Please read this information leaflet before you start using Imiquimod and keep it for reference. It contains useful information to help you with your treatment.

What is Imiquimod cream?

Imiquimod cream is a 5% skin cream which works as an immune response modifier, which means that it stimulates your own immune system to fight the HPV infection. This drug is proven to be effective against abnormal pre-cancerous cells (VIN) and genital warts.

Why have I been given this treatment?

You have been given Imiquimod cream to treat your vulval intraepithelial neoplasia (VIN). VIN means that there are abnormal cells in the skin of your vulva. These abnormal cells ARE NOT cancer, but in a small number of women they may develop into cancer over many years. We have no way of knowing whether your abnormal cells will develop into cancer or not. Treatment may reduce the risk of developing cancer at a later date.

What is the aim of this treatment?

The main aim of treating VIN is to relieve symptoms such as pain, itching or burning. Treatment may also reduce the risk of developing cancer at a later date.

How often to use the cream

Week 1:  Use the cream once.

Week 2: Increase the frequency to twice a week.

Week 3-16: Increase until you are using it three times a week. If it is very uncomfortable, wait until the symptoms subside before using the cream again. Be guided by how severely you react.

If you can manage three times a week ( Monday, Wednesday, Friday) , do so, but if not, use it as often as you can manage. It is expected that you should use this cream for up to 16 weeks.

How to apply the cream

Imiquimod cream should be applied before you go to bed and washed off the following morning (6- 10 hours later). The 5% product is supplied as a box of sachets, each containing 250 mg.

Cut the top off the sachet or pierce the sachet with a needle and squeeze out a tiny amount of cream onto your fingertip. Using a mirror to identify the area to be treated, rub the cream in gently until it has vanished. Use just enough to cover the area and note this may not be the whole sachet. Wash your hands thoroughly afterwards.

Wash the imiquimod off the following morning gently using Diprobase or Dermol 500 on washable flannels or cotton wool to avoid spreading of the cream.

You may also use these emollients as moisturisers and avoid using soap or shower gel on the area during treatment as this can make irritation worse.

What to expect

Imiquimod is not an easy treatment to use because it causes inflammation. It also takes time to be effective.

You will get some or all of the following to some degree within 3 to 5 days of starting the treatment:

  • Redness
  • Wearing away of the skin
  • Flakiness
  • Swelling
  • Blisters
  • Tenderness

The skin reaction tends to be worst in week 2 to 3 of application. Typically, the more the inflammation, the better the outcome.

Rarely, the skin may ulcerate and get infected. If that is the case contact your GP and they can prescribe you some antibiotics. If the skin becomes too sore, reduce the frequency of using the cream. Take a break for one week and then re-start applying.

All symptoms decline in severity with less frequent use. Some women get ‘flu’ like symptoms such as headache, fatigue and occasionally diarrhoea. These symptoms clear within 2 or 3 weeks of stopping the treatment.

If the area is very sore flamazine can be prescribed by your GP and applied on a daily basis.

DO NOT have sex on the night you use the cream, even with a condom, as imiquimod weakens the latex of the condom. DO NOT take it by mouth or allow it to come in contact with your eyes. DO NOT share your cream with anybody else.

Other skin measures to take

Following general vulval care principles might help to soothe the vulval skin.

• Use Dermol or Diprobase emollient cream liberally in between imiquimod treatments.

• Keep the Dermol or Diprobase in the fridge and apply the cold emollient cream to soothe the irritation of the affected area.

• Maintain the usual care for vulval skin. For example, don’t use soap or wash underwear in biological powder. Use cotton undergarments.

If you need to visit your GP inform them of your treatment. Stop using imiquimod, if your reaction is severe and you are unable to tolerate it.

Further advice

We hope that you have found the information in this leaflet helpful.  If you require any further advice regarding any aspect of your care please do not hesitate to ask our specialist nurse on 07766524805/ 01228814217.

Useful websites for further information

https://dermnetnz.org/topics/imiquimod/

http://www.medicines.org.uk/emc/ingredient/38/imiquimod

Gynaecology Specialist Useful contacts

We hope you have found this information useful. If there is something you do not understand or if

you have any questions, please ask the clinic nurse or telephone our gynaecology/ colposcopy

Specialist nurses

Gynaecology Specialist Nurse Cumberland Infirmary Tel 01228 814217

Gynaecology Specialist Nurse West Cumberland hospital Tel 01946 523217

Colposcopy Specialist Nurse Tel: 01228 814220

Nurse West Cumberland hospital Tel 01946 523217

Colposcopy Specialist Nurse Tel 01228 814220

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302