Imiquad Cream (Imiquimod 5%) is a topical immunomodulatory agent indicated for the treatment of external genital and perianal warts/condylomata acuminata, superficial basal cell carcinoma (sBCC), and actinic keratosis (AK). As a toll-like receptor 7 (TLR7) agonist, it stimulates local immune responses, enhancing the body’s natural defense mechanisms to target abnormal skin cells. This prescription medication represents a non-invasive therapeutic option with demonstrated efficacy across multiple dermatological conditions, offering patients an alternative to surgical or destructive procedures. Proper application and adherence to treatment protocols are essential for optimal therapeutic outcomes and minimal adverse effects.

Features

• Contains 5% imiquimod as the active pharmaceutical ingredient
• Available in single-use packets or multi-use tubes (5g, 12s, or 25g)
• White-to-light yellow oil-in-water emulsion base
• pH maintained between 6.0–7.5 for skin compatibility
• Preservative-free formulation (benzyl alcohol as stabilizer)
• Requires refrigeration (2°C–8°C) before opening; stable at room temperature (20°C–25°C) after opening for limited duration

Benefits

• Induces localized immune activation specifically targeting virally infected or dysplastic cells
• Provides non-invasive treatment alternative to surgical excision, cryotherapy, or laser ablation
• Demonstrates high clearance rates for external genital warts with reduced recurrence compared to destructive methods
• Shows excellent histologic clearance in superficial basal cell carcinoma with favorable cosmetic outcomes
• Effective field therapy for actinic keratosis, addressing both visible and subclinical lesions
• Enables patient-administered treatment with proper medical guidance, enhancing convenience

Common use

Imiquad Cream is primarily prescribed for three clinical indications. For external genital and perianal warts, it is applied to visible lesions to stimulate cell-mediated immunity against human papillomavirus (HPV)-infected tissue. In superficial basal cell carcinoma, it is used as a non-surgical treatment option for properly selected lesions, typically on the trunk, neck, or extremities (excluding face and anogenital areas). For actinic keratosis, it serves as field therapy to treat clinical and subclinical lesions within a defined treatment area, particularly on the face and scalp. Treatment duration and frequency vary significantly by indication, requiring precise medical supervision.

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, then wash area with mild soap and water. Treatment continues until complete clearance or maximum 16 weeks.

Superficial basal cell carcinoma: Apply 5 times per week (Monday through Friday) to lesion and approximately 1cm of surrounding skin. Leave on for 8 hours before washing. Treatment duration is 6 weeks, followed by 12-week post-treatment observation period before evaluation.

Actinic keratosis: Apply 2 times per week (e.g., Monday and Thursday) to entire affected area. Leave on for 8 hours before washing. Treatment duration is 16 weeks.

Always wash hands thoroughly before and after application. Use sufficient cream to cover treatment area, but not to the point of saturation. Do not occlude with bandages unless directed by physician.

Precautions

• For external use only; avoid contact with eyes, lips, nostrils, and mucous membranes
• Not recommended for treatment of internal (vaginal, cervical, intra-anal, urethral) warts
• Sexual contact should be avoided while cream is on skin as it may weaken condoms and diaphragms
• Application may cause local skin reactions including erythema, erosion, flaking, and edema
• Patients with autoimmune disorders or those undergoing immunosuppressive therapy should use with caution
• Sun exposure should be minimized during treatment; use protective clothing and sunscreen
• Do not use on areas previously treated with other therapies until fully healed
• Not recommended for use in children under 12 years of age

Contraindications

• Hypersensitivity to imiquimod or any component of the formulation
• Patients with congenital or acquired immunodeficiencies
• Use on broken, inflamed, or irritated skin beyond the treatment area
• Concurrent use with other topical medications on the same treatment area
• Pregnancy (Category C) unless potential benefit justifies potential risk to fetus
• Nursing mothers (unknown if excreted in human milk; caution advised)

Possible side effect

Very common (>10%): Application site reactions (erythema, edema, itching, burning, tenderness, scaling, flaking, erosion, ulceration), fatigue, headache, muscle aches, fever

Common (1-10%): Application site pain, induration, bleeding, scabbing, viral infections (cold sores, herpes simplex), diarrhea, nausea

Uncommon (0.1-1%): Lymph node enlargement near treatment area, fungal infections, dizziness, insomnia

Rare (<0.1%): Hypopigmentation or hyperpigmentation at application site, severe skin reactions, autoimmune phenomena (e.g., psoriasis flare, vitiligo onset)

Most local skin reactions are mild to moderate, peak around week 3-4 of treatment, and resolve within 2-4 weeks after therapy cessation. Systemic reactions are generally mild and transient.

Drug interaction

• No formal drug interaction studies conducted
• Theoretical potential for interactions with other immunomodulatory agents
• Concurrent use with other topical products may increase skin irritation or absorption
• Avoid concomitant use with corticosteroids on same treatment area (may reduce efficacy)
• Caution with other medications that might increase skin sensitivity
• No known interactions with systemic medications, but caution with drugs that affect immune function

Missed dose

Apply missed dose as soon as remembered, unless it is almost time for next application. Do not apply double dose to make up for missed one. Resume regular application schedule. If uncertain, contact healthcare provider for guidance. Extended treatment beyond recommended duration without medical supervision is not advised.

Overdose

Excessive application may intensify local skin reactions and increase potential for systemic absorption. Symptoms may include severe local reactions (pain, erosion, ulceration) and flu-like symptoms (fever, fatigue, muscle aches). Treatment involves washing area thoroughly with mild soap and water to remove residual cream. Symptomatic and supportive care should be provided. Systemic toxicity is unlikely due to minimal absorption, but medical evaluation is recommended for significant overdose. No specific antidote exists.

Storage

Store unopened packets or tubes refrigerated at 2°C–8°C (36°F–46°F). Do not freeze. Once opened, tube may be stored at room temperature (up to 25°C/77°F) for extended periods, but discard any remaining cream after specified duration (typically 4-6 weeks after opening). Keep in original container, tightly closed. Protect from light and excessive heat. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Imiquad Cream is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Treatment decisions should be based on individual patient assessment, including proper diagnosis, consideration of alternative therapies, and evaluation of risk-benefit ratio. Patients should follow their physician’s instructions precisely and report any adverse reactions promptly. The manufacturer does not guarantee specific results and is not liable for complications arising from improper use.

Reviews

Clinical studies demonstrate: In randomized controlled trials, Imiquad Cream achieved complete clearance of external genital warts in 50-75% of patients versus 0-5% with vehicle. For superficial basal cell carcinoma, histologic clearance rates of 82-92% were observed at 12 weeks post-treatment. Actinic keratosis studies showed complete clearance in 45-57% of patients versus 2-5% with vehicle.

Physician feedback: Dermatologists report high satisfaction with cosmetic outcomes compared to surgical alternatives, particularly for facial actinic keratosis. Many note the importance of proper patient education regarding expected skin reactions and application technique. Some express concern about variability in patient adherence due to local skin reactions.

Patient reports: Users frequently describe initial discomfort with local skin reactions but generally express satisfaction with final results, particularly appreciating the non-invasive nature of treatment. Some report frustration with treatment duration and application frequency. Most would recommend to others with similar conditions when properly managed.