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Imiquimod (IH-mih-KWIH-mod) is a topical non-steroidal medication that up regulate the immune system. It is distributed under the trade names Aldara (5%) and Zyclara (3.75%). When used for dermatologic purposes, this medication is primarily available as a cream, which is dispensable through a pump or tube.

Mechanism: Imiquimod stands alone in the category of immunomodulators as the only agent to enhance both acquired and innate immunity. When applied topically, imiquimod induces cytokine production by the keratinocytes, activates langerhans cells and induces production of mature B-lymphocytes. This causes activation of the immune system to mount a greater response against the skin lesion, leading to its resolution.

Uses: Imiquimod is a topical agent that is applied by the patient to the affected area. It has received FDA approval for the treatment of precancerous growths, skin cancers and external genital warts (condyloma acuminata). The following are specific approved uses for imiquimod:

Another common use of imiquimod is for the treatment of squamous cell carcinoma in situ (Bowen’s disease). It is best to apply imiquimod prior to bedtime and leave it on the affected area for 6-10 hours. Imiquimod can be removed from the skin by gently washing the area with mild soap and water. Always use caution when applying imiquimod to areas near the mouth, nose or eyes. Additionally, do not apply imiquimod to any area of the body other than the prescribed area. In certain situations your physician may recommend a rest period, at which time imiquimod should be discontinued until the local inflammation has subsided.

Side Effects: The overwhelming majority of patients using imiquimod develop side effects. The most common side effects include irritant contact dermatitis, redness, swelling, burning sensation, pain, tenderness and flaking, peeling or crusting at the application site. Although these secondary responses can be startling, some research has suggested that the greater the inflammatory reaction, the greater the clearance of the skin lesions. If shortness of breath, difficulty breathing or a rash develops in an area distant from the treatment site, contact your dermatologist immediately. Overall, imiquimod has been shown to be safe, effective and a first-line therapy for the common skin conditions noted above.


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