Disadvantages
Nonspecific inflammation and dermatitis can occur during use of imiquimod for genital warts and molluscum. This often occurs where the skin is traumatized from scratching or between skin folds. Blisters, bloody dry eschar, pain, and discomfort often follows the use of imiquimod for skin cancers and precancerous growths. During the treatment of large superficial basal cell carcinoma or squamous cell cancer in situ, areas of black dried crust often form. Many individuals with extensive actinic keratoses cannot tolerate the resulting reaction. Fortunately, despite frequent significant inflammation, the areas treated generally heal well with no scarring.
Recurrence of skin cancer can occur with imiquimod, but often appears to be localized. It is more common when there are deeply penetrating nests of tumor cells such as in nodular basal cell carcinoma. However, nodular basal cell carcinomas should generally not be treated with imiquimod. Recurrence of superficial basal cell carcinomas can be treated by repeat courses of imiquimod, surgically by simple local excision or by Mohs' micrographic surgery. The recurrence rate depends on the condition being treated and the frequency of topical imiquimod application. A 6-week study on 99 patients with superficial basal cell carcinomas found success rates of 100%, 88%, 73% and 70% for twice daily, once daily, 6 times weekly and 3 times weekly application, respectively.
Other side effects include headaches, back pain, muscle aches, tiredness, flu-like symptoms, swollen lymph nodes, diarrhea, and fungal infections.
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