Is imiquimod 5 cream (Aldara) OTC?

Table of Content:
What is it used for? | Is imiquimod 5 cream available OTC? | How to get a prescription? | How to apply it? | Side effects | FAQ

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What is imiquimod 5 cream used for?

Dr. Howell, a board-certified dermatologist who offers treatment to patients via Miiskin explains that imiquimod 5% cream is primarily used to treat certain skin conditions caused by abnormal or virus-infected cells. In his dermatology practice, the most common uses include:

• External genital and perianal warts (condyloma acuminata) caused by human papillomavirus (HPV)
• Actinic keratoses, which are precancerous rough spots caused by sun damage
• Superficial basal cell carcinoma, a type of early, non-aggressive skin cancer
  

When used for genital warts, the cream works by stimulating the body’s own immune system to attack and remove the virus-infected cells, rather than directly killing the virus. This immune response is what causes the redness, swelling, or crusting seen during treatment, which are signs that the medication is actively working¹.

Are Aldara and imiquimod the same?

Dr. Howell explains that Aldara was the brand name for a cream whose active ingredient was imiquimod, but is now discontinued. When treating genital warts, both terms are often used interchangeably, but Aldara referred specifically to the 5% imiquimod cream approved for topical use on external genital and perianal warts in adults.

 Is imiquimod 5 cream available over the counter (OTC)?

Dr. Howell confirms that imiquimod 5% (Aldara) cream is not available over the counter (OTC)—it can only be obtained with a prescription from a dermatologist.

How to get an imiquimod 5 cream prescription online?

Dr. Howell says that in order to get an online prescription for Aldara cream, you can consult him or any other dermatologists in the Miiskin network who are licensed in your state. Consultation price ranges from $30 – $59, depending if you are an existing patient in need of a prescription renewal or a new patient seeking treatment for the first time.

Where to buy Aldara cream?

Aldara has been discontinued by the manufacturer, however, after you receive your e-prescription, you can buy your imiquimod 5% cream at the local or online pharmacy you have selected.

Is there a generic version of Aldara cream?

Yes. While the brand Aldara 5% cream has been discontinued, generic imiquimod 5% cream is widely available and FDA-approved². This generic version is considered therapeutically equivalent to Aldara and is produced by multiple manufacturers.

What is the price of imiquimod 5 cream?

Generic imiquimod 5% cream is generally significantly more affordable than brand name drugs. You can expect to pay between $20 and $40 out-of-pocket for a typical course of generics, depending on pharmacy or mail-order options.

How to apply imiquimod 5 % cream?

Dr. Howell says you should always follow your prescriber’s exact instructions. However, as a general rule, here’s a clear, step-by-step guide on how to apply Aldara cream over genital warts.

Step by step guide on how to apply Aldara cream

Before you start
Dr. Howell recommends washing and drying the area and to only treat external warts (not inside the vagina, cervix, urethra, or anus). Consider a thin film of petroleum jelly on nearby healthy skin as a barrier. Wash hands before/after, don’t occlude (no tight bandages), and pause if severe irritation occurs. 

1. Every other day, before going to bed, apply a thin layer to each wart and rub in until it disappears.  
2. Leave for 6–10 hours while you sleep.
3. In the morning, wash off with mild soap and water.
4. Repeat 3 times a week until total clearance or for a maximum of 16 weeks.
5. If irritation is strong, you can pause treatment for a couple of days and restart when the area is not irritated anymore.

What are the side effects of imiquimod 5 % cream?

Common side effects of Aldara cream

• Redness and irritation — almost all patients will experience some degree of redness where the cream is applied.
• Itching or burning — mild to moderate discomfort is common, especially on sensitive genital skin.
• Swelling — the area may appear puffy or inflamed.
• Flaking, peeling, or dryness — the skin may shed as the abnormal cells are destroyed.
• Crusting or scabbing — this is part of the healing process but can be uncomfortable.
• Soreness or tenderness — particularly if the skin reaction is strong.

Less common but possible local reactions of Aldara

• Erosion or ulceration — open sores can develop if the reaction is intense.
• Discoloration — temporary lighter or darker patches of skin may remain after healing³.

FAQ about  imiquimod 5% cream

How effective is imiquimod 5%?

For genital warts, Dr. Howell has seen imiquimod 5% achieve clearance rates between 50–70%, depending on wart size, location, and patient compliance. Some patients respond faster than others, and recurrence is still possible because the virus can remain in surrounding skin.

Can imiquimod clear HPV?

Dr. Howell clarifies that imiquimod does not eliminate HPV from the body. It works by stimulating the local immune system to attack and remove visible warts. While the lesions may clear, the underlying virus may still be present and can cause future outbreaks.

What can I use instead of imiquimod?

When treating genital warts, Dr. Howell often discusses alternatives such as cryotherapy, podophyllotoxin solution or gel, trichloroacetic acid application, and surgical removal. Choice of treatment depends on wart location, number, patient tolerance, and cosmetic concerns.

Where can you not put Aldara 5%?

Dr. Howell advises patients not to apply Aldara to internal mucosal surfaces—such as inside the vagina, urethra, or rectum—unless specifically directed. The cream should be limited to external genital or perianal skin, avoiding open sores or severely inflamed areas.

How to heal skin after imiquimod?

After a course of imiquimod for genital warts, Dr. Howell recommends using gentle cleansing and bland moisturizers to soothe redness or irritation. Avoiding sexual contact until the skin has fully recovered reduces discomfort and prevents irritation of healing tissue.

Does imiquimod leave scars?

For genital warts, Dr. Howell notes that scarring from imiquimod is rare. Temporary redness, flaking, or pigment changes may occur, but these usually resolve over time. True scarring is more likely if severe inflammation or ulceration develops and is left untreated.

Can I put Vaseline over imiquimod?

Dr. Howell advises against applying Vaseline directly over active imiquimod on genital skin, as it may reduce absorption. Vaseline can be applied after the cream is washed off—usually the next morning—to soothe any irritation or dryness.

Can you put Aldara on a scab?

In genital wart treatment, Dr. Howell advises against putting Aldara on scabbed areas, as the medication works best on intact skin. Application to scabs may cause unnecessary irritation without improving effectiveness.

How do I know Aldara is working?

Dr. Howell explains that signs of effectiveness on genital warts include redness, mild swelling, and sometimes crusting around the treated lesions, followed by wart shrinkage or disappearance. Some patients may see results within a few weeks, while others take longer.

 When to stop Aldara?

He recommends stopping when the prescribed treatment period is complete, when all visible warts have cleared, or if there is a severe skin reaction that requires physician review. Continuing beyond the advised duration can cause irritation without added benefit.

Is 4 weeks of Aldara enough?

For genital warts, Dr. Howell says four weeks is often not enough for complete clearance. Many patients require 8–16 weeks of treatment, with application three times per week, depending on wart persistence and skin tolerance.

Can I use Aldara more than 3 times a week?

In genital wart therapy, Dr. Howell generally does not recommend exceeding three applications per week. More frequent use tends to increase irritation without significantly improving wart clearance.

How long does it take for Aldara to heal?

After stopping Aldara for genital warts, skin reactions usually heal within 2–4 weeks. In more irritated cases, especially in sensitive genital skin, healing may take longer and require supportive skin care.

Does Aldara fight HPV?

For genital warts, Dr. Howell stresses that Aldara stimulates the immune system to target cells infected with HPV, leading to wart clearance. However, it does not eradicate the virus from the body, so recurrence is possible.

What happens if you use too much Aldara cream?

Overuse in the genital area can cause intense redness, swelling, burning, and sometimes open sores. Dr. Howell warns that excessive irritation may delay healing and recommends pausing treatment and seeking medical advice if overapplication occurs.

Can pregnant women use imiquimod 5% cream?

Dr. Eric Howell says no—imiquimod 5% cream is not recommended for use during pregnancy unless the potential benefits clearly outweigh the risks. There’s limited safety data in pregnant women, and while animal studies haven’t shown major birth defects, the effects on human pregnancy are not well established. For genital wart treatment during pregnancy, doctors usually prefer safer alternatives like cryotherapy.

Can teenagers use imiquimod 5% cream?

 Dr. Howell explains that imiquimod 5% cream is generally not approved for children under 12 years old, but it can be prescribed to teenagers for genital warts if a doctor decides it’s appropriate. Use in teens should be guided and monitored by a healthcare provider to ensure correct application and to manage skin reactions.

Article References:
https://www.ncbi.nlm.nih.gov/books/NBK557413/
https://www.accessdata.fda.gov/drugsatfda_docs/anda/2010/078548Orig1s000.pdf
https://www.mayoclinic.org/drugs-supplements/imiquimod-topical-route/description/drg-20067474