Aldara 5% cream
- Treatment for external genital and perianal warts with Aldara 5% cream
- Access Aldara 5% cream following an online medical consultation
- What is Aldara 5% cream?
- Genital warts and HPV
- Diagnosis and suitability: what to establish before treatment
- How imiquimod works
- How to use Aldara 5% cream
- Sex during treatment and contraception
- Side effects and local reactions
- Follow-up and alternatives
- How DoktorABC works
- Active substance and excipients
Treatment for external genital and perianal warts with Aldara 5% cream
Aldara 5% cream is a prescription-only topical treatment for external genital and perianal warts (condylomata acuminata) in adults. It contains imiquimod 50 mg per gram (5% w/w) as the active ingredient and is manufactured by Meda Pharmaceuticals. Each pack contains individual single-use sachets, each containing 250 mg of cream. The cream is applied in a thin layer to visible wart tissue on three non-consecutive nights per week, left in place for six to ten hours, then washed off, for up to sixteen weeks.
Access Aldara 5% cream following an online medical consultation
Start the online consultation and complete the medical questionnaire. A UK-registered prescriber will review your answers and, where appropriate, approve a prescription for Aldara 5% cream.
Important information
DoktorABC UK is a digital health platform that connects patients with independent, UK-registered prescribers. DoktorABC UK does not itself provide medical care, issue prescriptions, or dispense medicines. All clinical decisions are made by the UK-registered prescriber following an individual medical assessment.
What is Aldara 5% cream?
Aldara 5% cream is indicated for the topical treatment of external genital and perianal warts (condylomata acuminata) in adults. It is a prescription-only medicine (POM) in the UK and is not available without a valid prescription from a registered prescriber.
Each single-use sachet is sufficient to cover a wart area of approximately 20 cm². Sachets should not be re-used once opened.
Aldara 5% cream has additional licensed indications for actinic keratosis and superficial basal cell carcinoma. These are separate indications with different dosing regimens and are not covered by this product page.
Genital warts and HPV
Genital warts are caused by certain strains of the human papillomavirus (HPV), most commonly HPV types 6 and 11. HPV is transmitted through close skin-to-skin contact, including sexual contact. The virus can be present in the body and transmissible without any visible warts, and it can remain dormant for weeks, months, or longer before warts appear.
Treatment with Aldara cream addresses visible wart tissue. It does not eradicate HPV from the body, and warts may recur after treatment. Recurrence is common and does not necessarily indicate treatment failure.
Condoms reduce but do not eliminate the risk of HPV transmission, as the virus can be present on skin not covered by a condom. HPV vaccination, available through the NHS for eligible groups, protects against the strains most commonly associated with genital warts and certain cancers. Women between the ages of 25 - 64 should continue attending routine cervical screening in line with NHS programme guidance.
Diagnosis and suitability: what to establish before treatment
Aldara cream should only be used on lesions that have been clinically confirmed as external genital or perianal warts by a healthcare professional. A sexual health clinic assessment before starting treatment can confirm the diagnosis, assess the extent and location of warts, test for other sexually transmitted infections, and advise on whether self-applied treatment or a clinic-applied procedure is the most appropriate option.
Important: Do not use Aldara cream on:
- Lesions that have not been clinically confirmed as genital warts
- Warts inside the vagina, urethra, or rectum
- Broken, inflamed, or recently treated skin before it has fully healed
- Skin on which another genital wart treatment has recently been applied.
Only apply to affected areas and avoid any application on internal surfaces.
Pregnancy and breastfeeding
Aldara cream is not recommended during pregnancy. If you are pregnant, trying to become pregnant, or breastfeeding, speak to your GP or a sexual health clinician before using this product.
Autoimmune conditions
People with autoimmune disease should discuss the use of imiquimod with their prescriber before starting, as imiquimod works by modifying the immune response.
Organ transplant recipients and people on immunosuppressive treatment
Imiquimod should be used with caution in people who are immunosuppressed. A prescriber assessment is required, as the immune-modifying mechanism of imiquimod may interact with immunosuppressive therapy.
Uncircumcised men treating warts under the foreskin
The SmPC advises that uncircumcised men treating warts under the foreskin should retract the foreskin and clean it daily to reduce the risk of local skin reactions, including scarring and changes to the foreskin.
Age
Aldara cream is for use in adults. It is not recommended for use in children.
Allergies
Do not use if you are allergic to imiquimod or any of the other ingredients listed in the PIL.
How imiquimod works
Imiquimod works differently from podophyllotoxin-based treatments such as Warticon. Rather than directly targeting wart tissue, imiquimod is an immune response modifier. Imiquimod does not demonstrate direct antiviral activity, but through induction of cytokines results in immune-based resolution of wart tissue and reduction of viral burden.
When applied to the skin, imiquimod stimulates the local immune system to produce cytokines, which are signalling molecules that trigger an immune response against the HPV-affected cells. This immune-mediated process leads to the gradual breakdown of wart tissue.
Because the mechanism relies on the immune response, the treatment course is longer than podophyllotoxin-based treatments, and the response varies between individuals. Some people respond within a few weeks, others take longer. The maximum treatment period is sixteen weeks.
How to use Aldara 5% cream
The following guidance is based on the current UK SmPC for Aldara 5% cream (Meda Pharmaceuticals, medicines.org.uk, last updated 2023). Always read the full PIL supplied with your medication before use.
Application schedule
Aldara cream is applied on three non-consecutive nights per week, for example Monday, Wednesday, and Friday, or an equivalent pattern with at least one day between applications. It is not applied on consecutive nights.
Step-by-step application
- Wash your hands thoroughly before application.
- Wash the wart area gently with mild soap and water and allow it to dry completely.
- Open one sachet and apply a thin layer of cream to the external wart surface only.
- Rub the cream in until it vanishes into the skin. Apply only to affected areas and avoid any application on internal surfaces.
- Do not cover the area with a dressing or bandage after application.
- Imiquimod cream should be applied prior to normal sleeping hours. During the 6 to 10 hour treatment period, showering or bathing should be avoided.
- After six to ten hours, wash the treated area thoroughly with mild soap and water to remove all traces of the cream.
- Wash your hands again after removal.
- Dispose of the used sachet. Do not reuse an opened sachet.
Duration
Treatment may continue for up to sixteen weeks. The prescriber will specify the appropriate duration for your circumstances.
Missed applications
If you miss an application, apply the cream on the following night and then adjust your schedule to maintain the three-times-weekly, non-consecutive pattern. Do not apply on two consecutive nights to make up for a missed application.
Important: Application of an excess of cream or prolonged contact with the skin may result in a severe application site reaction. Apply only a thin layer and remove it after the specified period. Do not apply more cream than directed in the belief that it will improve results.
Sex during treatment and contraception
Avoid sexual activity while the cream is on the skin. It is recommended that patients refrain from sexual intercourse while treating warts with the cream and until the skin has healed. If a patient does engage in sexual intercourse, a condom must be used.
Aldara cream may weaken condoms and diaphragms. Do not rely on latex or rubber contraceptives for protection during or immediately after application of the cream. Use an alternative method of contraception if needed.
Do not allow the cream to contact a partner's skin or internal surfaces.
Side effects and local reactions
Local skin reactions are common with Aldara cream and are a recognised part of treatment. They do not confirm that treatment is working, and more severe reactions are not associated with better outcomes.
Common and expected local reactions
- Redness at the application site
- Soreness, burning, or stinging
- Flaking or peeling of the skin surface
- Mild erosion of the skin in the treated area
These reactions typically occur after a period of use and may fluctuate during the course. If reactions are pronounced, your prescriber may advise a temporary rest period from treatment, allowing the skin to recover before continuing.
When to stop and seek medical advice
Stop using Aldara cream and contact your prescriber or sexual health clinic if you experience:
- Severe pain, significant swelling, or ulceration at the treatment site
- Blistering or extensive skin breakdown
- Difficulty with urination (if warts or reactions are near the urethra)
- Signs of skin infection including increasing redness, warmth, or discharge
- Systemic flu-like symptoms, including fever, fatigue, or muscle aches
Important: Local reactions that are severe, extensive, or affecting normal function are not a reason to continue treatment. Stop using the cream and contact your prescriber for guidance on whether to take a rest period or stop treatment.
Report any suspected side effects to the MHRA via the Yellow Card scheme.
Follow-up and alternatives
If visible warts do not respond after a full course of Aldara cream, or if lesions are uncertain, contact your prescriber or sexual health clinic for reassessment. STI testing alongside wart assessment is recommended at a sexual health clinic for anyone who has not recently been tested.
Comparison with other treatments
| Treatment | Route | How it works | Key considerations |
|---|---|---|---|
| Aldara 5% cream (imiquimod) | Self-applied topical cream | Stimulates immune response to target wart tissue | Three times weekly for up to sixteen weeks; immune-mediated mechanism |
| Warticon cream (podophyllotoxin 0.15%) | Self-applied topical cream | Inhibits cell division in wart tissue | Three days on, four days off; up to four weeks; different mechanism |
| Cryotherapy | Clinic-applied | Freezes and destroys wart tissue | Performed at sexual health clinic; suitable for warts not responding to topical treatment |
| Trichloroacetic acid | Clinic-applied | Chemical destruction of wart tissue | Applied by a clinician; may suit smaller or harder warts |
Aldara and podophyllotoxin work through different mechanisms, which means that a person who does not respond to one may respond to the other. A prescriber or sexual health clinician can advise on the most appropriate sequence of treatment for your circumstances.
How DoktorABC works
DoktorABC UK is a digital health platform that connects patients with independent, UK-registered healthcare professionals through a secure online process.
- Complete a short medical questionnaire covering your symptoms, medical history, and any relevant medicines.
- An independent UK-registered prescriber reviews your information and determines whether Aldara 5% cream is clinically appropriate for you.
- If treatment is considered suitable, a prescription is approved by the UK-registered prescriber in accordance with UK regulations.
- Your medication is dispensed by a GPhC-registered pharmacy and delivered to your door in discreet packaging.
DoktorABC UK does not itself provide medical care, issue prescriptions, or dispense medicines. All clinical decisions are made by the independent prescribing healthcare professional following an individual assessment.
Active substance and excipients
Active substance: Imiquimod 50 mg per gram (5% w/w).
Other ingredients: Isostearic acid, cetyl alcohol, stearyl alcohol, white soft paraffin, polysorbate 60, sorbitan monostearate, glycerin, methyl hydroxybenzoate (E218), propyl hydroxybenzoate (E216), xanthan gum, purified water, benzyl alcohol, and citric acid.
Product PIL: Available at medicines.org.uk/emc/product/823/pil
