Aldara (imiquimod) cream is a prescription topical immunotherapy agent indicated for the treatment of certain dermatological conditions, including external genital and perianal warts, superficial basal cell carcinoma, and actinic keratosis. As a toll-like receptor 7 agonist, it functions by stimulating a localized immune response, enabling the body to target and eliminate abnormal cells. This mechanism offers a non-invasive, patient-administered treatment option with a favorable efficacy and safety profile when used under appropriate medical supervision.

Features

• Contains 5% imiquimod as the active pharmaceutical ingredient
• Available in single-use packets or multi-use pump dispensers, depending on indication
• White-to-light-yellow oil-in-water emulsion cream formulation
• Requires refrigeration storage (2°C to 8°C) prior to dispensing
• Applied topically to affected areas, typically at bedtime
• Treatment duration varies by indication (2-16 weeks)
• Requires prescription and medical diagnosis before use

Benefits

• Provides a non-invasive alternative to surgical procedures for certain skin conditions
• Stimulates localized immune response to target abnormal cells while sparing healthy tissue
• Allows for convenient at-home administration with proper medical guidance
• Demonstrates high clearance rates for external genital warts when used as directed
• Offers tissue-sparing treatment for superficial basal cell carcinoma in selected cases
• May provide cosmetic advantages over destructive therapies for facial actinic keratosis

Common use

Aldara cream is primarily prescribed for three dermatological indications. For external genital and perianal warts (condylomata acuminata) in immunocompetent patients, it is applied three times per week. In the treatment of clinically typical, non-hyperkeratotic, non-hypertrophic actinic keratosis on the face or scalp, it is applied twice weekly. For superficial basal cell carcinoma, it is applied five times per week for a six-week course, specifically for lesions less than 2 cm in diameter located on the neck, trunk, or extremities (excluding hands and feet), when surgical methods are less appropriate.

Dosage and direction

Application frequency and duration vary significantly by indication. For external genital warts: apply a thin layer to wart tissue three times per week (e.g., Monday, Wednesday, Friday), leaving on for 6-10 hours before washing off. Treatment continues for up to 16 weeks. For actinic keratosis: apply twice weekly to the affected area for 16 weeks. For superficial basal cell carcinoma: apply five times per week (e.g., Monday through Friday) for 6 weeks. Wash hands before and after application. Apply sufficient cream to cover the treatment area, but not so thick that it causes excessive runoff. The medication should be rubbed in until the cream is no longer visible.

Precautions

Patients should be advised that local skin reactions are common and expected, including erythema, erosion, flaking, edema, and scabbing. These reactions typically peak during the third or fourth week of treatment and resolve within weeks after therapy cessation. Avoid contact with eyes, lips, and nostrils. Sexual contact should be avoided while the cream is on the skin, as it may weaken condoms and diaphragms and potentially transfer to partners. Sun exposure should be minimized during treatment. Do not use occlusive dressings over treated areas. Patients with autoimmune diseases or those undergoing immunosuppressive therapy should use with caution. Not recommended for treatment of urethral, intra-vaginal, cervical, rectal, or intra-anal human papillomavirus disease.

Contraindications

Aldara cream is contraindicated in patients with known hypersensitivity to imiquimod or any component of the formulation. Should not be used until complete healing following previous drug or surgical treatment. Not recommended for patients with congenital or acquired immunodeficiencies or those using immunosuppressive therapies. Contraindicated for the treatment of actinic keratosis in patients with baseline conditions that might require rest periods from treatment. Not for use on areas with broken skin or open wounds.

Possible side effects

The most frequently reported adverse reactions are local skin reactions including erythema (70-97% of patients), erosion (25-66%), flaking (25-65%), edema (20-58%), and scabbing (20-45%). Systemic reactions may include fatigue (6-10%), headache (5-11%), fever (2-5%), myalgia (3-7%), and influenza-like symptoms. Less common reactions include itching, burning, pain at application site, and regional lymph node enlargement. Severe local reactions may occasionally necessitate temporary treatment cessation. Pigmentary changes, including hypopigmentation and hyperpigmentation, have been reported in some patients.

Drug interaction

Formal drug interaction studies have not been conducted with topical imiquimod. However, concomitant use with other topical medications applied to the same area may increase skin irritation and systemic absorption. Caution is advised when using concurrently with other immune-modulating therapies. The effect on vaccines has not been studied. No known interactions with systemic medications, though physicians should be informed of all concomitant medications.

Missed dose

If a dose is missed, patients should apply it as soon as remembered, unless it is nearly time for the next application. In that case, skip the missed dose and resume the regular schedule. Do not apply extra cream to make up for a missed dose. Doubling up on applications may increase the risk of severe local reactions without improving efficacy.

Overdose

Topical overdose may result in severe local skin reactions including intense erythema, edema, erosion, and pain. Systemic overdose is unlikely due to minimal absorption, but if large amounts are applied extensively or to compromised skin, systemic effects such as fatigue, fever, influenza-like symptoms, and nausea might occur. There is no specific antidote. Treatment should be symptomatic and supportive. In case of accidental ingestion, seek medical attention immediately as gastrointestinal irritation may occur.

Storage

Store unopened packets or pump at refrigerated temperatures between 2°C to 8°C (36°F to 46°F). Do not freeze. Once opened, the pump may be stored at room temperature up to 25°C (77°F) for extended periods, but individual packets should be used immediately after opening. Keep out of reach of children and pets. Discard any unused product after the completion of therapy or after expiration date, whichever comes first.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Aldara cream is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual results may vary. Proper diagnosis and treatment planning by a physician are essential. Patients should follow their prescribing physician’s instructions precisely and report any adverse reactions promptly. The full prescribing information should be consulted before use.

Reviews

Clinical studies demonstrate that Aldara cream achieves complete clearance of external genital warts in 50-60% of patients after 8-16 weeks of treatment, with recurrence rates of approximately 10-20% over follow-up periods. For actinic keratosis, complete clearance rates range from 45-55% across studies. In superficial basal cell carcinoma, histologic clearance at 12 weeks post-treatment ranges from 75-85% for appropriately selected lesions. Dermatologists frequently note the convenience of patient-administered therapy and the tissue-sparing nature of treatment compared to destructive methods. Many patients appreciate the avoidance of surgical procedures, though some report frustration with the duration of treatment and local skin reactions that can temporarily affect daily activities and cosmetic appearance.