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Are you concerned about your skin health and considering Imiquimod cream as a potential treatment option? It’s essential to have a comprehensive understanding of its benefits and risks to make an informed decision. This blog post will explore Imiquimod cream’s applications, proper usage, side effects, precautions, and special considerations for various age groups and situations.

Typical BCC of the right lower eyelid

Key Takeaways

  • Imiquimod cream is a prescription medication used to treat skin and eyelid skin cancer, actinic keratosis and genital warts.
  • Proper application and dosage instructions should be followed for optimal results.
  • Potential side effects of Imiquimod cream must be taken into consideration, as well as allergies, drug interactions and lifestyle factors.

Understanding Imiquimod: Uses and Mechanism

Imiquimod cream, known by the brand names Aldara and Zyclara, is a prescription medication that helps combat certain skin conditions, including skin cancer, actinic keratosis, and genital or anal warts. The cream works by stimulating the immune system to fight abnormal skin growths.

But what makes it effective for these diverse conditions? Let’s explore its applications and how it works.

Eyelid Skin Cancer Treatment

If you’ve been diagnosed with basal cell carcinoma (BCC) on or near your eyelid, you may be understandably worried about treatment options. Surgical procedures like Mohs surgery or excision can be highly effective for eyelid cancers, but they also carry risks of scarring, poor cosmetic outcomes, and damage to delicate eyelid structures.

Luckily, recent research suggests a topical cream may provide an innovative non-surgical treatment approach. Imiquimod cream, which has been used for years to treat other skin cancers, is showing great potential for BCC on the eyelid and surrounding periocular area.

In multiple clinical studies, over 75% of patients saw their nodular eyelid BCCs completely clear after applying the imiquimod cream as directed for 6-12 weeks. Even better, in 3-year follow up the cancers did not return. Researchers were able to safely treat peri-ocular lesions near the eyelid as well by carefully applying the cream and avoiding spread to the eye itself.

So if you’re facing eyelid BCC, ask your ophthalmologist or dermatologist if this innovative non-surgical cream could be right for you. Topical treatments like imiquimod offer new hope for effectively treating eyelid cancers with minimal fuss or downtime.

Actinic Keratosis Management

Actinic keratosis, a precancerous skin condition that can potentially develop into squamous cell carcinoma, can also be managed using Imiquimod cream. The cream is applied once a day, 3 days a week for 4 weeks, targeting abnormal cells at the cellular level.

Imiquimod cream activates toll-like receptor 7 (TLR7), which recognizes pathogens and initiates an immune response, ultimately eradicating the abnormal cells associated with actinic keratosis. This immune-system-mediated action makes Imiquimod an effective option for managing this potentially dangerous skin condition.

Genital Warts Elimination

Genital warts can be a source of discomfort and embarrassment, but Imiquimod cream provides relief by activating the immune system to target the affected area. Studies have reported clearance rates of up to 88% for external genital and perianal warts, and up to 50% for intra-anal warts.

To apply the cream, follow these steps:

  1. Wash the affected area with mild soap and water.
  2. Apply a thin layer of cream to the affected area.
  3. Leave the cream on for about 8 hours.
  4. After 8 hours, wash off the cream with water.

With consistent treatment, genital warts typically disappear within 10 weeks, but it may take a few months for some cases.

Proper Application and Dosage

To ensure the effectiveness of Imiquimod cream, it’s crucial to follow proper application and dosage guidelines. Different conditions may require varying dosages, and your doctor will determine the appropriate amount based on factors like age, weight, and severity of the condition.

The following sections will guide you through the correct application of the cream and discuss dosage recommendations for different conditions.

Applying Imiquimod Cream

To apply Imiquimod cream correctly, follow these steps:

  1. Wash your hands and the affected area with mild soap and water, then dry the skin thoroughly.
  2. Apply a thin layer of cream to the area just before bedtime and gently rub it in.
  3. Leave the cream on for approximately 8 hours.
  4. Remove the cream by washing the area with mild soap and water.

Avoid applying the cream to cuts, scrapes, or burns, and rinse it off immediately with water if it makes contact with these areas. Dispose of single-use packets after use and do not save leftover cream.

When using Imiquimod cream for conditions around the eyelids, it’s important to use the medication cautiously to avoid eye irritation. Here are more specific instructions, including the use of artificial tears or steroid drops:

  1. Consult with an Ophthalmologist or Dermatologist: Before applying Imiquimod near the eyes, consultation with an eye specialist or skin doctor is essential for precise instructions and monitoring.
  2. Application on Eyelids: Only apply Imiquimod to the eyelids if your doctor specifically directs it for a condition that is appropriate for treatment with Imiquimod. Do not apply on the inside of the eyelid or near the tear duct.
  3. Use of Artificial Tears: If you experience dryness or irritation in the eyes from Imiquimod, your doctor may recommend using artificial tears to provide lubrication and comfort. Use these drops before applying Imiquimod to create a protective layer for your eyes.
  4. Use of Steroid Drops: In some cases, doctors may prescribe steroid eye drops to manage inflammation or irritation that might occur with Imiquimod use. Follow your doctor’s instructions closely on how to use them in conjunction with Imiquimod.
  5. Application Technique: Use a cotton swab or a clean fingertip to apply a very small amount of cream to the prescribed area of the eyelid. Do not rub the cream in. Instead, dab it gently to form a thin layer.
  6. Avoiding Contamination: Do not touch the tip of the cream tube or the cap to any surface, including the skin around the eye, to avoid contamination.
  7. Timing of Application: Apply Imiquimod cream at least one hour before bedtime to reduce the likelihood of the cream spreading to other areas during sleep.
  8. Aftercare: If you use steroid drops, wait for the Imiquimod application to dry before using them. If using both artificial tears and steroid drops, space their use appropriately, as per medical advice.
  9. Wash Hands Thoroughly: Always wash your hands before and after applying Imiquimod cream to prevent transferring the medication into your eyes or to other people.
  10. Monitor for Side Effects: Observe any changes in skin texture, increased irritation, or signs of an allergic reaction, and report these to your doctor immediately.
  11. Follow-Up: Regular follow-up appointments with your doctor are important to monitor the treatment’s progress and manage any side effects.

It’s important to remember that the information provided here is general advice and that the actual use of Imiquimod cream should be as per the directions given by a healthcare provider familiar with your individual health situation. Always follow the doctor’s specific instructions for the best outcome and safety.

Dosage Recommendations

Dosage recommendations for Imiquimod cream vary depending on the condition being treated. For skin cancer and actinic keratosis, the cream is typically applied once a day, 5 days a week for 6 weeks.

Imiquimod is the treatment of choice for genital warts. It is to be applied 3 times per week for no more than 16 weeks. In case of a missed dose, apply the cream as soon as possible or skip the missed dose and continue with the regular dosing schedule if the next dose is near.

Consult your healthcare provider for specific dosage instructions and follow their recommendations closely. Don’t forget to read the patient information leaflet provided with your medication.

Potential Side Effects and When to Seek Help

Imiquimod cream is a relief for various skin conditions, but awareness of potential side effects and understanding when to seek medical help is key. Some side effects are common and manageable, while others are rare and need immediate attention.

Now, let’s examine the different side effects and the correct response if they occur.

Common Side Effects

Common side effects associated with Imiquimod cream include skin irritation, itching, and redness. These effects are generally mild and may be managed by following proper application and dosage guidelines.

However, if any of these side effects become severe or persist, it’s essential to inform your doctor or pharmacist and seek their advice.

Rare Side Effects

Rare side effects of Imiquimod cream may include:

  • Blisters on the skin
  • Body aches or pain
  • Chills
  • Cough
  • Difficulty with breathing
  • Itching in the genital or other skin areas

These side effects are less common but should be closely monitored.

Rare Side Effects of Imiquimod Cream
Blisters on the skin
Body aches or pain
Difficulty with breathing
Itching in the genital or other areas

If you experience any unusual problems while using Imiquimod, contact your doctor promptly for guidance.

Seeking Medical Assistance

In case of severe skin irritation or flu-like symptoms while using Imiquimod cream, discontinue the treatment and seek medical assistance immediately. If you suspect an allergic reaction to the cream, such as rash, severe dizziness, or difficulty breathing, contact your doctor or emergency medical services without delay.

It’s crucial to prioritize your health and well-being while undergoing treatment with Imiquimod cream.

Precautions and Interactions

To ensure safe and effective treatment with Imiquimod cream, it’s important to take precautions and consider potential interactions.

We’ll cover potential allergies, drug interactions, and lifestyle considerations in this part of the article.

Allergies and Medical History

Before using Imiquimod cream, inform your doctor if you have ever had an unusual or allergic reaction to this medicine or any other medicines, as well as any other types of allergies, such as to foods, dyes, preservatives, or animals.

Additionally, provide your doctor with a comprehensive medical history, including any recent or unhealed surgery on the treated area, or any immune system disorders.

Drug and Dietary Interactions

Although no specific drug interactions have been identified with Imiquimod cream, it’s essential to inform your healthcare professional if you are taking any other prescription or nonprescription medicine, including vitamins, herbal supplements, and over-the-counter remedies.

Be cautious of potential dietary interactions, such as grapefruit or grapefruit products, and consult your physician regarding any possible interactions.

Lifestyle Factors

While using Imiquimod cream, consider lifestyle factors such as sun exposure and sexual activity. Avoid exposing your skin to sunlight, sunlamps, or tanning beds, and wear protective clothing, such as cotton underwear, and sunscreen to minimize sun exposure.

If being treated for genital warts, abstain from any genital, oral, or anal sexual activity while the cream is on the skin to prevent spreading the warts and maximize treatment effectiveness.

Special Considerations: Pregnancy, Breastfeeding, and Age

People who are pregnant, breastfeeding, or belong to certain age groups might need to consider special precautions when using Imiquimod cream.

Let’s navigate these specific considerations and measures to achieve a safe and effective treatment in the designated treatment area.


If you are pregnant or planning to become pregnant, discuss the potential risks and benefits of using Imiquimod cream with your doctor. Animal studies have shown adverse fetal effects at high doses, but limited studies on its use in pregnant women have not indicated any adverse effects.

The FDA classifies Imiquimod as Pregnancy Category C, which means the potential risk to the fetus cannot be excluded.


The safety of using Imiquimod cream while breastfeeding is unknown, as no specific studies have been conducted on its use in this situation. Limited data suggests that Imiquimod use by the mother appears to be compatible with breastfeeding, but it’s essential to weigh the potential benefits against the potential risks before using the cream.

However, it is important to note the safety of Imiquimod cream while breastfeeding.

Pediatric and Geriatric Use

Imiquimod use in pediatric and geriatric populations may require special considerations. For children under 12 years of age, the use and dose of Imiquimod must be determined by a doctor, as safety and efficacy have not been established in this age group.

For adults and children 12 years and older, a thin film of the cream is applied once a day at bedtime for up to 8 weeks. Always consult your healthcare provider for specific dosage instructions based on age and medical condition.

Managing Missed Doses and Storage

Proper handling of missed doses and correct storage of Imiquimod cream are key in retaining its safety and effectiveness.

This section focuses on the best practices for managing missed doses and storing the medication correctly.

Handling Missed Doses

If you miss a dose of Imiquimod cream, apply it as soon as possible or skip the missed dose and continue with the regular dosing schedule if the next dose is near.

Do not double the dose to make up for the missed one, as increasing the dose may cause more serious side effects.

Storage and Disposal

Store Imiquimod cream at room temperature, away from direct light and moisture, and do not freeze it.

Keep the Zyclara cream pump in an upright position. This will ensure it is well stored..

Dispose of any medicine that has passed its expiration date and do not use leftover cream from single-use packets.


In conclusion, Imiquimod cream is a valuable treatment option for various skin conditions, including skin cancer, actinic keratosis, and genital warts. Proper application and dosage, awareness of potential side effects, and taking necessary precautions can help ensure safe and effective treatment. Always consult your healthcare provider for guidance and discuss any potential risks or benefits associated with Imiquimod cream, especially if you are pregnant, breastfeeding, or have specific medical conditions.

Frequently Asked Questions

What does imiquimod cream do?

Imiquimod cream is used to treat external genital or anal warts, as well as conditions such as actinic keratosis and certain types of skin cancer. It works by helping the body’s own immune system produce natural substances to fight the virus causing the warts.

Is Imiquimod 5% cream a chemo cream?

No, imiquimod 5% cream is not a chemo cream – it is an immunotherapy cream used to treat some small, superficial basal cell skin cancers.

Can imiquimod get rid of HPV?

Imiquimod has been studied as a potential therapy for various viral diseases, including HPV, and has been found to clear up to 76.3% of HPV infections with no persistent or abnormal histological changes. Thus, imiquimod may be an effective treatment for HPV.

How long does it take for imiquimod cream to work?

It typically takes 4-16 weeks to notice an improvement after using imiquimod cream, although it does not provide a complete cure.

Can Imiquimod cream be used to treat both skin cancer and genital warts?

Yes, Imiquimod cream can be used to treat both skin cancer and genital warts.


  1. Imiquimod Cream for Basal Cell Carcinoma: An Effective Treatment Option
  2. Imiquimod 5% Cream in the Treatment of Superficial Basal Cell Carcinoma: A 12-Week Open-Label Study
  3. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: Results of an open-label trial
  4. Imiquimod 5% cream as an effective treatment for basal cell carcinoma: Results of an open-label extension trial
  5. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: A double-blind placebo-controlled trial
  6. Imiquimod 5% cream as a novel treatment for basal cell carcinoma: Results of an open-label pilot trial
  7. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: Long-term follow-up of a 12-week open-label trial
  8. Imiquimod 5% cream for basal cell carcinoma: Response to treatment and factors predictive of response


Photo graph of Dr. Conlon operating with loops on.

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK and refractive cataract surgery.

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