clinicians.

Dosage and direction

External genital/perianal warts: Apply thin layer to wart tissue 3 times per week (e.g., Monday, Wednesday, Friday) prior to normal sleeping hours. Leave on skin for 6–10 hours before washing with mild soap and water. Continue treatment until complete clearance or maximum 16 weeks.

Superficial basal cell carcinoma: Apply 5 times per week to affected area including 1 cm margin of surrounding skin. Leave on for approximately 8 hours before washing. Treatment duration typically spans 6 weeks with post-treatment monitoring.

Actinic keratosis: Apply 2 times per week to affected area on face/scalp. Leave on for approximately 8 hours before washing. Treatment course typically lasts 16 weeks with evaluation at 8-week intervals.

Always wash hands thoroughly before and after application. Use sufficient cream to cover treatment area but avoid excessive application. Do not occlude with bandages unless specifically instructed.

Precautions

• For external use only—avoid ocular, nasal, oral, and vaginal mucosa
• Sexual contact should be avoided while cream is on skin
• May weaken condoms and diaphragms—avoid concurrent use during treatment hours
• Sun exposure should be minimized during treatment period
• Not recommended for immunocompromised patients except under specialist supervision
• Inflammatory reactions are expected—monitor for excessive reactions requiring treatment interruption
• Use with caution near mucous membranes due to increased absorption potential
• Pregnancy Category C: use only if potential benefit justifies potential risk to fetus

Contraindications

• Hypersensitivity to imiquimod or any component of the formulation
• Application to broken, inflamed, or irritated skin beyond treatment area
• Use in children under 18 years (safety not established)
• Concurrent use with other topical medications on same treatment area
• Patients with autoimmune disorders requiring immunosuppressive therapy
• Treatment of pigmented lesions without histological confirmation
• Application to internal genital areas (vaginal, cervical, urethral, rectal)

Possible side effect

Very common (>10%): Local skin reactions including erythema, edema, itching, burning, tenderness, flaking/scaling, erosion/ulceration, scabbing/crusting

Common (1-10%): Headache, fatigue, fever, myalgia, influenza-like symptoms, regional lymph node enlargement, nausea

Uncommon (0.1-1%): Hypopigmentation or hyperpigmentation, skin infection requiring antibiotics, severe local reactions requiring treatment discontinuation

Rare (<0.1%): Systemic allergic reactions, autoimmune phenomena exacerbation, scarring changes

Most local reactions peak around weeks 2-3 of treatment and gradually resolve after therapy cessation. Severe reactions may require temporary treatment interruption or dosage reduction.

Drug interaction

• No formal drug interaction studies conducted
• Theoretical potential for increased systemic absorption when used with topical corticosteroids
• Possible enhanced inflammatory response when used with other irritant topical agents
• Caution advised with concomitant immunosuppressive therapies
• No known interactions with systemic medications, though limited data exists
• Avoid concurrent use with other topical medications on treatment area

Missed dose

Apply as soon as remembered if within few hours of scheduled time. If close to next application time, skip missed dose and resume regular schedule. Do not apply double dose to compensate. Maintain consistent application schedule rather than increasing frequency. Extended treatment duration beyond recommended maximum is not advised.

Overdose

Topical overdose may cause severe local reactions including ulceration, bleeding, or intense inflammatory response. Systemic overdose is unlikely due to minimal absorption but theoretically could cause flu-like symptoms. Treatment involves thorough washing with mild soap and water, symptomatic management, and medical evaluation if systemic symptoms occur. No specific antidote exists.

Storage

Store refrigerated at 2°C–8°C (36°F–46°F). Do not freeze. Keep in original packaging until use. Discard any unused cream from opened packet after application. Unopened packets remain stable until expiration date printed on packaging. Protect from light and excessive heat. Do not use if discolored or separated.

Disclaimer

This information describes the approved uses, dosage, and safety information but does not replace professional medical advice. Treatment decisions must be made by qualified healthcare providers considering individual patient circumstances. Patients should report any adverse reactions to their prescribing physician and medication regulatory authorities. Off-label use carries additional uncertainties and should only be undertaken with informed consent and specialist guidance.

Reviews

Clinical studies demonstrate complete clearance rates of 50-85% for genital warts after 8-16 weeks treatment, with recurrence rates of 5-20% at 3-month follow-up. For superficial basal cell carcinoma, histological clearance rates of 80-90% have been reported 6 weeks post-treatment. Actinic keratosis studies show complete clearance in 45-55% of patients after 16-week course. Patient-reported outcomes indicate high satisfaction with non-invasive nature despite frequent local skin reactions. Long-term follow-up data supports sustained efficacy with proper patient selection and application technique.