Imiquad Cream: Targeted Topical Immunotherapy for Skin Conditions
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Imiquad Cream is a prescription topical immunomodulator indicated for the treatment of external genital and perianal warts/condylomata acuminata in adults and children 12 years of age and older. It is also approved for the treatment of superficial basal cell carcinoma (sBCC) and actinic keratosis (AK) in immunocompetent adults. The cream contains imiquimod as its active ingredient, which works by stimulating the local immune response to help the body fight abnormal cells and certain viruses. This document provides a comprehensive, expert-level overview of its proper use, mechanisms, and safety profile for healthcare professionals and informed patients.
Features
- Active Ingredient: Imiquimod 5%
- Formulation: Oil-in-water emulsion-based cream
- Available Strengths: Single-use packets (250 mg) and multi-use tubes (5 g and 12 g)
- Mechanism of Action: Toll-like receptor 7 (TLR7) agonist
- Pharmacologic Class: Immune response modifier
- Prescription Status: Rx-only medication
Benefits
- Non-invasive Treatment Option: Provides a topical, non-surgical alternative for managing certain skin lesions, minimizing scarring and procedural risks.
- Dual-Action Efficacy: Elicits both potent antiviral and antitumor activity through localized induction of cytokines such as interferon-alpha, tumor necrosis factor-alpha, and interleukins.
- Targeted Immune Stimulation: Activates the body’s own innate and acquired immune defenses specifically at the site of application, reducing systemic exposure.
- High Complete Clearance Rates: Demonstrated efficacy in achieving histologically confirmed clearance of targeted lesions in clinical studies for its approved indications.
- Patient-Administered: Allows for convenient at-home application according to a prescribed dosing schedule, improving adherence and quality of life.
- Minimal Systemic Absorption: The drug is minimally absorbed through the skin, resulting in a favorable systemic safety profile.
Common use
Imiquad Cream is primarily used in dermatology and genitourinary medicine. Its use is strictly indication-specific:
- External Anogenital Warts (Condylomata Acuminata): Applied to visible warts to reduce and clear the lesions. Treatment is typically initiated after other physical methods (e.g., cryotherapy) have been considered or used.
- Actinic Keratosis (AK): Used on clinically typical, non-hyperkeratotic, non-hypertrophic AKs on the face or scalp in immunocompetent individuals. It treats both visible and subclinical lesions within the field of application.
- Superficial Basal Cell Carcinoma (sBCC): A non-surgical treatment option for histologically confirmed primary sBCCs less than 2.0 cm in diameter on the neck, trunk, or extremities (excluding hands and feet). It is not recommended for morphoeic (sclerosing), micronodular, or mixed-type BCCs.
Dosage and direction
Dosing is indication-specific. The cream should be applied in a thin layer to the treatment area and rubbed in until no longer visible.
- For Anogenital Warts: Apply three times per week (e.g., Monday, Wednesday, Friday) prior to normal sleeping hours. Leave on the skin for 6 to 10 hours, then wash off with mild soap and water. Treatment should continue until there is total clearance of the warts or for a maximum of 16 weeks.
- For Actinic Keratosis: Apply twice per week (e.g., Monday and Thursday) to the entire affected area prior to normal sleeping hours. Leave on the skin for approximately 8 hours, then wash off. The treatment course is 16 weeks.
- For Superficial Basal Cell Carcinoma: Apply five times per week (e.g., Monday through Friday) prior to normal sleeping hours. Leave on the skin for approximately 8 hours, then wash off. A 6-week treatment course is standard. A rest period of several weeks is required post-treatment before assessing the clinical outcome and considering a biopsy for confirmation of clearance.
Hands must be washed thoroughly before and after application. A single-use packet contains sufficient cream to cover a wart area up to 20 cm² or an AK/sBCC area up to 25 cm² (5 x 5 cm).
Precautions
- For External Use Only: Imiquad Cream must not be applied orally, intravaginally, intra-anally, or in the eyes.
- Local Skin Reactions: Severe local skin reactions (e.g., intense erythema, edema, erosion, ulceration, weeping, and scabbing) are common. Treatment may need to be suspended until the skin heals. Do not occlude the treatment area.
- Sun Exposure: The treatment area may be more sensitive to sunlight. Patients should avoid sun exposure, use protective clothing, and apply sunscreen.
- Autoimmune Disorders: Use with caution in patients with pre-existing autoimmune conditions (e.g., psoriasis, vitiligo, lupus erythematosus) due to the potential for exacerbation.
- Weakened Immune System: The safety and efficacy of imiquimod have not been established in immunocompromised patients (e.g., organ transplant recipients, HIV-positive individuals).
- Sexual Contact: The cream may weaken condoms and diaphragms. It can also transfer to a partner. Avoid sexual contact while the cream is on the skin.
Contraindications
Imiquad Cream is contraindicated in the following scenarios:
- Known hypersensitivity to imiquimod or any component of the formulation.
- Use on areas with broken or inflamed skin, or near mucosal surfaces (e.g., nostrils, lips, eyes, vagina, urethra, anus) unless specifically indicated for anogenital warts applied to external skin.
- Its use in children under 12 years of age for any indication other than external anogenital warts.
Possible side effect
Local skin reactions at the application site are extremely common and are considered a marker of immune activation. Systemic reactions are less common due to minimal absorption.
- Very Common (>10%): Application site reactions (erythema, edema, itching, burning, scaling, flaking, dryness, scabbing, crusting, erosion, ulceration); fatigue; headache; myalgia; influenza-like symptoms.
- Common (1-10%): Application site pain, bleeding, induration, excoriation, exfoliation, discharge, tenderness; back pain; diarrhea; nausea; fungal infection; sinusitis.
- Uncommon (<1%): Lymphadenopathy (local to application site), skin discoloration (hypo- or hyperpigmentation) at the site, alopecia at the application site, conjunctivitis.
Severe local reactions may lead to scarring. Pigmentation changes may be permanent.
Drug interaction
Formal drug-drug interaction studies have not been conducted. However, considerations include:
- Other Topical Products: Concomitant use of other topical medications, creams, or ointments on the same treatment area is not recommended, as it may increase skin irritation or interfere with the absorption of imiquimod.
- Immunosuppressants: Theoretically, systemic immunosuppressive agents could diminish the efficacy of imiquad, as its mechanism relies on stimulating an immune response.
Missed dose
If a dose is missed, it should be applied as soon as remembered on the same day. If remembered the next day, skip the missed dose and resume the normal schedule. Do not apply extra cream to make up for a missed dose. Maintaining the prescribed intervals (e.g., not applying on two consecutive days for a 3x/week regimen) is important to manage local skin reactions.
Overdose
Topical overdose would manifest as a severe exacerbation of local skin reactions (e.g., severe erythema, edema, pain, ulceration). There is no known systemic antidote for imiquimod. Accidental ingestion may lead to systemic effects like fatigue, nausea, vomiting, and flu-like symptoms. In case of ingestion, medical attention should be sought. Treatment is supportive and symptomatic. The cream should be removed from the skin by washing with mild soap and water.
Storage
- Store at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F).
- Do not freeze.
- Keep the tube or packets in the outer carton to protect from light.
- Keep out of reach and sight of children.
- Discard any unused cream from an opened single-use packet. A multi-use tube should be discarded 1 month after first opening.
Disclaimer
This information is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The full official prescribing information should be consulted before administering this product.
Reviews
- Clinical Consensus: Imiquad (imiquimod) 5% cream is regarded as a valuable tool in the dermatological armamentarium. Its efficacy in clearing anogenital warts and select non-melanoma skin cancers is well-documented in numerous randomized controlled trials. Its key advantage lies in its immunomodulatory mechanism, which offers a field treatment effect for actinic keratosis and treats subclinical disease.
- Practitioner Feedback: Dermatologists appreciate it as a non-surgical option for compliant patients. The predictable and manageable local skin reactions are viewed as a necessary correlate of efficacy. A common point of discussion is patient education; success is highly dependent on carefully instructing patients on the application technique, expected reaction timeline, and how to manage side effects to ensure treatment completion.
- Patient Reported Outcomes (PROs): Patient satisfaction is often high among those who achieve clearance, particularly those seeking to avoid scarring from procedures. The most common challenge reported by patients is navigating the sometimes severe local skin reactions, which can impact daily activities and require diligent adherence to the prescribed dosing holidays. The convenience of home administration is frequently cited as a major benefit.