DermHelpCentral

Aldara

Aldara Cream (Imiquimod)

    Imiquimod is an immune response modifier. It is manufactured as a 5% cream called Aldara.  Imiquimod is mainly used to treat actinic keratoses, some basal cell and squamous cell skin cancers, genital warts and molluscum.  Your doctor may prescribe it for some other uses.

    Imiquimod works by stimulating the immune system to release a number of chemicals called cytokines, which are important in fighting viruses and destroying cancer cells.

    Aldara comes in boxes of 12 individual sachets or foil packs.  The FDA mandates that these are “For Single Use,” but this is costly and unnecessary.  Many patients get two, three and four applications from a single foil pack.

How To Use
    Here’s a method that was recommended to me by Doug Johnson a dermatologist from Honolulu.

1.  Make a small pin hold in a corner of the foil pack (click photo to enlarge).
2. Squeeze out a tiny amount of Aldara.
3. Rub well into treatment area with a finger and leave on overnight.
4. Fold over packet edge and secure with paper clip.  Store in a cool place.

It’s simple, frugal, and allows you to use the product more economically.

What to Expect
After a few days, the areas treated with Aldara will be come inflamed. (See photos below) The effects may include itching, burning, redness, ulceration (sores), scabbing, flaking and pain. These reactions indicate that the cream is likely to be effective.  If there is no inflammation, imiquimod is unlikely to clear the lesions. An exaggerated response may clear the skin lesion sooner than expected - sometimes in as few as three or four applications. In some patients, surrounding untreated areas also become inflamed but this will settle when treatment is discontinued.

If you develop a severe reaction with black scabs and ulceration, stop applying the cream and arrange to see your doctor as soon as possible.

Systemic side effects
These are unusual, but may include flu-like symptoms, such as low- grade fever, fatigue, headache, nausea, diarrhoea and muscle pain. These are generally mild and may be treated with Tylenol.  However, if they are troublesome, stop applying imiquimod cream and contact your doctor.  Enlarged lymph nodes can rarely appear in sites near the treated area.  The systemic side effects should resolve within a few days of stopping treatment. They may also resolve with continuing treatment.

Length of Treatment will depend on the frequency of use, the area treated and an individual’s response to the agent.  There are many protocols for use and each physician has his or her personal modifications.

Final Results
Healing after treatment is usually excellent. In spite of the marked inflammation there is rarely any permanent mark at the treatment site.

Photos of a Severe Reaction

Superficial Skin Cancer after 9 days

Same Lesion after 3 weeks

Same area 3 weeks after stopping Aldara

Non-Sutured Wound Care

Wound Care for Shave Biopsy and other No Stitches Procedures

All wounds heal best when kept clean, moist and covered.

The following steps will promote optimal wound healing and yield the best cosmetic result.

1. Keep the dressing dry for at least 24 hours.

Sometimes the wound may start to bleed. If this happens, apply local pressure with gauze or Kleenex to the wound for 15 minutes. That should stop the bleeding. If it does not, continue to apply pressure and call us.

2. Clean the wound daily with mild soap and water. Gently cleanse with a soft washcloth to remove crust or debris.  Only use hydrogen peroxide to help break up crusts that do not come away easily with a washcloth.  After cleansing, pat area dry gently.

3.  Apply a thin layer of Aquaphor or Vaseline to the wound.  Most skin surgeons prefer Aquaphor ot Vaseline to topical antibiotics since the latter can cause allergy. 

4.  Apply a non-stick dressing.  Telfa, Curad or NexCare are three suitable ones.  We especially like the latter because they are waterproof.

5. Repeat this simple regimen daily until the wound is completely healed or you are asked to stop by your doctor.  Keeping the dressing off and letting the wound dry out will slow the healing process.  You may shower or bathe 48 hours after surgery.

If the dressing gets wet, it should be changed as soon as possible.
Note: the wound should not hurt! It will be sore, like a bruise, the first night, and after that it may be tender to touch, but it should not hurt. It may sting or burn if it gets wet, or if it is exposed to the air without a protective coating of ointment.

Please contact your dermatologist for any of the following

Pain in or around the wound site
Redness extending more than about 1/3 inch from the edge of the wound
Swelling of the wound or the area around it
If you are worried that there might be something wrong

Useful Web Sites

This is a list of some online dermatology resources:

We will update it periodically.  Last update: May 2007

These have no commercial bias.  One needs to be careful when visiting many sites since they are underwritten by organizations and individuals with something to sell.  Even patient support organizations are often heavily funded by pharmaceutical companies.

Images:
DermIS has thousands of images.  Takes a while to learn how to navigate and  not all pictures are of great quality, but it is worth checking.

Global Skin Atlas: The International Atlas of Dermatology and Dermatopathology is a joint effort of doctors in various countries to cover the spectrum of skin disease in all skin colours and races. The images may be freely used for self-education and for teaching purposes.                     The Inaugural Editors are: Drs. Shahbaz Janjua (Pakistan), Ian McColl (Australia) and Jayakar Thomas (India)

Dermatology Image Database: from the University of Iowa

DermAtlas.org out of Johns Hopkins -- lots of pediatric pictures -- quirky but worth visiting. 10,000 images

Disease Information:
DermNet NZ  This is the Mother of All Derm sites.  Start here.

Emedicine gives in-depth information on a great number of common and rare skin disorders.  It may be more than one wants; but it is kept current and is a valuable resource.  It is a very complete dermatology resource, and has much else relating to general medicine and other specialties.

Clinical Knowledge Summaries from the U.K.'s National Library of Health is a valuable resource.  CKS is growing and definitely worth visiting.  You may need to register for parts, but it is free.  It is generally more conservative than some U.S. sites and there is no commercial bias.  As with eMedicine, this has much more than dermatology.  A valuable resource.

Melanoma - Misdiagnosis

There was a fine piece on NPR today about the over diagnosis of melignant melanoma.

Melanoma, the deadliest form of skin cancer, is diagnosed at more than twice the rate it was just 20 years ago. But some doctors worry this isn't a signal of melanoma epidemic. Instead, it could be an epidemic of skin biopsies.  Download the NPR essay:  Download npr___melanoma.pdf

You can also probably listen to this at: NPR.org

Your comments will be appreciated.