Viral and nonviral uses of imiquimod: a review.
BACKGROUND
Imiquimod is a topical immunomodulator that is indicated for the treatment of external genital and perianal warts. This drug has been recently approved for the treatment of actinic keratoses and superficial basal cell carcinoma. There is a growing body of evidence for its effectiveness in treating a variety of other skin conditions.


OBJECTIVE
This review examines the role of imiquimod 5% cream in the treatment of skin diseases such as actinic keratoses, basal cell carcinoma, Bowen's disease, lentigo maligna, and extramammary Paget's disease.


METHODS
Published literature containing the words "Imiquimod" or "Aldara" was reviewed and summarized.


RESULTS
This agent has demonstrated indirect antiviral and antitumor effects in animal models. Although the exact mechanism of action is unknown, imiquimod is an agonist for toll-like receptor (TLR) 7 and is thought to act by inducing cytokines, such as interferon alpha (IFN-alpha), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-alpha). These cytokines trigger the immune system to recognize the presence of a viral infection or tumor and the associated lesion is ultimately eradicated. Side effects are generally well tolerated with local skin reactions reported most frequently.


CONCLUSIONS
Imiquimod has been shown to be a safe and effective treatment for a variety of skin conditions.
Gupta
Aditya K
AK
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center, University of Toronto, Toronto, Ontario, Canada. agupta@execulink.com
Cherman
Andrea M
AM
Tyring
Stephen K
SK
D000276:Adjuvants, Immunologic / Q000494:pharmacology / Q000627:therapeutic use*; D000287:Administration, Topical; D000634:Aminoquinolines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001913:Bowen's Disease / Q000188:drug therapy; D002280:Basal Cell Carcinoma / Q000188:drug therapy; D017326:Clinical Trials, Phase III as Topic; D003218:Condylomata Acuminata / Q000188:drug therapy; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000188:drug therapy; D000077271:Imiquimod; D007642:Keratosis / Q000188:drug therapy; D018448:Models, Immunological; D009824:Ointments; D010145:Paget Disease, Extramammary / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012871:Skin Diseases / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012878:Skin Neoplasms / Q000188:drug therapy
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D009824:Ointments; D000077271:Imiquimod