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Table of Contents
Year : 2022  |  Volume : 26  |  Issue : 3  |  Page : 38-39

Imiquimod cream improves photodamaged skin

1 Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
2 Derma Clinic, Riyadh, Saudi Arabia

Date of Submission16-Jul-2019
Date of Decision30-Jul-2019
Date of Acceptance09-Aug-2019
Date of Web Publication22-Aug-2022

Correspondence Address:
Dr. Suliman S Alfaraj
Makkah Al Mukarramah Rd, As Sulimaniyah, Riyadh 12233
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdds.jdds_39_19

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Chronic exposure to ultraviolet light causes wrinkles and dyspigmentation. Imiquimod cream is an immune-modulator medication approved for the treatment of genital warts, actinic keratosis, and superficial basal cell carcinoma. Few scientific papers were published in the literature on the effect of imiquimod on photodamaged skin. We report four patients with benign and malignant cutaneous neoplasms who were treated with 5% imiquimod cream and noticed improvement in their skin appearance. We believe that imiquimod cream is a safe and effective option for improving photodamaged skin with excellent safety profile.

Keywords: Imiquimod, photodamage, skin

How to cite this article:
Alfaraj SS, Ghobara YA, Aleisa AM. Imiquimod cream improves photodamaged skin. J Dermatol Dermatol Surg 2022;26, Suppl S1:38-9

How to cite this URL:
Alfaraj SS, Ghobara YA, Aleisa AM. Imiquimod cream improves photodamaged skin. J Dermatol Dermatol Surg [serial online] 2022 [cited 2022 Dec 8];26, Suppl S1:38-9. Available from: https://www.jddsjournal.org/text.asp?2022/26/3/38/354312

  Introduction Top

Chronic exposure to ultraviolet (UV) light leads to wrinkling and dyspigmentation. Persistence UV exposure causes multiple cutaneous carcinomas.[1] Imiquimod is approved for the treatment of genital warts, actinic keratosis, and superficial basal cell carcinoma (BCC).[2],[3] Imiquimod is a Toll-like receptor 7 agonist that induces inflammation through the activation of nuclear factor kappa-B (NF-KB).[4]

We report four patients with benign and malignant cutaneous neoplasms who were treated with 5% imiquimod cream and who had improvement in the appearance of their photodamaged skin.

  Case Report Top

Four patients (mean age: 71.25 years) received 5% imiquimod cream every other day to treat their skin conditions [Table 1]. Patient 1 is a 71-year-old female with biopsy-proven BCC on her left cheek. The patient was treated with imiquimod for 3 months. Patient 2 is a 78-year-old female with seborrheic keratosis on the left check and received treatment for 2 months [Figure 1]a. Patient 3 is a 61-year-old male with biopsy-proven superficial BCC on the lower back. The patient applied the topical medication for 3 months. Patient 4 is a 75-year-old male with biopsy result showing pigmented BCC on the right lateral eyebrow. This patient applied imiquimod cream for 6 months [Figure 2]a.
Figure 1: (a) Before imiquimod cream and (b) after 2 months with notable improvement of wrinkles and pigmentation

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Figure 2: (a) Patient at baseline and (b) after 6 months with significant improvement in the appearance of the skin

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Table 1: Summary of patients' demographics

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In addition to resolving of their primary skin condition, our patients had improvement in their skin appearance from their baseline status. Serial photographs on a monthly basis were taking from our patients and showed improvement. Wrinkles and dyspigmentation were better than in baseline photographs [Figure 1]b and [Figure 2]b. Three out of four patients did not have severe skin irritation or major side effects of the medication and therefore completed the treatment duration. Patient 2 had mild skin irritation after 1 week of applying the cream, which resulted in holding the medication and prescribing topical corticosteroid cream for 3 days; imiquimod treatment resumed after 1 month.

  Discussion Top

Prolonged exposure to UV light results in photoaging of the skin.[1] The mechanism of action of imiquimod in improving photodamaged skin is unclear, as both UV radiation and imiquimod result in activation of NF-KB, complex activator protein-1, and subsequent transcription of proinflammatory cytokines.[5] Imiquimod downregulates matrix metallopeptidase 9 (MMP-9), basic fibroblast growth factor, and vascular endothelial growth factor and upregulates tissue inhibitor of MMP-1.[5] These features might explain how imiquimod works in improving photodamaged skin.

There have been few reports in the literature about use of imiquimod in photodamaged skin. One study of 5% imiquimod cream reported improvement of subjects' photodamaged skin.[5],[6],[7] In a meta-analysis, imiquimod cream 2.5% and 3.75% improved appearance.[8] The group treated with 3.75% cream showed more improvement (44.1%) than the 2.5% group (31.9%).[8] They did not include imiquimod cream 5% in their review.

It appears that 5% imiquimod cream is a safe and effective treatment for malignant and premalignant skin cancer, in addition to improving the overall appearance of the skin. In our study, only one patient out of four held the medication temporarily due to irritation. Imiquimod also improves histological appearance of the skin, with correction of the thickness of epidermis, decreases the number of atypical keratinocytes, and decreases solar elastosis.[5],[7],[9],[10]

The lack of histological correlations of our patients is one of our study limitations in addition to small number of subjects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Chung JH, Hanft VN, Kang S. Aging and photoaging. J Am Acad Dermatol 2003;49:690-7.  Back to cited text no. 1
Miller RL, Gerster JF, Owens ML, Slade HB, Tomai MA. Imiquimod applied topically: A novel immune response modifier and new class of drug. Int J Immunopharmacol 1999;21:1-4.  Back to cited text no. 2
Tyring S. Imiquimod applied topically: A novel immune response modifier. Skin Therapy Lett 2001;6:1-4.  Back to cited text no. 3
Hanna E, Abadi R, Abbas O. Imiquimod in dermatology: An overview. Int J Dermatol 2016;55:831-44.  Back to cited text no. 4
Metcalf S, Crowson AN, Naylor M, Haque R, Cornelison R. Imiquimod as an antiaging agent. J Am Acad Dermatol 2007;56:422-5.  Back to cited text no. 5
Altalhab S. The effectiveness of imiquimod 5% cream as an anti-wrinkle treatment: A pilot study. J Cosmet Dermatol 2019;00:1-4. doi=10.1111%2Fjocd.12939  Back to cited text no. 6
Kligman A, Zhen Y, Sadiq I, Stoudemayer T. Imiquimod 5% Cream Reverses Histologic Changes and Improves Appearance of Photoaged Facial Skin 2006;19:704-11.  Back to cited text no. 7
Del Rosso J, Swanson N, Berman B, Martin GM, Lin T, Rosen T. Imiquimod 2.5% and 3.75% cream for the treatment of photodamage: A meta-analysis of efficacy and tolerability in 969 randomized patients. J Clin Aesthet Dermatol 2018;11:28-31.  Back to cited text no. 8
Kaidbey K, Owens M, Liberda M, Smith M. Safety studies of topical imiquimod 5% cream on normal skin exposed to ultraviolet radiation. Toxicology 2002;178:175-82.  Back to cited text no. 9
Smith K, Hamza S, Germain M, Skelton H. Does imiquimod histologically rejuvenate ultraviolet radiation-damaged skin? Dermatol Surg 2007;33:1419-28.  Back to cited text no. 10


  [Figure 1], [Figure 2]

  [Table 1]


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