What are the aims of this leaflet?

This leaflet has been written to help you understand more about imiquimod cream. It tells you what it is, how it works, how it is used, and where you can find out more about it.

What is imiquimod, and how does it work?

Imiquimod cream is used to treat actinic keratoses. It works by activating the body’s immune system to recognise and destroy damaged skin cells.

In the UK, two strengths of imiquimod cream are available, a 5% cream and a 3.75% cream. You need a prescription from a healthcare professional for all forms of this cream.

What skin conditions are treated with imiquimod cream?

Imiquimod cream is licensed to treat actinic keratoses. These are areas of skin damaged by the sun. They are not dangerous, but there is a small chance they can turn into skin cancer if left untreated for many years.

The higher strength (5%) cream is also licensed to treat:

• a type of skin cancer known as superficial basal cell carcinoma
• genital viral warts on the outer genital skin.

Imiquimod cream can sometimes be used off-licence for other conditions. These include nodular basal cell carcinoma, non-genital viral warts, keloid scars, melanoma metastases, other pre-cancerous conditions and cancers such as squamous cell carcinoma, disseminated actinic porokeratosis, lentigo maligna, cutaneous T-cell lymphoma, vulval intraepithelial neoplasia and extra-mammary Paget disease.

For further information on licensed, unlicensed, and off-licence use of medicines, visit our Jargon Buster webpage: skinhealthinfo.org.uk/support-resources/jargon-buster/.

Will imiquimod cream improve my skin condition?

Imiquimod cream can improve many skin problems, but it does not work for everyone. For some people, it can stop them from coming back, but the effects are not permanent in some cases. When you apply the cream on the affected area, the skin usually gets inflamed (red and sore) before it gets better. This is normal when imiquimod cream is working for you. The redness and soreness usually settle in about 2 weeks after stopping the treatment. 

How often should I use imiquimod cream?

Your healthcare professional will advise you how many times a week to use imiquimod cream. Always follow their instructions.

How often and for how long you need to use imiquimod cream depends on:

• what you are using the cream for, and
• the strength of the cream you are prescribed.

If imiquimod cream is prescribed for a large area of skin (for example, the whole forehead), your healthcare professional may advise you to treat it in sections. This means treating one part of the area first, then moving on to the rest. This can help reduce inflammation, which some people find difficult to tolerate if the whole area is treated at once.

If you miss a dose, apply the cream as soon as you remember. Then, continue with your regular schedule. Do not use the cream more than once a day.

How should I use imiquimod cream?

You should usually apply imiquimod cream at night and wash it off in the morning. It should always be washed off about 8 hours after it was applied.

• Before going to bed, wash your hands and the treatment area with mild soap and water, then dry completely.
• Cut a corner of the sachet and squeeze some cream onto your finger to apply it to the damaged area.
• Rub gently into the skin until the cream disappears.
• Let the cream go over the edge of the damaged area (about 1 cm), onto the surrounding healthy-looking skin.
• After application of the cream, throw away the opened sachet. Wash hands with soap and water.
• You should not cover the treated area with a plaster or dressing unless your doctor tells you to.

Do not put anything else on the skin for at least 8 hours after you apply the cream. A bland moisturiser can be used after 8 hours if needed to calm the skin, but should be washed off before putting on imiquimod cream again. Moisturiser can also be used to soothe the skin in the weeks after treatment is complete, if needed.

What cautions apply for use of imiquimod cream?

Imiquimod cream can be used on the eyelids and lips, but this needs to be done carefully so it does not get into your eyes or mouth. Your healthcare professional will give you advice on how to use it in those areas.  Avoid using imiquimod cream on broken skin unless you are told to. Do not use the cream if you:

• are allergic to any of the ingredients
• are pregnant or breastfeeding
• are spending time in strong sunlight or using sunbeds

Imiquimod can make your skin more sensitive to sunlight. Use sunscreen and also protect your skin from the sun with clothing, such as long sleeves and a hat.

What are the common side effects of imiquimod cream?

Within 3 to 5 days, the skin treated with imiquimod cream can get inflamed (red and sore). This can also happen to normal looking skin around the area, because some damaged cells may not be visible. The skin may weep, peel, crack or even blister and then be covered by a scab. The area may be itchy, sore and burn. This is caused by the abnormal cells dying and shows that the treatment is working. The reaction tends to be the worst in week 2 to 3 of treatment. For most people, the more inflamed the skin becomes, the better the treatment works. It is normal for redness and crusting to persist for around 2 weeks after the treatment course has finished.

When treating actinic keratoses, it may appear that the number of actinic keratoses is increasing early in the treatment period. This is due to the cream causing inflammation and revealing damaged skin that was not visible before. These will also get better with the treatment.

Some patients develop flu-like symptoms such as swollen lymph nodes, aches and pains, mild fever and generally feeling unwell. Paracetamol tablets can  help.

If the skin or general reaction becomes too much to tolerate, you can choose to stop the cream for a week or so before restarting it again once the skin is more comfortable.

The inflammation caused by imiquimod cream can temporarily affect the skin’s protective barrier. This can increase the chance of a skin infection. If you are unsure about your skin’s reaction or worry about infections, you should consult your healthcare professional.

What are the rare side effects of imiquimod cream?

Rarely, imiquimod cream can cause serious side effects and not all are listed here.

Imiquimod cream can cause strong skin reactions. For example, the treated area may form a wound. This can happen most commonly on the legs.

If the skin becomes very inflamed, its natural colour may change, becoming darker or lighter. This is true for all skin tones. In rare cases, the change in colour can last for a long time. There is also a small risk of scarring and loss of hair in the treated area.

In some people with autoimmune diseases (where the immune system attacks parts of our own body), using imiquimod cream can trigger a flare-up. This is because imiquimod cream activates the immune system. However, this is rare. Very rarely, imiquimod cream can cause a serious reaction which can be due to allergy.

If you experience any of the following, stop using imiquimod cream and contact your health care professional immediately:

• red spots turn into a dot with a circle around it (like a shooting target) on your skin
• shortness of breath
• burning or painful eyes
• mouth sores

It is important to report suspected side effects of medicines. The Medicines and Healthcare products Regulatory Agency (MHRA) manages the Yellow Card scheme. This scheme collects information and safety concerns about medicines and medical devices. Anyone can report these side effects or concerns by using:

• the Yellow Card website mhra.gov.uk/yellowcard or
• the Yellow Card app

Where may I find more information on imiquimod cream? 

Weblinks to other relevant sources:

DermNetNZ: www.dermnetnz.org/treatments/imiquimod.html

EMC: www.medicines.org.uk/emc/search?q=%22imiquimod%22

Jargon Buster: skinhealthinfo.org.uk/support-resources/jargon-buster/

 Please note that the British Association of Dermatologists (BAD) provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.  

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS  PATIENT INFORMATION LEAFLET 

PRODUCED | AUGUST 2011

UPDATED | NOVEMBER 2014, FEBRUARY 2018, FEBRUARY 2026

NEXT REVIEW DATE | FEBRUARY 2029

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