Imiquimod

INTRODUCTION

Indications

External genital or perianal warts/condylomata (condyloma acuminatum). Typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp. Biopsy-confirmed, primary superficial basal cell carcinoma.

Action

May induce the formation of interferons that have antiproliferative and antiviral properties. Therapeutic Effects: Regression of external genital or perianal warts/condylomata, actinic keratoses, or basal cell carcinoma lesions.

Adverse Reactions/Side Effects

Local: irritation, pain, pruritus, burning, swelling, fungal infections (women).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess skin lesions whenever possible to help determine if drug therapy is successful in controlling infection. Report any local irritation, pain, itching, swelling, or other skin reactions at the application site.

Interventions

• Avoid contact with cutaneous lesions when treating patient.

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient to apply medication as directed. Imiquimod should not be used more frequently or longer than prescribed.

• For patients with actinic keratosis and basal cell carcinoma, advise patient to use sunscreens, wear protective clothing, and avoid prolonged sun exposure to prevent further skin damage from UV rays.

Pharmacokinetics

Absorption: Minimal absorption.

Distribution: Action is primarily local.

Metabolism and Excretion: <0.9% excreted in urine and feces.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: None known.

Use Cautiously in: Previous treatment/surgery in affected area (area should be healed prior to use); Preexisting inflammatory skin lesions (may be exacerbated); Immunocompromised patients (safety not established); Pregnancy, lactation, or children <12 yr (safety not established).

Interactions

Drug-Drug: None known.

Route/Dosage

External Genital Warts

Topical (Adults and children >12 yr): Apply thin layer to warts at bedtime every other day (3 times weekly); leave on for 6–10 hr, then rinse off with mild soap and water. Repeat until lesions are completely cleared or up to 16 wk.

Actinic Keratoses

Topical (Adults): Apply thin layer to clean, dry affected area twice weekly; leave on for 8 hr, then rinse off with mild soap and water. Continue for 16 wk.