Zyclara Cream: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Zyclara Cream (imiquimod) is a prescription topical medicine that works with your immune system to treat actinic keratosis on the face or balding scalp in adults, and external genital and perianal warts in people 12 and older when using the 3.75% strength. It comes in 2.5% and 3.75% strengths and is applied directly to the skin following a specific schedule. It can cause local skin reactions and other side effects, so it should be used exactly as prescribed.

What is Zyclara Cream

Zyclara is a prescription cream that changes how your immune system works to treat certain skin conditions. It comes in 2.5% and 3.75% strengths.

Zyclara Cream uses

• Treats actinic keratosis (a skin condition caused by too much sun exposure) on the face or balding scalp of adults over 18
• Treats external genital and perianal warts in people 12 years and older (Zyclara 3.75% only)

Benefits of Zyclara Cream

• In studies, about 36% of people using Zyclara 3.75% had their actinic keratosis completely cleared, compared to about 6% of people using a placebo cream
• In studies of genital warts, about 27-29% of people using Zyclara 3.75% had all warts clear within 16 weeks, compared to about 9-10% of people using placebo
• Has a simpler dosing schedule than some other similar treatments, which may make it easier to stick with

How Zyclara Cream works

Zyclara works by activating your immune system where it's applied on the skin. It causes the release of natural substances called cytokines, including interferon, which help the body clear away abnormal skin cells.

Zyclara Cream dosage

Use exactly as your doctor prescribes and follow the instructions that come with your medicine. This medicine is for use on the skin only — do not swallow it or use it near your eyes, mouth, nose, anus, or vagina. Wash your hands before and after applying the cream.

Wash the area to be treated with mild soap and water and let it dry before applying. Apply a thin layer and rub it in completely until you can't see the cream anymore. Apply once a day before bedtime and leave it on overnight, then wash it off in the morning. Do not cover the treated area with plastic bandages; cotton gauze or cotton underwear can be used instead.

For actinic keratosis: apply daily for two weeks, then take a two-week break, then apply again for two weeks. For genital warts: apply daily until the warts clear or for up to a set number of weeks as directed by your doctor.

Uncircumcised men treating warts under the foreskin should pull back the foreskin and clean the area daily. Women treating genital warts should be careful when applying near the vaginal opening and avoid getting cream inside the vagina.

If you miss a dose, just apply your next dose at the regular time — do not use two doses at once. Keep using the medicine for the full length of time prescribed, even if your symptoms improve quickly. This medicine has not been shown to be safe and effective in children under 12 (for genital warts) or under 18 (for actinic keratosis).

Available forms and strengths

• Cream 2.5% in pump bottles
• Cream 3.75% in unit-dose packets and pump bottles

Side effects of Zyclara Cream

Common

• Skin redness, irritation, itching, dryness, flaking, scabbing, crusting, or swelling where applied
• Changes in skin color where applied (may be permanent)
• Headache
• Tiredness
• Nausea
• Diarrhea
• Loss of appetite
• Dizziness
• Chest pain
• Back pain
• Cold sores or fever blisters
• Cold symptoms such as stuffy nose, sneezing, or sore throat
• Vaginal itching or discharge

Serious

• Signs of an allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat
• Serious skin reactions: severe itching, burning, oozing, bleeding, or skin breakdown where the cream was applied
• Severe swelling around the vagina or trouble urinating
• Flu-like symptoms: fever, chills, nausea, tiredness, body aches, or swollen glands
• Bleeding or swelling where the cream was applied
• Signs of shingles: sores or blisters, itching, tingling, burning pain, or rash on the face or torso

Warnings and precautions

• Zyclara should only be used during pregnancy if your doctor prescribes it. It's not known if the medicine can harm an unborn baby.
• It's not known if Zyclara passes into breast milk. If you breastfeed while using this medicine, avoid letting your treated skin touch your baby's mouth or eyes.
• For external topical use only; do not swallow or use in the eyes, mouth, nose, vagina, or inside the anus. Avoid broken, irritated, burned, infected, or damaged skin.
• May cause strong local skin reactions, including redness, swelling, burning, itching, crusting, weeping, erosion, or ulceration. Severe reactions may require temporarily stopping treatment. Do not use other imiquimod products on the same treatment area unless specifically instructed.
• Avoid sexual contact while the cream is on genital or perianal skin. Zyclara may weaken condoms and vaginal diaphragms. In females, severe genital swelling can occur and may cause difficulty passing urine; stop treatment and seek medical advice if this occurs.
• May cause flu-like symptoms such as fever, chills, fatigue, nausea, muscle aches, or joint aches. Contact a healthcare professional if these are significant. Limit sunlight and tanning-bed exposure during treatment. Use sunscreen and protective clothing; do not apply to sunburned skin until healed.
• Tell your doctor if you have immune-system problems or chronic graft-versus-host disease, as Zyclara may worsen inflammatory skin conditions. If the skin was recently treated with another medicine or procedure, wait until it has healed before applying Zyclara. Discuss use with your healthcare professional before treatment if pregnant or breastfeeding, and during breastfeeding avoid applying it where the baby could contact or ingest the treated area.
• Using too much Zyclara or using it for too long increases the risk of severe skin reactions.
• Do not use Zyclara on broken, wounded, or burned skin — wait until it has healed first.
• Tell your doctor before use if you have a weak immune system, an autoimmune disorder, graft-versus-host disease, or have had a bone marrow or cord blood transplant.
• When treating genital warts around the vagina, avoid getting the cream on the sensitive inner vaginal tissue, as this can cause swelling, irritation, and painful urination.
• Avoid sunlight and tanning beds while using this medicine, since it can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher).
• Zyclara does not cure genital warts and does not stop you from spreading the condition to others through sexual contact. New warts may appear even during treatment.
• This medicine does not protect against sexually transmitted diseases such as chlamydia, gonorrhea, herpes, HIV, syphilis, and trichomoniasis.
• Avoid sexual activity while the cream is on your skin if treating the genital or rectal area — it can weaken condoms and diaphragms, which could lead to unplanned pregnancy if they break.
• Avoid using two different imiquimod products on the same area of skin, as this can raise the risk of side effects.
• Avoid swimming, bathing, or showering while the medicine is on your skin.

Storage

• Store at room temperature between 68°F to 77°F (20°C to 25°C)
• Store pump bottles upright
• Do not freeze
• Keep each packet unopened until you are ready to use it
• Safely throw away cream that is out of date, unused, or partially used
• Keep out of the reach of children

When to see a doctor

• Get emergency medical help right away if you have signs of an allergic reaction, such as hives, trouble breathing, or swelling of your face, lips, tongue, or throat.
• Wash off the cream and call your doctor right away if you have a serious skin reaction such as severe itching, burning, oozing, bleeding, or skin changes.
• Stop using Zyclara and call your doctor right away if you have severe swelling or trouble urinating when treating genital warts around the vagina.
• Call your doctor if you have flu-like symptoms such as fever, chills, nausea, tiredness, body aches, or swollen glands.
• Call your doctor if you have symptoms of shingles, such as sores or blisters, itching, tingling, burning pain, or a rash on your face or torso.
• Contact your doctor promptly if a skin reaction at the treatment site restricts your daily activities or makes it hard to keep using the cream.
• Seek emergency medical attention if you think you have taken too much of this medicine. Overdose symptoms may include severe skin irritation, feeling light-headed, or fainting.

Alternatives

• Imiquimod 5% cream
• Podofilox 0.5%
• Sinecatechins 15% ointment