Aldara, 5%, cream for external use, 250 mg, 12 pcs.

Doctors' opinions on the most effective methods of treating warts and papillomas

The chief physician of Moscow City Hospital No. 62 describes his vision on this matter. Anatoly Nakhimovich Makhson Medical practice: more than 40 years.
“I have been treating people’s papillomas and warts for many years. I’m telling you as a doctor, papillomas along with HPV and warts can really lead to serious consequences if they are not dealt with.

The human papillomavirus is present in everyone on whose body there are papillomas, moles, warts and other pigmented formations. According to rough estimates, 80-85% of the planet's population has it. By themselves they are not dangerous. The problem is that an ordinary papilloma can become melanoma at any time.

These are incurable malignant tumors that kill a person in just a few months and from which there is no salvation.

Unfortunately, in Russia and the CIS countries, pharmaceutical corporations sell expensive medications that only relieve symptoms, thereby hooking people on one drug or another. That is why in these countries there is such a high percentage of cancer diseases and so many people suffer from “non-working” drugs.

The only drug that I want to recommend, and it is also officially recommended by WHO for the treatment of papillomas and warts, is Papinol. This drug is the only remedy that has an effect not only on external factors (that is, it removes papillomas), but also acts on the virus itself. At the moment, the manufacturer has managed not only to create a highly effective product, but also to make it accessible to everyone. In addition, within the framework of the federal program, every resident of the Russian Federation and the CIS can receive it for 149 rubles.”

To find out more, read this article.

Human papillomavirus is a disease that can affect anyone. Multiple warts and growths on legs are the main symptoms of a possible infection of the body. Many patients are interested in the issue of safely getting rid of papillomas using external means and without pain. Drugs for the treatment of HPV can be in the form of solutions, pencils, and also in tablet and cream forms. Numerous consumer reviews indicate that Aldara is the most effective cream in the treatment of papillomavirus.

You can buy the product at any pharmacy kiosk. It is sold in the form of a cardboard package with 12 sachets of 250 mg medication. The drug is intended for external use. It has a whitish or light yellow tint.

The main active ingredient is imiquimod, an immune system inducer. The cream has no effect on papillomas. Aldara cream 5% activates immune processes in the body, facilitating the progression of papillomavirus and accelerating the disappearance of growths from the body. The cytostatic activity of active imiquimod protects against papillomas and stops the growth of malignant cells.

The drug penetrates the bloodstream in a minimal amount. Unprocessed residues are excreted by the intestines and kidneys.

Analogues of Aldara cream

If for any reason the patient cannot take advantage of the medicinal effect of the drugs, experts recommend no less effective analogues, which are similar in component composition to Aldar.

In terms of popularity and effectiveness, the leading positions are occupied by: Viroplex, Acyclovir, Keravort, Zovirax, Verrukacid solution.

The cost of medicines depends on the number of intermediaries, the manufacturer and the amount of trade markup. The average cost of Aldar in pharmacies in the Russian Federation is 5,000 rubles.

Instructions for use of Aldara cream

Before using the cream, it is recommended to examine the problem area by a doctor and read the instructions for use. Pay special attention to the indications and contraindications sections, which will be decisive when prescribing the drug.

The cream is prescribed to patients suffering from human papillomavirus, characterized by multiple rashes of warts and neoplasms on the legs. In addition, doctors consider it advisable to use the drug for diseases such as:

• Basalioma. Basal cell form of cancer, manifested in the form of nodular rashes that rise above the surface of the dermis and are prone to degeneration into malignant forms.
• Actinic keratosis. The main places where the disease is affected are the head and facial skin. Risk categories include people exposed to direct sunlight for a long time. Keratosis appears as scaly indurations.
• Perianal condylomas. Located in the intimate part of the body. When diagnosing this disease, treatment with Aldara cream is permitted only for adults. Pay attention to side effects.

Contraindications:

• age less than 18 years
• intolerance to the components of the composition
• papillomatosis in the area of ​​the vagina, anus and genitourinary system

The use of the drug requires passing a preliminary test for the presence of HIV infection and conducting a conversation with the patient about taking other medications.

For women planning a pregnancy, carrying or nursing a child, the drug is prescribed by a doctor, taking into account the degree of risk for the baby and the desired benefit for the mother. If the drug is prescribed while breastfeeding, Aldar will have to be discontinued. Are papillomas dangerous in pregnant women?

In order to quickly achieve the desired results and a long-term stage of remission, the patient must adhere to a personal treatment regimen that involves an integrated approach.

According to the instructions included with the medicine, when it is sold, Aldara cream is applied before going to bed. The affected area is lubricated with a thin layer. The duration of the cream on the skin is 6-10 hours.

1. Removal of warts and papillomas in the intimate area. The delicate area is treated 3 times a week, no more than 1 time per day. The course of treatment is 4 months. Interruption of treatment is unacceptable until the problem is completely eliminated.
2. Treatment for basal cell carcinoma involves using the product for 5 days without interruption. The product is applied to the affected area and within a radius of 1 cm from it. The duration of the course is 1.5 months.
3. Treatment of actinic keratosis. The treatment regimen provides for one-time lubrication of the problem area for 3-4 days. The first effectiveness of the therapeutic effect makes itself felt after 4 months.

Before applying Aldara cream, you must follow the rules of personal hygiene, including washing your hands with laundry soap.

• Take the disposable sachet with dry, sterile hands and squeeze out a small amount of cream.
• Apply it to the problem area in a thin layer, rub in with massaging movements until completely absorbed.
• The use of dressings is not recommended.
• Cannot be combined with other ointments for HPV.
• For 6-10 hours, the use of water procedures and contact with water is prohibited.
• In the future, use contact with water as necessary.
• During treatment, it is recommended to avoid sexual intercourse, since some of the Aldara cream may be washed off during sex.
• Using a condom does not solve the problem, since they worsen the medicinal effect of Aldar.
• If there are injuries or scars on the skin after surgery, the patient will have to wait for the skin to completely heal.
• Treatment for human papillomavirus involves minimizing exposure to direct sunlight.

Introduction

Imiquimod is a synthetic compound that belongs to a new class of drugs called imidazoquinolones. In the body, it acts as an immune response modifier with strong antiviral and antitumor activity. In 1999, the Food and Drug Agency (FDA) approved imiquimod for the treatment of genital and perianal condylomata acuminata, and in 2004 for the treatment of actinic keratoses and superficial basal cell carcinoma. Recently, it has been found that imiquimod may be useful in various dermatological conditions. This article will review the clinical use of Imiquimod 5% cream for precancerous dermatoses and skin malignancies.

Antitumor mechanism of action in malignant skin tumors

Imiquimod acts on the innate and adaptive immune response both directly and indirectly. Its direct action is through binding to Toll-like receptors (TLRs) of macrophages, monocytes and dendritic cells and through the induction of apoptosis. The indirect effect occurs through the induction of immune modulatory cytokines by Imiquimod. The effectiveness of Imiquimod is also due to its action on Langerhans cells, stimulating their ability to present antigens and their migration to the draining lymph nodes, where antigens are presented to T cells, thereby activating the body's adaptive immune response. Recent studies have indicated the possibility of a direct effect of imiquimod on skin malignancies, with the main mechanism in tumor cell lines being the induction of apoptosis. Imiquimod activates apoptosis, namely proteases of the caspase family. There are two pathways that induce apoptosis: extrinsic and intrinsic. Imiquimod has been shown to lead to apoptosis by working through the intrinsic pathway in mitochondria. When the intrinsic apoptosis pathway is activated, pro-apoptotic molecules are released, such as apoptosis-inducing factor, CMAK, HtrA2, cytochrome C and endonuclease G. These molecules then stimulate the activity of caspase-9 in a multimeric complex called the apoptosome or cause the destruction of malignant cells in an independent manner. An independent manner in which Imiquimod induces apoptosis in tumor cell lines is through up-regulation of pro-apoptotic proteins of the Bcl-2 family, namely Bax and Bak, and of the BH3 family only proteins such as BIM, Bid, BMF, NOXA and Puma. Thus, there is up-expression and down-regulation of anti-apoptotic proteins. The indirect action of Imiquimod occurs by inducing the release of various cytokines. These cytokines stimulate the cellular immune response, which may be important for the antitumor activity of the drug. The main induced cytokines are IL-12, tumor necrosis factor alpha (TNF-alpha), interferon (INF)-gamma. They, in turn, increase the levels of cytotoxic T cells and natural killer cells in the local environment by inducing 2'5'oligoadenylate synthetase and block angiogenesis. Further increase in IL-12 downregulates IL-10 and thus stimulates anti-tumor T cells.

Pharmacokinetics

Resorption of 5% Imiquimod cream applied to the skin is minimal. Less than 0.9% of the drug is excreted from the body in urine and feces.

Use of Imiquimod for precancerous and malignant skin tumors

Actinic keratosis

Actinic keratosis is a precancerous skin lesion that is more common in fair-skinned people and is at risk of developing into invasive squamous cell carcinoma. Imiquimod 5% cream was first approved by the FDA as a therapeutic agent for actinic keratoses in 2004 and has shown extremely encouraging results for this pathology. Imiquimod cream has recently been released in a lower concentration of 3.75%, which is as effective as 5% Imiquimod cream, but causes fewer skin side effects. In addition, an additional advantage was the shorter duration of treatment with 3.75% Imiquimod cream and the ability to apply it to a larger area compared to 5% cream (i.e., an area of ​​up to 200 cm 2 compared to 25 cm 2 for the 5% drug Imiquimod).

New mechanisms of action of Imiquimod in actinic keratosis

1. In addition to its usual immunomodulatory effect in actinic keratosis, imiquimod stimulates the expression of E-selectin in tumor blood vessels, thereby promoting the activation of CD8+ cytotoxic T cells, leading to tumor regression.
2. After using Imiquimod, there is a decrease in the risk of actinic keratosis relapse due to memory T cells remaining in the body.

Imiquimod treatment regimens for actinic keratosis [Table 1]

A new, powerful and related drug to Imiquimod is Resiquimod, which is 10-100 times more potent than Imiquimod. A phase II European study demonstrated resolution of 40-74.2% of actinic keratosis lesions when the cream was applied 3 times a week for 4 weeks. Superficial basal cell carcinoma is a common, rarely metastatic skin neoplasm. However, if treatment is neglected, it can proceed aggressively with destruction of the underlying tissues. In addition to the mechanisms of action mentioned above in basal cell carcinoma, Imiquimod has an additional mechanism that consists in blocking the activation of the glioma-associated oncogene (GLI) signaling pathway. It has been suggested that abnormal activation of this pathway plays an important role in the pathogenesis of basal cell carcinoma. Imiquimod binds to adenosine receptors and activates protein kinases, which in turn phosphorylate glioma-associated oncogene, reducing GLI 1 mRNA and protein levels in basal cell carcinoma cells. This has a negative effect on the GLI HH signaling pathway, thereby interfering with its oncogenic potential. The first study using Imiquimod 5% cream for the treatment of superficial basal cell carcinoma was published in 1999. In the study, 35 patients were randomized into several groups with different dosing regimens of 5% cream Imiquimod and a control group using cream base. Treatment was carried out for 16 weeks. If local reactions to the cream occurred, it was discontinued for 7 days. All patients who used the cream 1 to 3 times a day experienced complete resolution of skin rashes, confirmed histologically. When using the cream 2 times a week, complete skin cleansing was observed in 60% of patients. Among patients who applied Imiquimod only once a week, 50% of patients achieved complete remission. The course of treatment in the group applying the cream 2 times a day lasted 10 weeks, in those applying the cream once a day - 13 weeks, and in those applying the cream three times a week - 14.5 weeks.

Key points

• Imiquimod 5% cream was found to be effective in the treatment of small superficial skin tumors up to 2 cm in diameter, as demonstrated by several controlled studies and one systematic review. Imiquimod has also been tested in case series of large superficial basal cell carcinomas larger than 2 cm with good results. A favorable outcome of several cases of basal cell carcinoma after application of 5% Imiquimod was observed in Gorlin syndrome and xeroderma pigmentosum. However, although imiquimod has been used in basal cell carcinomas, it may only be useful as a treatment modality for selected low-risk primary lesions. Surgical techniques such as Mohs micrographic surgery continue to be the gold standard with excellent treatment outcomes.

Nodular basal cell carcinoma

Imiquimod 5% cream can be used as an alternative in patients with small nodular basal cell carcinoma in which surgery is not the first-line treatment. Phase II clinical trials demonstrating the effectiveness of imiquimod in nodular basal cell carcinoma have been completed in a 6-week study in Australia and New Zealand and a 12-week study in the United States. After 6 weeks of treatment, complete, histologically confirmed cure was achieved by 71% of patients who used the cream daily once a day and 76% of patients who used the cream with the same frequency for 12 weeks.

Sclerodermaform basal cell carcinoma

The literature describes a case of successful treatment of sclerodermaform basal cell carcinoma. The use of 5% Imiquimod cream 3 times a week for 16 weeks resulted in complete, histologically confirmed, disappearance of the tumor with the preservation of scar tissue at the site of the tumor. There was no relapse observed over the next 9 months.

Squamous cell carcinoma in situ or Bowen's disease

Squamous cell carcinoma in situ (in situ) can occur on the skin and mucous membranes. Of particular importance is the involvement of the mucous membranes of the genital organs in Bowen's disease. These lesions are usually associated with human papillomavirus, in particular type 16, which is able to suppress the activity of the tumor suppressor proteins p53 and Rb.

New properties of Imiquimod in Bowen's disease with genital localization

When squamous cell carcinoma is localized in the vulvar and anal region, Imiquimod, in addition to its antitumor effects, showed antiviral activity against HPV and, therefore, this action may potentiate the antitumor effect of Imiquimod in this tumor, because Elimination of HPV is a prerequisite for pharmacological therapeutic efficacy.

Main features of the use of Imiquimod for squamous cell carcinoma in situ

Invasive squamous cell carcinoma

Imiquimod 5% cream has been shown to be effective even against invasive squamous cell carcinoma. An additional novel mechanism of action of imiquimod in invasive squamous cell carcinoma is through the antiapoptotic regulator A20, thereby stimulating nuclear transcription factor-Kappa signaling pathways in keratinocytes, ultimately leading to apoptosis and tumor regression. Two kidney transplant patients with invasive squamous cell carcinoma of the skin due to immunodeficiency were treated with Imiquimod 3 times a week for 12 weeks (the first patient) and Imiquimod 3 times a week for 5 weeks and then twice a week for another 7 weeks (the second patient). patient). Follow-up 6 and 8 months (respectively) revealed no evidence of tumor.

Lentigo maligna

Lentigo maligna is an in-situ melanoma. Progression of lentigo maligna to invasive melanoma occurs slowly due to sluggish peripheral growth and is observed in 5 The first report described the successful treatment of lentigo maligna on the scalp in an elderly patient who refused surgical treatment. Treatment was carried out for 7 months and ended in complete clinical and histological remission, without relapses in the subsequent 9 months of observation. In another study, 53-75% of treated patients achieved cure. However, the main limitation for most of these studies was the insufficiently long follow-up period, not exceeding 1 year, which is insufficient in the extremely slow radial growth phase of lentigo maligna.

Basic moments

1. Lentigo maligna requires long-term treatment with Imiquimod
2. It can be combined with destructive methods such as CO 2 laser
3. Even after the lesion has disappeared histologically, it is recommended to continue using Imiquimod for a year.

Metastatic melanoma

Several recent published studies have shown that imiquimod may have promise in the treatment of metastatic melanoma. Imiquimod was first used in a patient with a breast tumor that was too large for surgery or radiation therapy. Imiquimod was applied 3 times a week in combination with systemic dacarbazine. After 12 weeks, lesions treated with Imiquimod were completely resolved. Histological examination after 18 weeks revealed apoptotic melanocytes surrounded by a dense lymphocytic infiltrate.

Recent Postulates on the Role of Imiquimod in the Treatment of Metastatic Melanoma

Recently, the role of imiquimod in suppressing melanoma has been further developed. Imiquimod activates TLR7, stimulating dendritic cells, plasma cells, which accumulate in the tumor and sentinel lymph nodes, where they produce tumor necrosis factor associated with apoptosis-inducing ligands, granzymes, lysozyme, interferon-alpha and other angiogenesis inhibitors. Vascular endothelial growth factor is considered a known angiogenic factor in melanoma, promoting tumor growth. When these substances are released under the influence of Imiquimod, tumor vascularization processes are blocked, and with them tumor growth.

Basic provisions

1. Metastatic melanoma requires long-term treatment with imiquimod
2. Imiquimod may be used together with other therapies such as radiation therapy and CO 2 laser
3. Although imiquimod is able to eliminate cutaneous metastases of melanoma, it is not able to prevent lymphatic spread of the tumor.

Mycosis fungoides

Imiquimod was effective in mycosis fungoides, especially in the treatment of its early forms, which may be due to the ability of Imiquimod to induce the production of interferon-alpha and cytokines.

Key points

1. For mycosis fungoides, imiquimod is an alternative treatment for localized plaques that are resistant to conventional treatments.
2. Duration of treatment ranges from 4 months to 2 years
3. In persistent cases, Imiquimod can be combined with systemic interferons.

Keratoacanthoma

Keratoacanthoma was successfully treated with Imiquimod administered daily for 4 to 12 weeks. Clinical regression was observed after 4-6 weeks. There were no relapses during the 4-6 month follow-up period.

Extramammary Paget's disease

Extramammillary Paget's disease is a clinical condition that histologically mimics Paget's disease of the breast and is clinically characterized by weeping, eczematous and erythematous plaques. The effect of Imiquimod in this pathology is due to its immunomodulatory effect, stimulating the synthesis of proinflammatory cytokines and the induction of apoptosis of malignant cells. In a retrospective study, imiquimod was shown to promote clinical remission at disease onset as well as during relapses. Of the 29 cases of Paget's disease in the vulva, clinical resolution was achieved in 50% of patients with primary disease and in 73% of patients with recurrent disease. In some cases of extramamillary Paget's disease, imiquimod is not able to lead to complete resolution of the lesions. However, even partial reduction in the size of the lesions is beneficial for both the patient and the treating physician because once the lesions are reduced in size, a more gentle surgical approach can be used, resulting in a better cosmetic and functional outcome.

Infantile hemangioma

The effect of Imiquimod here is due to its antiangiogenic properties. A separate study demonstrated the effectiveness of 5% Imiquimod in superficial infantile hemangioma.

Merkel cell carcinoma

Merkel cell carcinoma is a rare neuroendocrine tumor with high malignant potential. We have reported a case of achieving complete remission in Merkel cell carcinoma after using 5% Imiquimod in combination with radiation therapy.

Kaposi's sarcoma

Kaposi's sarcoma is a vascular tumor characterized by reddish-brown nodules and papules. Imiquimod acts by activating cytokines that block angiogenesis, suppress proangiogenic factors, and induce apoptosis in endothelial cells. A successful treatment outcome using Imiquimod 5% cream was reported in an 87-year-old man with extensive Kaposi's sarcoma of both lower extremities. A successful outcome was described in another patient after using 5% Imiquimod cream 3 times a week for localized Kaposi's sarcoma under occlusion for 8 hours after a 3-month course. In localized forms of Kaposi's sarcoma, Imiquimod can be used as monotherapy.

Skin metastases in breast carcinoma

Breast cancer is a frequently diagnosed malignant tumor in women with an increased potential for cutaneous metastasis. The exact mechanism of imiquimod in breast cancer is unknown. However, it has been suggested that by binding to TLR7, imiquimod stimulates dendritic cells and macrophages to release cytokines that accelerate tumor cell apoptosis. Adams and Dr. Devan et al indicated the effectiveness of imiquimod in the treatment of skin metastases in breast cancer. Henriques and further substantiated the positive role of Imiquimod in metastatic breast cancer. Imiquimod was used 3 times a week in combination with chemotherapy, which resulted in a decrease in lesion thickness and pain.

Side effects

The most common side effects of Imiquimod are itching, burning, pain and tenderness at the application site. Other local reactions include erythema, erosions, desquamation, crusting and vesicles. Less common side effects include hypopigmentation, hyperkeratosis, rhinitis, upper respiratory tract infections, myalgia and headache. Fatigue, dyspepsia, alopecia, chills, diarrhea, fever and angioedema have been rarely reported.

conclusions

Imiquimod 5% cream has demonstrated effectiveness in a variety of skin cancer conditions. Unfortunately, the effectiveness of imiquimod has primarily been studied in the form of case reports or small open-label studies. There are very few double-blind crossover studies. There is a need for larger, multicenter studies that would better assist clinicians in successfully utilizing the immune modifier activity of Imiquimod in a variety of dermatological conditions.

be careful

The presence of papillomas, warts, condylomas, moles and spines on the body is the first sign of malignant melanoma!

We hasten to warn you that most medications “treat” warts, papillomas, moles, etc. - this is a complete deception of marketers who make hundreds of percentage points on drugs whose effectiveness is zero. They do not cure the disease, but only mask the symptoms.

The pharmacy mafia makes huge money by deceiving sick people.

But what to do? How to treat if there is deception everywhere? Doctor of Medical Sciences Anatoly Makhson conducted his own investigation and found a way out of this situation. In this article, the Doctor also told how to 100% protect yourself from melanoma, for only 149 rubles! Read the article in the official source via the link.

Aldara cream reviews

Let's see what patients and doctors say about the drug.

The diagnosis of papillomavirus was an unexpected moment in my life for me, since I lead a healthy lifestyle. As it turned out, the way HPV entered my body was through the birth canal. Multiple rashes of small growths on my neck affected my appearance. A visit to a dermatologist helped diagnose the disease and help develop a treatment regimen. I have been using Aldara cream for more than a month. The number of growths has decreased. In some places the changes have become noticeable. There is no need to doubt the effect, everything that is written is true. Irina, 28 years old, Moscow.

Before using the cream, Aldara did not listen to doctors’ recommendations and used traditional methods. For some time now I have reconsidered my views and admit that modern medicines can work miracles. Aldara cream helped me get rid of warts caused by HPV, which I could not do with my grandmother's methods. I recommend it to others for use. Leonid, 42 years old, St. Petersburg.

Treatment of patients with papillomatosis has long ceased to be a rarity. Practical and theoretical observations have shown the achievement of high effectiveness in getting rid of papillomas and warts with Aldara cream. You shouldn't expect quick results. Treatment of the disease requires patience, perseverance and adherence to the patient's regimen. Only then does the drug show its 100% effectiveness. Melnikov Ivan Petrovich, dermatologist, Yelets.

If you have been diagnosed with HPV, you should not self-medicate. Going to a specialist for help will help solve problems in the shortest possible time. An example of this is Aldara’s papillomas cream, which helps speed up the healing process. By accessing the services of our website, you will have the opportunity to fully familiarize yourself with the symptoms of the disease and its treatment.

This video talks about the composition and purpose of the cream, so if anything is unclear, watch it now:

Aldara, 5%, cream for external use, 250 mg, 12 pcs.

Aldara cream is applied only to the affected areas.

Avoid contact of the cream with the mucous membranes and contact of the cream with the eyes. If the cream gets into your eyes, it is recommended to rinse them with water.

Aldara cream is used before bedtime. Using an excess amount of cream or longer contact of the cream with the skin may cause a severe local reaction.

Reuse of an opened bag is not allowed.

You should wash your hands thoroughly before and after applying the cream.

Uncircumcised men who are treating genital warts located under the foreskin should wash the affected area daily by retracting the foreskin. It is recommended to immediately stop treatment if early signs of phimosis are detected.

If a local reaction to the drug causes serious discomfort for the patient, or if an infectious process develops in the area where the cream was applied, it is allowed to take a break from treatment for several days. If an infection develops, the necessary measures are taken.

Aldara cream can cause exacerbation of inflammatory skin diseases.

It is not recommended to use Aldara cream until the skin has healed after other types of medical or surgical treatment.

You should not start treatment with Aldara cream on areas with open ulcers or wounds until they have healed.

The fillers methyl parahydroxybenzoate, propyl parahydroxybenzoate, cetyl alcohol and stearyl alcohol may cause an allergic reaction. If a hypersensitivity reaction is detected, it is recommended to discontinue therapy.

It is not recommended to use an occlusive dressing during treatment with Aldara.

Use of imiquimod in doses higher than recommended may result in an increased risk of severe local reactions.

During the period of use of Aldara cream, exposure to sunlight (including sunlight lamps) should be avoided or minimized, as there is a risk of sunburn.

Since imiquimod does not have a direct antiviral and cytotoxic effect, after therapy, new condylomas of the genital and perianal areas may appear.

Based on current knowledge, treatment of urethral, ​​intravaginal, cervical, rectal or intraanal genital warts with Aldara cream is not recommended.

Before sexual intercourse, Aldara cream should be washed off the surface of the skin.

Aldara Cream may reduce the effectiveness of a condom or vaginal diaphragm, so it is not recommended to use these contraceptives while using Aldara Cream. An alternative method of contraception should be chosen.

In patients with immunodeficiency, it is not recommended to reuse Aldara cream.

Impact on the ability to drive vehicles and operate machinery

Studies of the effect of the drug on the ability to drive a car and operate machinery have not been conducted.