Indications and Usage

Aldara Cream is indicated for the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adults.

Aldara Cream is indicated for the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2.0 cm, located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured. The histological diagnosis of superficial basal cell carcinoma should be established prior to treatment, since safety and effectiveness of Aldara Cream have not been established for other types of basal cell carcinomas, including nodular, morpheaform (fibrosing or sclerosing) types.

Aldara Cream is indicated for the treatment of external genital and perianal warts/condyloma acuminata in individuals 12 years old and above.

Clearance rates for imiquimod relate to treatment exposure

Dose–response effects for imiquimod treatment have been investigated in several trials comparing treatments ranging from once or twice daily dosing to 3, 5 or 7 days per week.26,27,29,42 In a pooled analysis comparing higher- and lower-dose treatment regimens, a 51% (95% CI 35% to 75%) reduction in histologically confirmed risk of BCC recurrence was reported for higher-dose treatments; however, this was also associated with more LSRs.7 Alternative doses have also been studied for SK involving two or three doses per week in a continuous treatment,34–37 cyclical dosing with a treatment-free period,33,43,44and lower concentration imiquimod creams.45 Lower recurrence was observed in an open-label follow-up study in patients treating SK using three applications of imiquimod per week compared with two.39 Overall, the available data suggest that reducing the dosing frequency does lead to improved tolerability of LSRs but reduces efficacy.

Advise patients to adhere to the treatment schedule and not to apply excess cream to the treatment area

Treatment schedules for imiquimod reflect a balance between achieving therapeutic efficacy with tolerability of LSRs. A treatment regimen of 5 days/week is recommended for sBCC because of the improved safety profile and similar clearance rates with this dose compared with daily treatment,19 while for SK the recommended treatment schedule is three times per week.2 Higher than recommended doses may lead to increased LSRs.2

The contents of one 250 mg sachet or the amount delivered in one full actuation of the pump may be more than is required for a single application. cheap aldara 5% cream low price Advise patients against applying excessive cream to the treatment area and to discard unused cream at each application. In the event of a severe LSR, the cream should be removed by washing the treatment area with mild soap and water. Interruptions in treatment are recommended to allow severe inflammatory reactions to resolve.2 In clinical studies there were few discontinuations due to LSRs, and rest periods were taken around 3–4 weeks after treatment started but occurred as early as the first and as late as the last week of treatment.19,46

Strength of Recommendation

Diagnosis by biopsy and viral typing is not recommended for routine or typical lesions.

When podophyllin resin is used to treat genital warts, the skin should be washed one to four hours after application to reduce local irritation.

Colposcopy, acetowhite staining, and other methods should not be used to.screen for subclinical warts in a general patient population or in patients with a history of genital warts.

The choice of treatment depends on the number, size, and location of lesions; there is little evidence that any approach is more effective than another, although costs differ.

Patients should be offered a follow-up evaluation two to three months after treatment.

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