From the Guidelines
Imiquimod 5% cream, also known as Aldara, is the recommended treatment for Bowen's disease, with a regimen of applying the cream to the affected area three times a week for 4 weeks, which can be repeated for a further 4 weeks if needed, as supported by a meta-analysis of five RCTs showing a 50% complete clearance rate 1. When treating Bowen's disease with Imiquimod, it is essential to consider the potential side effects, which are generally well tolerated but may include local skin reactions such as redness, swelling, erosion, and scabbing.
- The treatment regimen involves applying the 5% cream to the affected area at night and washing it off in the morning 8 hours later.
- The cream should be applied to clean, dry skin, and treatment areas should be limited to less than 25 cm² per application.
- Patients may experience local skin reactions, which are expected and indicate an immune response, and these reactions typically peak after 2-4 weeks of treatment.
- If severe reactions occur, a treatment break of several days may be necessary before resuming. The effectiveness of Imiquimod in treating Bowen's disease is supported by a head-to-head open trial between Imiquimod 5%, its cream vehicle, and diclofenac 3% gel, which showed complete clearance of 19% at the end of the respective treatment 1. Additionally, a three-armed RCT between cryosurgery, 5-FU 5%, and Imiquimod found that the proportions of the intention-to-treat population maintaining clearance at 12 months were 1%, 33%, and 76%, respectively, highlighting the long-term efficacy of Imiquimod in treating Bowen's disease 1.
From the Research
Treatment of Bowen's Disease with Aldara (Imiquimod)
- Imiquimod 5% cream has been used as a treatment option for Bowen's disease, with studies showing its efficacy in achieving complete clinicopathologic regression 2.
- A study published in 2006 found that 80% of Bowen's disease lesions treated with imiquimod 5% cream showed complete regression after 8 to 12 weeks of treatment 2.
- Another study published in 2003 used a cycle regimen of imiquimod 5% cream, applying it three times weekly for 3 weeks followed by a 4-week rest period, and found that both cases were clinically clear after a second cycle of therapy 3.
- However, a study published in 2022 found that imiquimod had a relatively high recurrence rate of 33.33% compared to other treatment modalities such as surgical excision and photodynamic therapy 4.
- The dosage and treatment duration of imiquimod 5% cream may vary depending on the individual case and the severity of the disease.
Comparison with Other Treatment Modalities
- Photodynamic therapy has been shown to be an effective treatment option for Bowen's disease, with a meta-analysis finding that it had a significantly higher complete response rate and less recurrence compared to other treatments such as cryotherapy and 5-fluorouracil 5.
- Surgical excision remains the gold standard for treating Bowen's disease, with a study published in 2022 finding that it had the highest clearance rate and the lowest recurrence rate 4.
- Imiquimod 5% cream may be considered as an alternative treatment option for patients who are unsuitable candidates for surgery or who have large or multiple lesions 2.