Imiquimod topical is an immune response modifier that is applied topically or directly to the body. Each gram contains 50 mg of imiquimod in an off-white oil-in-water vanishing cream base consisting of isostearic acid, cetyl alcohol, stearyl alcohol, white petrolatum, polysorbate 60, sorbitan monostearate, glycerin, xanthan gum, purified water, benzyl alcohol, methylparaben, and propylparaben.
Topical imiquimod (5 percent) is marketed under the brand name Aldara. Each gram of Aldara is composed of 50 mg imiquimod. Aldara has an off-white color and consists of isostearic acid, cetyl alcohol, stearyl alcohol, white petrolatum, polysorbate 60, sorbitan monostearate, glycerin, xanthan gum, purified water, benzyl alcohol, methylparaben, and propylparaben. Aldara cream is sold in single-use packets, with 12 packets in each box. A patient should use no more than 3 boxes (36 packets) during the entire 16-week treatment period.
Topical iniquimod is used for a variety of conditions. Actinic keratosis, superficial basal cell carcinoma, and external genital warts are just three of the conditions that iniquimod is applied on the skin for. Iniquimod is used topically for the treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses that occur on either the face or the scalp in adults whose immune system are jeopardized.
People suffering from biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) may also use topical iniquimod. However, the use of iniquimod is advised only for a maximum tumor diameter of 2.0 cm. The tumor must also be found on the neck, trunk (except anogenital skin), or extremities (except the hands and feet). Topical iniquimod in these cases should be used only when surgery is a less viable option and if follow-up on the patient is possible. The safety and effectiveness of Aldara cream has been tested only for superficial basal cell carcinoma. Other types of basal cell carcinomas, such as nodular and morpheaform (sclerosing or fibrosing), should be ruled out.
Finally, iniquimod is applied topically against external genital and perianal warts or condyloma acuminata. The patient in this case should be a minimum of 12 years old.
The amount of Aldara cream to use is different for each person and usually depends on the skin condition. The patient must keep in mind that Aldara cream should not be put in the mouth, eyes, or vagina.
For people suffering from actinic keratosis, Aldara cream should be applied twice every week for a total of 16 weeks to a limited area on the face or on the scalp. There should be ample time in between the two days when Aldara is put on (for example, only on Monday and Thursday or only on Wednesday and Sunday). It is strongly advised not to apply Aldara on both the face and the scalp at the same time. The treatment area is ideally about 5 cm x 5 cm. it should be applied to the entire area and rubbed until the skin absorbs it. A maximum of one packet of Aldara cream should be used at each application period.
For people suffering from biopsy-confirmed superficial basal cell carcinoma, Aldara cream should be applied five times every week (for example, once per day, Monday through Friday) for a total of six weeks. Enough cream must be put on the area, including 1 centimeter of skin around the tumor itself. The cream should be rubbed into the skin until it disappears.
For people suffering from either actinic keratosis or superficial basal cell carcinoma, the cream should be applied before sleeping and left on the skin for about 8 hours. Afterwards, the cream can be washed off using running water and mild soap. It is best to wash one’s hands before and after applying the cream. Before application, the area to be treated should be washed using mild soap and water and given 10 minutes or so to dry.
Finally, for people with external genital warts, Aldara cream should be applied thrice every week (for example, Monday, Wednesday, Friday or Tuesday, Thursday, Saturday) until a complete disappearance of the genital or perianal warts. However, a maximum of 16 weeks of application is advised. It should be left for 6-10 hours on the skin.
When using topical iniquimod, the patient should avoid putting it on the eyes, nostrils, and lips.
Skin reactions are common among users of topical iniquimod. The patient may take up to several days of rest period based on the intensity of the skin reaction. It is important, however, that the treatment period should be no longer than 16 weeks. The patient must inform his doctor if he has a lesion that does not change in spite of using this treatment.
Among the most common side effects of Aldara cream are reaction at the application site (itching, burning, bleeding, stinging, pain, induration, tenderness, and irritation), upper respiratory tract infection, sinusitis, headache, carcinoma squamous, diarrhea, eczema, back pain, fatigue, atrial fibrillation, viral infection, dizziness, vomiting, urinary tract infection, fever, rigors, and alopecia.
Topical iniquimod in the form of Aldara cream has been tested in children who have molluscum contagiosum aged 2 to 12 and has been shown to have no effectiveness. Keep the cream out of reach of children. Like other medications, do not use Aldara cream excessively.
The safety and effectiveness of Aldara cream in patients with suppressed immune systems have not been confirmed, so such people should be wary before using Aldara cream. Such patients include those suffering from Basal Cell Nevus Syndrome and Xeroderma Pigmentosum.
Both unused packets and partially-used packets of Aldara cream must be thrown away. Avoid freezing this cream.
Imiquimod has the following structural formula:
• Molecular formula of imiquimod is C14H16N4
• Imiquimod available : 5% cream
Brand name(s): Aldara
Review published on: 26 August 2009
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