Aldara cream, known by its generic name imiquimod, is a topical prescription medication. It is an immune response modifier, meaning it works by stimulating the body’s own immune system. Instead of directly attacking diseased cells, it activates immune pathways to recognize and fight abnormal skin growths. This provides a unique, non-surgical approach for treating specific skin conditions.
Conditions Treated by Aldara
Aldara is approved for treating three distinct skin conditions. One use is for actinic keratosis (AK), a common condition resulting from excessive sun exposure. These rough, scaly patches are considered precancerous, as they have the potential to develop into squamous cell carcinoma. The cream helps clear these damaged cells from the face or scalp.
The medication is also prescribed for superficial basal cell carcinoma (sBCC), a non-melanoma skin cancer. This type of cancer is the most common form, appearing as a slightly raised, pearly, or waxy bump. Aldara is considered for sBCC when surgery is not a suitable option, providing a non-invasive method to target cancerous cells on the trunk, neck, or extremities.
A third use is for external genital and perianal warts, caused by certain strains of the human papillomavirus (HPV). Aldara helps resolve the warts, but it is not a cure for the underlying HPV infection. New warts may appear during or after treatment.
Application and Treatment Regimen
Application instructions vary by condition, so following a doctor’s prescription is necessary. Before application, the hands and treatment area should be washed with mild soap and water and dried thoroughly. A thin layer is rubbed into the affected area until no longer visible, and it is applied just before bedtime.
For actinic keratosis, the cream is applied two times per week for 16 weeks. The treatment for superficial basal cell carcinoma involves application five times per week for six weeks. For external genital warts, the frequency is three times per week, continuing until the warts are gone, but for no more than 16 weeks.
The cream should remain on the skin for a specified time before being washed off with mild soap and water. For AK and sBCC, this period is around 8 hours, while for genital warts, it is 6 to 10 hours. Avoid getting the cream in the eyes, mouth, or nose, and wash hands thoroughly after application.
Common Skin Reactions and Side Effects
Using Aldara causes local skin reactions at the application site, which are signs the medication is activating the immune system. These reactions include redness, swelling, itching, a burning sensation, and pain or tenderness. As treatment progresses, flaking, scabbing, crusting, or weeping of clear fluid from the treated area can also occur.
While most reactions are on the skin, some individuals may experience systemic, flu-like side effects. These can include fever, chills, body aches, and a general feeling of tiredness or weakness. Contact a healthcare provider if these flu-like symptoms or severe skin reactions occur.
If skin reactions cause significant discomfort, a doctor may recommend a temporary break from treatment for several days. Treatment can be resumed once the reaction has subsided. Changes in skin color, either lightening or darkening, can also occur at the treatment site and may be permanent.
Important Precautions and Warnings
The medication makes the skin more sensitive to the sun, increasing sunburn risk. Patients should avoid sun exposure, sunlamps, and tanning beds while using the cream. When outdoors, wear protective clothing and use a high-SPF, broad-spectrum sunscreen on treated areas.
Inform your doctor of any pre-existing health conditions, particularly autoimmune diseases, before starting treatment. It is also important to discuss use if you are pregnant, planning to become pregnant, or breastfeeding. The cream should not be applied to broken, inflamed, or sunburned skin.
Aldara may weaken latex condoms and vaginal diaphragms, so their concurrent use is not recommended. Uncircumcised men treating warts under the foreskin must retract the foreskin and clean the area daily to prevent irritation. Stop use and seek immediate medical advice if severe skin reactions or urination problems develop.