Imiquimod cream (also known as Aldara) works by boosting your body’s immune response to the area of abnormal tissue. It is proven to be active against pre-malignant skin conditions of the vulva and vagina such as vulval intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VaIN).

It is thought to work by adapting your body’s immune response to the abnormal skin cells.

How should I apply the cream?

In order for the Imiquimod cream to work, it should be applied regularly, ideally 3 times a week for up to 16 weeks. We would aim to start using the cream once a week and if tolerated, increase to 3 times a week.

The best way to apply the cream is to look at the vulval area in a mirror, apply simple Vaseline to protect the surrounding normal skin and then apply the Imiquimod cream to the abnormal areas. It is best to rub the Imiquimod cream in until it vanishes.

The cream should be left on for 8-10 hours and is therefore best applied at bedtime. It should be washed off with water and a soap substitute e.g. QV or Dermol the next morning. An emollient such as Zeroderm, Epimax or Hydromol can then be applied to the skin. You should avoid sexual contact on the nights the cream is applied.

If you are unsure how to apply the cream, we are happy to show you or advise as you apply it for the first time in the clinic.

Advice for vulval care while using Imiquimod

As the cream works, it may cause blistering of the skin and this can be very painful (like a burn) until healthy skin grows back. When this happens it is important you keep the area clean and dry. Antibiotics are not usually required but simple painkillers should help. We might also suggest 5% Lignocaine ointment, which is a local anaesthetic to numb the area where the cream is applied.

What are the side effects of using Imiquimod?

Imiquimod cream takes time to be effective. The skin reaction tends to be at its worst in the third week of application. Your skin is likely to become red, swollen and sore at the site of application within 5 days of starting treatment. Your skin may peel, crack, blister and then scab. You may also experience itching, burning or stinging. Rarely, if you develop weepy skin or an open wound, there is a risk that this may become infected. If you are concerned that your wound is infected, please ask your GP or practice nurse to have a look or call us for advice.

Inflammation is a good sign as it shows the cream is working. Generally the more intense the inflammation, the better the end result. The surrounding skin may also become inflamed, but this will settle when you stop using the cream. Skin redness may take up to 4 weeks to subside after stopping treatment.

If your skin becomes too sore, take a rest week off treatment until the symptoms have improved, then restart treatment. If your skin is too painful, it may be best to use the cream every other week. Rarely, ulceration (an open skin wound) may occur. This may cause changes to the skin pigmentation, making it lighter or darker.

Allergic reactions to Imiquimod are rare. If you have a severe reaction, there is a small risk of scarring or hair loss. Rarely, it can cause a flare up of a pre-existing autoimmune disease. You may develop flu-like symptoms such as fever, swollen lymph nodes, aches and generally feeling unwell. You may need additional rest from the cream if these symptoms develop and paracetamol can be helpful.

Will Imiquimod cure my VIN?

The main problem caused by VIN is vulval discomfort, soreness and itch. We hope that the Imiquimod treatment will help these symptoms. VIN also carries a small chance of developing into cancer and neither surgical treatment nor Imiquimod remove this risk completely. Therefore, whether your VIN is treated with surgery, cream or both, you will need to be followed up in the clinic.

If you ever notice a lump, sore or ulcer on your vulva, particularly something new or that feels as if it is getting bigger, please contact the clinic and we will see you urgently rather than waiting until your next appointment.