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Imiquimod is a medication used to manage and treat anogenital warts, superficial basal cell carcinomas, and actinic keratoses. It is in the immune modulator class of drugs. This activity describes the indications, action, and contraindications for imiquimod as a valuable agent in treating anogenital warts, superficial basal cell carcinomas, and actinic keratoses. In addition, this activity will highlight the mechanism of action, adverse event profile, and other key factors, such as toxicity and monitoring, pertinent for members of the healthcare team in the management of patients with anogenital warts, superficial basal cell carcinomas, and actinic keratoses. Objectives: Describe the indications of imiquimod. Identify the adverse effects of imiquimod. Review the mechanism of action of imiquimod. Summarize the importance of improving care coordination amongst the interprofessional team to improve outcomes for patients receiving imiquimod. Access free multiple choice questions on this topic.

While most side effects of topical imiquimod use are mild, there are reports of severe local or systemic adverse effects associated with topical imiquimod use, in which case the prescriber may need to halt treatment.[22][23] For patients with autoimmune conditions, the application of imiquimod over large areas of the body should prompt caution, given the potential for a systemic immune response.[22]

An interprofessional team of clinicians is needed to coordinate the care of patients with external anogenital warts, actinic keratoses, or superficial basal cell carcinomas. Patients with external anogenital warts may first present to a clinician in the fields of primary care, pediatrics, family medicine, dermatology, internal medicine, obstetrics, and gynecology, or urology. Similarly, patients with actinic keratoses or superficial basal cell carcinomas may first present to health care professionals within the fields of internal medicine, primary care, family medicine, or dermatology. Primary care, family medicine, and internal medicine clinicians may refer patients to dermatologists and/or plastic surgeons to manage actinic keratoses or basal cell carcinomas. Patients must be instructed on the appropriate application of topical imiquimod cream to ensure safety and optimal treatment results. Nurses, physicians, and physician assistants can help ensure appropriate medication usage by providing written and verbal instructions to patients and/or caregivers. Pharmacists can also play a role by clarifying application instructions if necessary. Members of the healthcare team should also monitor for appropriate treatment response or side effects due to topical imiquimod.[20] [Level 5] Patients with external anogenital warts should undergo testing for other sexually transmitted diseases. They should let current sexual partners know about a diagnosis of anogenital warts because the causative agent, human papillomavirus, can be transmitted sexually and because their partners may wish to undergo testing for sexually transmitted diseases or examination for anogenital warts. Patients should also receive counsel to avoid sexual activity with any new sexual partners while anogenital warts are still present. Condom use and safe sexual practices should be encouraged, although condom use may not entirely prevent the transmission of human papillomavirus if uncovered areas are also infected. Although the human papillomavirus vaccine will not treat existing external anogenital warts, it may merit consideration to protect against oncogenic types of human papillomavirus.[20] [Level 5] The coordination of care amongst a team of healthcare professionals is essential to achieve improved patient outcomes.