- Best Results4-16 weeks
- Treatment Recovery1-3 weeks
- Procedure Time2 minutes
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- Back to WorkVariable
Aldara for sunspots
Aldara or imiquimod is an immune modifier. This gel wakes up your immune system to fight abnormal cells including solar keratosis, & superficial skin cancers such as BCCs & thin squamous cell cancers. It is also used to treat viral infections including warts & molluscum.
FactsFacts On Aldara
- Aldara is a good treatment for some forms of skin cancer & sun damage
- It is on the PBS for superficial BCCs
- Application is three times a week as tolerated for up to 16 weeks
- Side effects include flu like symptoms as well as rare activation of autoimmune conditions
- Your dermatologist-skin cancer GP will discuss this treatment with you
What is Aldara?
Aldara or Imiquimod is a cream that modifies your immune system to destroy abnormal cells. The concentration of cream ranges between 3.75% to 5%. In Australia, only the 5% cream is available.
How does Aldara work?
This treatment uses your own immune system to fight the skin cancer cells & solar damage. The inflammation then destroys the skin cancer cells.
What types of skin cancer can Aldara treat?
On label indications for imiquimod 5% include-
- Solar keratosis or sunspots-actinic keratosis. This included pigmented SKs.
- Superficial basal cell carcinomas.
*Off label treatments include superficial SCCs & various other skin conditions.
*A biopsy may be taken by your dermatologist as this is under the PBS for sBCCs.
Will imiquimod cream cure all skin cancers & sunspots?
Nope. Imiquimod cream can cure or improve solar damage & superficial cancers, however like all cancer treatments, it has a failure rate. In the context of actinic keratosis, the efficacy is around 70-80%. Remaining sunspots may require additional treatment or a biopsy to exclude more sinister causes. Be guided by your dermatologists.
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How effective is Aldara?
It’s pretty good & up there with Efudix, PDT, & laser therapy. Efficacy is proportional to compliance. Inflammation is expected in most cases.
What is the application frequency for sunspots / solar keratosis?
Aldara (Imiquimod) is applied for 3 days a week (alternate days) for 4 weeks. It should be left on for 6-10 hours. Ideally applied in the evening. The course can be repeated after 4 weeks, if necessary, for a maximum of 16 weeks.
In the United States, the application frequency is twice a week for 16 weeks. Your dermatologist may have their own protocols for Aldara, be guided by them.
What are the advantages and disadvantages of Aldara?
Advantages: Cheap, on the PBS for BCCs, your GP does not need equipment.
Disadvantages: compliance needed, flu like symptoms, autoimmune disease activation, a wee bit of hand holding needed.
What is the meaning of combination field treatments for sun spots?
The current literature supports the use of combination therapy for sunspots. Aldara can be used as a ‘mop up treatment’ (this is my most frequent mode of application), following field treatments such as PDT, laser assisted PDT & fractional laser resurfacing.
An example is twice a week application of Aldara for a total of 12 weeks to isolated solar keratosis, starting 4 weeks after laser assisted PDT.
What cautions should you follow when applying Aldara?
Be guided by your dermatologist as many of us use this medication for both on label & off label treatments (eg molluscum, warts). As a rule-
- Don’t use if pregnant or breastfeeding
- Caution on eyelids & mucous membranes
- Caution on lower limbs
- Caution if you have a history of lupus, autoimmune thyroid, polymyositis or undiagnosed muscle aches & pains
What are the more common side effects of Aldara?
It is important to differentiate the difference between expected effects & side effects. Remember, Aldara works by stimulating your immune system, hence if you do not have inflammation, chances are Aldara may not work for you. Expected outcomes-
- Localised inflammation (red, sore, itchy, angry) within 3-6 days of application.
- Moderate to severe inflammation, at week 2-4. It may seem that the number of actinic keratoses is increasing. This is due to the cream causing inflammation in the treated & surrounding areas (subclinical sun spots). Don’t stress. These will also get better with the treatment.
Be guided by your dermatologist as we all have a different way of modulating inflammation.
Are flu-like symptoms common?
Yup. they are. This is because Aldara works by revving up your immune system. This upregulation of immune cells causes inflammation in the treated areas. The flipside is that inflammation within your body can give you muscle aches, pains, flu like illness, lymph nodes, low grade fever & lethargy. Paracetamol every four hours may help.
What are the rare side effects of imiquimod?
As with every medication, sh*t hits the fan in a minority of cases. This is based upon probability & not possibility. Rare side effects include-
- Ulceration & scarring. Usually on the lower limbs, usually in patients who do not know how to modulate dosing or are not taught by their treating physician. Higher in diabetic & in those with poor circulation.
- True allergies are uncommon (actual allergies & not inflammation which is normal)
- Autoimmune disease flare ups, including lupus, thyroid disease, polymyositis. Imiquimod may either initiate or potentiate autoimmunity. Roll the dice.
Does Aldara work on everyone?
Nope. Again, it’s a probability percentage that physicians work on. Hence in a very small number of patients (if you are special), the toll receptor expression on your skin is diminished or absent. If this is the case, your treating dermatologist may try one of two things-
- Try another treatment (PDT, Efudix, cryotherapy, lasers, curette)
- Try to stimulate your immune system (topical retinoids, cryo)
How much is Aldara?
Not much. It is subsidised by the PBS for the treatment of superficial Basal Cell Cancers, but there is no subsidy for solar keratosis. It costs about $90 to $160.
What are the other uses of Aldara?
Lots. Dermatologists employ imiquimod to treat gential warts, warts, plantar warts, plane warts, molluscum infection, palliative melanoma in-situ, Paget’s disease, & other skin cancers. Be guided by their decision & direction.
Davin’s Viewpoint on Aldara Treatment
As a procedural dermatologist, I do not use Aldara to treat sunspots & skin cancers, however I acknowledge that this is a good treatment with a high efficacy rate of clearance, especially for sunspots. Application frequency will vary depending on who you see.
One of the biggest problems with Aldara is the fact that it can potentially unmask or worsen autoimmune conditions, as it systematically stimulates the immune system. On this basis the prescribing physician should, ideally pre-warn the patient- especially if there is a personal or family history of immunity. Treatments such as high-density lasers or photodynamic therapy will circumvent this conversation; be guided by your dermatologist.
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