Imiquimod and the related compound resiquimod are topical immune response modifiers that lack direct antiviral effects. Instead, these agents induce activation of immune cells (monocytes, macrophages, natural killer cells) to produce antiviral cytokines, particularly interferon-α and tumor necrosis factor-α. Topical imiquimod cream is approved for the treatment of anogenital warts ( Chapter 381 ). In immunocompetent patients, imiquimod leads to complete clearance of warts in 37 to 52% of patients. It may also be beneficial in patients with refractory cutaneous leishmaniasis ( Chapter 356 ) and for molluscum contagiosum ( Chapter 380 ). It is administered as a topical cream three times weekly for a maximum of 16 weeks and is washed off 6 to 10 hours after application.
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