Cytodestructive or surgical
therapy for patients with anogenital
warts is frequently associated with recurrence. In February 1997, the US Food and Drug Administration approved
imiquimod as a 5% cream for the treatment of anogenital
warts. Activity of the
drug results primarily from
interferon alfa and other
cytokine induction in the skin. These
cytokines stimulate several other aspects of the innate immune response. In addition,
imiquimod stimulates acquired immunity, in particular the cellular arm that is important for control of
viral infections and
tumors. Published studies indicate that
imiquimod results in complete clearance of
warts in more than 50% of patients. Residual
warts can be surgically excised. Our long-term follow-up (ie, 2 to 7 years) of patients who had a 16-week course of
imiquimod cream with subsequent removal of remaining
warts showed a much lower rate of recurrence in comparison with those patients who were treated with surgery alone. Therefore, treatment with
imiquimod followed by excision of residual lesions may provide long-term clearance of anogenital
warts in those patients in whom
imiquimod monotherapy is insufficient.