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Imiquimod (Aldara[R]): modifying the immune response. (Pharmacology Review).

Publication: Dermatology Nursing
Publication Date: 01-AUG-02
Format: Online - approximately 2444 words
Delivery: Immediate Online Access

Article Excerpt
Immune response modifiers are the new wave in topical dermatologic pharmacology. One of these new agents is imiquimod which was approved by the FDA in 1997 for treating genital and perianal human papilloma virus (HPV) infections. Imiquimod is an immunomodulating agent that enhances the of the...

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...ability immune system's antiviral and antitumor activity. Because of this ability, imiquimod may have wide use in treating a variety of benign, premalignant, and malignant conditions. Clinical investigation is currently being conducted with imiquimod in the treatment of common warts (nongenital HPV infection), molluscum contagiosum, basal cell carcinoma, Bowen's disease, actinic keratoses, and herpes simplex infection. In addition, the use of imiquimod in alopecia areata and vitiligo is being discussed.

How Does Imiquimod Work?

The exact mechanism of action of imiquimod is not fully defined. It does not exhibit direct antiviral activity; however, imiquimod is a potent inducer of cytokines within the keratinocytes to both slow down viral replication and enhance the cell-mediated immunity (Dahl, 2000; Sander, 2000). Cytokines, including interferons, are proteins produced in cells such as keratinocytes and are part of the innate immune response. Through stimulation of these cytokines within the immune system, imiquimod helps infected cells and their neighbors slow down viral replication within the cell and limit the spread until a specific cell-mediated immune response can be induced and eventually eliminate the virus.

Viral infections of the epidermis pose problems for the body's immune system defense. Warts and molluscum sit high in the epidermis and are insulated from cells of the immune system that roam in the dermis below. So the immune system has little exposure to the virus and, therefore, has difficulty mounting a specific immune response. This allows the infection to thrive and not be affected by cell-mediated immunity. In addition to stimulating cytokines, imiquimod breaks down the communication barriers between the viral-infected cells of the epidermis and the immune system so that the body can better fend off these viruses. Imiquimod appears to activate and enhance the migration of Langerhans' cells to the lymph nodes for presentation of antigens to T lymphocytes. This presentation activates the cutaneous immune response. The local reaction of erythema is an indication that imiquimod is having...

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