Imiquimod

Imiquimod 

  • Pregnancy Category C

Formulations 

  • 5% or 3.75% cream

Dosage 

  • Condyloma:

    • 5% cream: apply 3x / week for 16 weeks or 3.75% cream apply daily x 8 weeks
    • Combination with destructive treatments
  • Superficial basal cell carcinoma (BCC) <2cm and non-facial:

    • 5% cream 5x / week x 6 weeks
  • Actinic Keratosis (face/scalp):

    • 5% cream 2x / week x 16weeks (US); 3x / week x 4-8 weeks elsewhere (max 25cm2)
    • 3.75% or 2.5% cream 2 weeks on / 2 weeks off / 2 weeks on

  • Activates toll-like receptor (TLR)-7 leading to increased tumor necrosis factor (TNF)-α and Interferon (IFN)-α with indirect antiviral activity. Also, increases IFNγ, interleukin (IL)-6, IL-1α, IL-1β, IL-8, IL-12, GM-CSF and G-CSF

FDA

  • External genital and perianal warts
  • Superficial basal cell carcinoma (5% cream in immunocompetent patients)
  • Actinic keratosis

Off label

  • Other warts, molluscum contagiosum (not recommended), Genital herpes simplex virus that is resistant to acyclovir, squamous cell carcinoma in situ, nodular basal cell carcinoma, lentigo maligna, melanoma metastases, T-Cell lymphoma, Paget disease, leishmaniasis, prevention of keloid recurrence after surgery

  • Local skin reaction (erythema, pain, burning, pruritus, ulceration), depigmentation

* For further reading refer to a pharmacology source

  • Applied at night without occlusion, washed off in AM
  • Do not place under occlusion (increased irritation)