Efficacy of Imiquimod 5% Cream in the Treatment of Recalcitrant Warts in Children

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Abstract
Long‐lasting cutaneous warts are a therapeutic challenge, especially widespread or symptomatic recalcitrant warts in children. It can be speculated that natural immunity to these human papillomavirus (HPV)‐ induced lesions is extremely poor. Therefore ideally treatment should focus on increasing local immune response. Recently imiquimod, a topical immune modifier, has been successfully used in the treatment of external genital warts. Our purpose is to report on our experiences with imiquimod 5% cream applied to therapy‐resistant, long‐lasting (duration 2–7 years) common warts in children. In 18 children, imiquimod cream was self‐applied by the patients or by their parents to the warts twice a day. Assessment for response and occurrence of adverse effects was performed every 4 weeks until clinical cure. Follow‐ups could be arranged in 14 of the 18 patients 1–2 years after total clearance. Sixteen of 18 patients experienced total clearance of their warts; 2 showed partial improvement but were lost to follow‐up. The mean duration of treatment was 5.8 months. Two of the 14 patients in whom a follow‐up was performed showed a small number of new warts after a period of at least 1 year without recurrence. Our data demonstrate that the topical application of imiquimod 5% cream is an effective treatment for long‐lasting cutaneous warts in children.