Dermatologist's Take
Imiquimod (Aldara) is a prescription cream that helps your immune system fight warts and certain skin growths, including genital warts, sun spots, and a superficial skin cancer. Redness and crusting are expected and show it is working. It acts slowly and can cause lasting skin color changes.
At a glance
- AKA: Aldara; also sold as Zyclara (a different strength)
- Drug Class: Topical immune response modifier
- Rx or OTC: Prescription only
- Typical Dose: Thin layer to the area a few times a week; the exact schedule depends on what is being treated
- Time to Work: Weeks; genital warts often take up to 16 weeks
- Evidence Level: Good for external genital warts, actinic keratoses, and superficial basal cell cancer; used off-label for some common warts
- Important: Local redness, crusting, and soreness are expected and show the medicine is active
What is it?
What is it text.
How it works
Imiquimod does not kill warts or abnormal cells directly. Instead, it wakes up the skin's local immune system. It prompts nearby cells to release natural defense chemicals (such as interferon) that attack the wart virus (HPV) or abnormal cells. This immune response causes the redness, swelling, and crusting seen in the treated area. That reaction is expected and is a sign the medicine is working.
What it treats
How it's typically used
How you use imiquimod depends on the condition, so follow your doctor's exact plan:
- External genital and anal warts (Aldara 5%): apply a thin layer 3 times a week at bedtime; wash off after 6 to 10 hours; continue until warts clear or for up to 16 weeks.
- Actinic keratoses (rough sun spots): schedules vary by product and strength (for example, Aldara 5% twice a week for 16 weeks).
- Superficial basal cell carcinoma (a low-risk skin cancer): often 5 times a week for 6 weeks.
- Common warts on hands or feet: sometimes used off-label; follow your doctor's instructions.
Wash your hands before and after applying. Do not cover with an airtight bandage unless told to. This is educational only.
Common side effects
- Redness, flaking, dryness, and scabbing or crusting at the site
- Itching, burning, or stinging
- Swelling and mild soreness
- Skin color changes (lighter or darker patches), which can last
- Oozing or a small amount of bleeding as the skin breaks down
Serious side effects
- Severe skin breakdown, open sores, or a lot of pain
- Signs of infection (spreading redness, warmth, pus, fever)
- Flu-like feelings: fever, chills, tiredness, muscle aches, or headache
- Rarely, worsening of an autoimmune condition
Call a doctor if the reaction is severe, if it spreads, or if you feel unwell. Your doctor may pause treatment to let the skin heal.
Who shouldn't take it
- Do not use if you are allergic to imiquimod or any ingredient in the cream.
- Do not use on skin that is broken, cut, or badly inflamed until it heals.
- Not for use inside the vagina, urethra, or anus, or on the eyes, lips, or nostrils.
- Avoid sunlamps and limit sun on treated skin, which can be more sensitive.
- Use caution if you have an autoimmune disease or a weakened immune system.