From the Guidelines
The recommended treatment dose for Bowen's disease with Aldara (imiquimod 5% cream) is typically application three times a week for 4 weeks, which can be repeated for a further 4 weeks if needed, as supported by the British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 2017 1.
Treatment Overview
The treatment should be applied at night and washed off in the morning 8 hours later. A thin layer should be applied to cover the lesion and a small margin of surrounding skin, allowing it to dry before covering with clothing. Patients should wash their hands thoroughly before and after application.
Efficacy and Safety
Imiquimod works by stimulating the local immune response to destroy abnormal cells through activation of toll-like receptors and production of cytokines. Common side effects include local skin reactions such as redness, swelling, erosion, and scabbing, which indicate an appropriate immune response. If severe irritation occurs, treatment may be temporarily suspended for a few days until the reaction subsides.
Follow-up and Evaluation
Complete healing may take several weeks after treatment completion, and follow-up examinations are important to confirm clearance of the disease. Treatment response should be evaluated regularly, and therapy may be extended if complete clearance is not achieved but improvement is observed.
Key Considerations
- Imiquimod is a topical immune-response modifier, available as a 5% and a 3.75% cream, with most data on treatment response pertaining to the 5% cream 1.
- A meta-analysis of the use of imiquimod 5% cream demonstrated a 50% complete clearance rate 1.
- The British Association of Dermatologists' guidelines for the management of Bowen's disease suggest imiquimod as a treatment option, with a strength of recommendation B and quality of evidence I 1.
From the Research
Treatment Dose for Bowen's Disease with Aldara
- The treatment dose for Bowen's disease with Aldara (imiquimod) is typically 5% cream applied once daily, 5 times a week, for a maximum of 16 weeks 2, 3.
- In one study, patients applied imiquimod 5% cream once daily for 16 weeks, with 93% of patients showing no residual tumor present in their 6-week posttreatment biopsy specimens 2.
- Another study found that 80% of Bowen's disease lesions showed complete clinicopathologic regression after 8 to 12 weeks of treatment with imiquimod 5% cream 3.
- The dosing schedule and length of treatment for Bowen's disease require further evaluation, as some patients ceased treatment early due to local skin reactions 2.
Combination Therapy
- Combination therapy using topical photodynamic therapy followed by topical 5% imiquimod cream has been shown to be effective in treating large Bowen's disease lesions 4, 5.
- One study found that complete responses were achieved in 84% of lesions after 3 months of treatment with photodynamic therapy, and 70% of lesions after 18 months 5.
- Patients who presented a partial response or recurrence were treated with topical 5% imiquimod and achieved complete responses 5.
Efficacy and Tolerability
- Imiquimod 5% cream has been shown to be an effective treatment for Bowen's disease, with 93% of patients showing no residual tumor present in their 6-week posttreatment biopsy specimens 2.
- Photodynamic therapy has also been shown to be an effective treatment option for extensive Bowen's disease, with 90% of lesions showing complete clinical response after 12 weeks of treatment 6.
- The treatment has few adverse effects and shows satisfactory results, particularly in multiple large lesions in areas of difficult surgical reconstruction or in elderly patients with a high surgical risk 5.