Self-administered topical 5% imiquimod cream for external anogenital warts in adolescent girls

Abstract Objective: To evaluate the safety and effectiveness of 5% Imiquimod cream in the treatment of external anogenital warts in adolescent girls. Methods: This was a nonrandomized trial in adolescent girls referred for external warts. All patients were treated with 5% Imiquimod cream every 3 days, and follow-up appointments were made on a monthly basis. Results were based on intent to treat and 50% clearance as end points. Results: Forty-two patients ages 11–18 from 5 different referral sources were treated. Six patients were HIV positive, but all had CD4 counts greater than 500. Twenty-seven patients (64%) had lesions totaling 3 , 13 (31%) had lesion 5–10 cm 3 , and 2 patients had lesions totaling > 10 cm 3 . Thirty-three (78.6%) had complete clearance, and 40 (95%) had > 50% reduction in size. Median time to clearance was 6.5 weeks. Only 14 of 42 (33%) kept all appointments; 16 of 42 were seen only twice, and 8 never returned after treatment but were contacted by phone or letter. Thirty-one (74%) had mild erythema, 6 (14%) had moderate irritation, and none discontinued treatment based on side effects. Conclusion: Imiquimod 5% is very effective in female adolescent patients and has a faster clearance time than in adult females. Clearance rates are comparable to those of adult females. Side effects are mild to moderate and did not interfere with treatment schedules. Adolescents have very poor compliance rates for clinic appointments, but clearance rates were excellent and the drug was well tolerated.