Imiquimod as an immune response modulator in infectious conditions

Imiquimod 5% cream is approved in the United States as a patient-applied treatment for external genital and perianal warts (condyloma accuminata) in adults and in children as young as 12 years of age. As noted in the Introduction by Dr Rosen, imiquimod functions as an immune enhancer. Local activation of portions of both the cell-mediated and innate arms of the acquired immune system yields antiviral and antitumor activity. Imiquimod's ability to use the host's immune system to treat cutaneous viral infections and tumors has led to many off-label uses. This section will review the published studies and case reports for the approved indication of genital warts, as well as the use of imiquimod in treating common and plantar warts, flat warts, molluscum contagiosum, and leishmaniasis.