External Genital Wart Treatment with Imiquimod
Getting Rid of HPV Infection of the Ano-Genital Area
Sep 28, 2009
Genital Warts, caused by the HPV (human papilloma virus), can be external or internal. External genital warts occur on the outer genital area, on the glans and body of the penis and scrotum in males and in the vulva outside the vagina in females. Perianal warts, as the name implies, occur around the anal opening. Internal ano-genital warts occur inside the vagina, urethra in both males and females and inside the anal canal. Imiquimod, which enhances the body’s immune system to fight against the human papilloma viruses, is indicated in the treatment of external genital and perianal warts.
Genital warts are spread mainly through sexual contact with an infected person, and can take a few weeks or months to appear as clinically visible lesions. Some infected individuals are capable of transmitting the HPV infection even in the absence of any visible warts. External genital and perianal warts appear as flesh colored or skin colored cauliflower like growths.
How Does Imiquimod Get Rid of the External Genital Warts?
Imiquimod is an immune modulator. When applied to the wart, imiquimod stimulates the cells, including the keratinocytes in the skin, to produce cytokines like the interferons. These cytokines are the body’s natural defense against viral infections. The interferon and other cytokines inhibit the multiplication of the human papilloma viruses and also stimulate stronger immune responses in the body. These concerted attacks kill the viruses and get rid of the warts. Thus imiquimod is a mediator which acts through the body’s immune system to treat the external genital warts. This makes it useful in treating some other skin diseases, infections and tumors as well.
Is Imiquimod Effective in all Types of Warts?
No. Imiquimod is not effective against the hard and verrucous types of warts seen in other areas of the body, and, at times, on the genitals. Imiquimod is more effective against the fleshy, soft type of warts, as seen in the sexually transmitted genital and perianal warts. Though not an official indication, some dermatologists do use imiquimod after removing the firm thick type of warts on the genital and extra genital areas through cryo or electrocautery. This helps in preventing recurrences and also gets rid of minute warts within the cells or outside, which are not visible to the naked eye.
How is Imiquimod Applied to the Warts?
Imiquimod is applied to the warts at bed time for 3 days a week, on alternate days. It should be applied till the warts disappear or up to a maximum of 16 weeks; not longer. The genital or perianal area should be washed and dried before applying the cream. It can be applied with clean and dry finger tips to the warts and rubbed in till the cream disappears. The treated area can be cleansed after 8 hours.
After Application of Imiquimod, What are the Changes Seen in the Genital Wart?
The skin surrounding the wart will become red and flaky. Layers of cells may peel off from the wart. There may be slight swelling in the surrounding skin. If the redness or swelling is increasing and there is itching or oozing, application should be stopped and the treating physician should be contacted.
Mild inflammatory reaction is indicative that imiquimod is working properly. Imiquimod has been found to get rid of the genital warts in about 50% of patients only. The average time required for wart clearance is 8-12 weeks.
What are the Side Effects of Imiquimod?
- Imiquimod can irritate the skin and cause irritant contact dermatitis
- Systemic side effects include headache, body ache, lymph node enlargement, flu like illness, diarrhea and fungal infections
What are the Precautions to be Taken While Applying Imiquimod for the Genital Warts?
- Imiquimod should be applied to the warts only; not to the uninvolved skin.
- Imiquimod should never be used inside the vagina, anus or urethra.
- Care should be taken not to get the cream inside the mouth, eyes etc.
- Sexual contact is forbidden when the cream in applied on the genitals.
Who Should Not Use Imiquimod?
Imiquimod is not indicated in children below 12 years and also in pregnant and lactating women. Those who have a history of dermatitis should avoid using imiquimod. Any skin ulceration near the warts limits its use in the area.
Imiquimod is available under the trade name of Aldara and is available only on prescription. Though Imiquimod does not cure all genital warts, it is definitely one among the best treatment options for anogenital warts. Imiquimod has also been found effective in the treatment of molluscum contagiosum, another viral infection affecting the genital area in adults.
Reference
- Daniel N. Sauder. Immunomodulatory and pharmacologic properties of imiquimod. J Am Acad Dermatol 2000;43:S6-11.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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