Read carefully the directions you are given for using imiquimod cream. If you are unsure how many times a week to apply the cream, ask your pharmacist to check for you.
Wash your hands after using the cream.
About imiquimod cream
|Type of medicine||An immunomodulator|
|Used for||Anogenital warts; basal cell carcinoma; actinic keratosis|
|Also called||Aldara®; Zyclara®|
|Available as||Cream supplied in individual sachets|
You will have been prescribed imiquimod to treat one of three different skin conditions. It is used to remove anogenital warts, or for a kind of sun damage called actinic keratosis, or for a type of skin cancer called basal cell carcinoma. It works with your body's immune system to help it fight damage to the skin. There are two strengths of cream available - 3.75% (brand name Zyclara®) and 5% (brand name Aldara®).
Anogenital warts are caused by the human papillomavirus (HPV) which can be passed on by close sexual contact. They are small lumps that develop on the genitals and around the anus (back passage).
Actinic keratoses (also known as solar keratoses) are small, thickened, scaly growths which develop on the skin. They usually develop on areas of skin which have received a lot of sun exposure over a period of time.
Basal cell carcinoma is a common skin cancer which typically develops on sun-exposed areas of the skin such as the head and neck.
Before using imiquimod cream
To make sure this is the right treatment for you, before you start using imiquimod cream it is important that your doctor knows:
- If you are pregnant or breast-feeding.
- If you have ever had a problem with your immune system. For example, let your doctor know if you know you are immunosuppressed or if you have an autoimmune disease.
- If you are a male using this cream for genital warts and you have not been circumcised.
- If you have ever had an allergic reaction to a medicine.
- If you are taking or using any other medicines. This includes any medicines you have bought without a prescription, such as herbal and complementary medicines.
How to use imiquimod cream
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack and any additional information you are given by your doctor. These will give you more information about how to use imiquimod cream and will provide you with a full list of the side-effects which you may experience from using it.
- Follow the instructions carefully when you are applying the cream and do not apply more than the recommended amount. You will be told how often to apply the cream and how long to use it for - this will depend upon the reason why you are using the cream. The directions will also be printed on the label of the pack to remind you what the doctor said to you. It is important that you read the label carefully. If you are prescribed Aldara®, you will be asked to apply the cream either on three nights a week, or on five nights a week. If you are prescribed Zyclara® you will be asked to apply the cream every night of the week. You should always apply the cream at bedtime.
- Wash your hands and the area to be treated with mild soap and water before applying the cream. Make sure your skin is dry before you apply the cream.
- Apply a thin layer of cream to the affected area, and gently rub it in until the cream is absorbed into the skin. Wash your hands again after applying the cream. Only use each sachet once - do not keep opened sachets to use later.
- The following morning, it is important that you wash the treated area with mild soap and water to remove any traces of the cream.
- If you forget to apply the cream on your usual day, use it on the next night and then continue with your regular schedule. Never apply the cream more than once a day.
- Do not apply the cream to any broken or irritated areas of your skin, and try to avoid the cream coming into contact with your eyes or lips, or the insides of your nostrils. If this does happen by accident, wash it off with warm water as soon as possible. Do not cover any treated areas with bandages or dressings.
- As the cream begins to work, the area of skin being treated may become red, sore and swollen. It is also likely to look different to the surrounding areas of healthy skin. This is to be expected. However, if you are concerned that your skin is reacting badly, or if you feel unwell in yourself, check again with your doctor.
- A course of treatment typically lasts for 2-6 weeks. Your doctor may check your skin a few weeks after you've finished applying the cream to decide if a further course of treatment will be necessary for you.
Getting the most from your treatment
If you are using imiquimod for anal or genital warts
- Be careful to apply the cream only to the wart. If the cream spreads on to normal skin it can cause skin reactions such as redness, swelling, flaking and irritation.
- When you have anogenital warts you will usually be advised to have tests to check for other sexually transmitted infections. Your doctor or clinic will arrange these for you.
- Sexual contact is not generally recommended while you are treating anogenital warts. You should ideally wait until your warts have gone and your skin has healed. If you do have sex, use a condom and do not apply imiquimod cream beforehand as the cream can damage latex condoms and diaphragms.
- Treatment usually continues until the warts have cleared. If the area has still not cleared after 16 weeks of using the cream, you must stop using imiquimod and see your doctor for further advice.
- Never use wart treatments that are sold over the counter in pharmacies to treat your anogenital warts.
If you are using imiquimod for actinic keratosis or basal cell carcinoma
- Some people find using an emollient (moisturiser) on the skin around the damaged areas helps to keep the skin supple and moist. Moisturisers can be applied several times a day if required.
- There is some general advice which will help prevent any further sun damage to your skin. Avoid being out in the sun between 11 am and 3 pm. Always use a broad-spectrum sunscreen with an SPF of 30 or higher, and which protects against both UVB and UVA light. Apply plenty of the sunscreen and re-apply it regularly, particularly after swimming and if you are sweating a lot. Do not use sunbeds.
- Check your skin regularly and tell a doctor if you notice any changes, such as new moles, small dark patches developing, or a change in an existing mole. When you have had a lot of sun exposure, your risk of developing other skin problems is increased.
Can imiquimod cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with imiquimod cream. You will find a full list in the manufacturer's information leaflet supplied with the cream. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Common imiquimod side-effects||What can I do if I experience this?|
|Skin irritation such as itching, pain, rash, swelling, ulceration or scabbing||If this becomes severe, allow your skin to recover before you use the cream again. If it continues to be troublesome, ask your doctor for advice|
|Headache, flu-like symptoms, muscle aches and pains||Ask your pharmacist to recommend a suitable painkiller|
|Feeling tired or sick||If this continues or becomes troublesome, speak with your doctor|
If you experience any other symptoms which you think may be due to the cream, speak with your doctor or pharmacist for further advice.
How to store imiquimod cream
- Keep all medicines out of the reach and sight of children.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Make sure that the person supplying this medicine knows about any other medicines that you are using. This includes medicines you buy and herbal and homeopathic medicines.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are using.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
This preparation is for use on the skin only. If you suspect that someone has swallowed some of it, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading & references
- Manufacturer's PIL, Aldara® 5% Cream; Meda Pharmaceuticals, The electronic Medicines Compendium. Dated April 2010.
- Manufacturer's PIL, Zyclara® 3.75% cream; Meda Pharmaceuticals, The electronic Medicines Compendium. Dated August 2012.
- British National Formulary; 67th Edition (March 2014) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Prof Cathy Jackson