Skin on Forty-Five

Imiquimod AKA Aldara

Imiquimod (Aldara)

This page has been written to help you understand more about Imiquimod (Aldara) cream. It tells you what it is, how it works, how it is used to treat skin conditions, and where you can find out more about it. For further information contact your accredited Skin Cancer Doctors at Skin on Forty-Five for advice or to review of any lesions of concern.

What is Aldara (Imiquimod) cream and how does it work?

Aldara cream contains the active ingredient Imiquimod. Imiquimod is an immune response modifier. It activates immune cells in the body. The immune cells then proceed to kill and remove cancer or virally infected cells.

What skin conditions are treated with Imiquimod cream?

Aldara 5% cream is licensed for the treatment of sun damage in the form of superficial pre-cancerous (actinic keratoses) and low-grade cancerous skin conditions (superficial basal cell carcinoma). It is also licensed to treat external genital viral warts.

Although Imiquimod is sometimes used for other conditions, it is not licenced in New Zealand for them at present.

How effective is Imiquimod (Aldara) treatment? 

Recent evidence suggests 5% imiquimod may be more effective than other non-surgical treatment options for superficial basal cell carcinoma and actinic keratosis. Imiquimod cream can improve many skin problems and, in some cases, cure the condition, but it does not work for everybody, and the effects may not be permanent. If imiquimod works for your condition, your skin usually gets red, ulcerated and sore then settles down as your body heals after destroying the cancer cells. The redness and soreness should settle about 2 weeks after stopping the treatment. If used for sun-damage, the skin will eventually appear much smoother. If you have more severe sun-damage, you may require repeated treatment courses in the future to maintain the improvement.

Important possible reasons not to use Imiquimod (Aldara).

To make sure this is the right treatment for you, before you start using imiquimod cream it is important that your doctor knows:

  • If you are pregnant or breast-feeding.
  • If you have ever had a problem with your immune system. For example, let your doctor know if you know you are immunosuppressed or if you have an autoimmune disease.
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking or using any other medicines. This includes any medicines you have bought without a prescription, as well as herbal and complementary medicines.
  • If you are a male using this cream for genital warts and you have not been circumcised.
How do I use Imiquimod (Aldara)?
  • Wash your hands with soap and water before and after using the medicine.
  • Use one or two packets or actuations of the pump of cream for each dose as directed by your doctor.
  • Apply a thin layer to the affected area of the skin just before bedtime.  Rub gently into the skin until the cream vanishes.
  • Allow the medicine to stay on the treated skin for 8 hours (for actinic keratosis or basal cell carcinoma) or 6 to 10 hours (for genital warts). Do not take a bath, swim, or get the treated area wet during this time.
  • After the right amount of time has passed, wash the treated area with mild soap and water.
  • Do not bandage or otherwise wrap the skin being treated, unless directed to do so by your doctor. Materials that are not airtight, such as cotton gauze or cotton underwear, may be used if needed.
  • Throw out any unused cream from the single-dose packet.
  • Men who are not circumcised and are treating genital warts under the foreskin should retract the foreskin and clean the area daily.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work in the same way.

Do not use this medicine together with any other products containing imiquimod in the same treatment area. This may increase the risk for more serious side effects.

What dosing should I be using?

The dose of this medicine will be different for different conditions. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

  • Actinic (Solar) Keratosis:
    Apply a thin film to the affected area of skin 3 times a week for 4 weeks. Your doctor will assess the response after a 4-week treatment-free interval then repeat a 4 weeks course in concern persists.


  • Superficial Basal Cell Carcinoma:
    Apply to the lesion (and 1 cm beyond it) on 5 days (Monday-Friday) each week for 6 weeks.  Your doctor will assess the response 12 weeks after completing the 6 week treatment course.
What kind of reaction can I expect during imiquimod (Aldara) treatment?

Aldara causes the immune system to attack any cancer cells in your skin around the site of application. This causes redness, ulceration and some pain. Because Aldara promotes you own immune system attacking cancer cells you can commonly find red patches developing at sites where you didn’t even know you had abnormal cells, these can be quite some way from the site of treatment. If you are concerned your reaction is too severe please contact Skin on Forty-Five for advice

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