Imiquimod is a new non-nucleoside heterocyclic amine compound with the chemical name of 1-(2-methylpropyl)-4-amino-1H-imiquino[4,5-C]quinoline. 5% imiquimod cream was the first topical immunomodulatory drug approved by the FDA in 1997 for the treatment of genital warts and is manufactured by 3M Pharmaceuticals, Inc. The domestic imiquimod cream is known as Minxin Liddi Cream. As a new topical immunomodulator, Imiquimod is effective, safe to use and has a low recurrence rate in the treatment of condyloma acuminata. Imiquimod also has anti-herpes virus and treatment of certain skin tumors, and the indications are expanding. It has also been used to treat infantile hemangiomas with some success. Imiquimod is only available in a 5% cream (ointment) formulation containing 50 mg of imiquimod per gram of ointment. The use of imiquimod in the treatment of infantile hemangiomas was first reported by Martinez MI in Annals of Dermatology, Vol. 7, 2002 [Martinez MI, Sanchez-Carpintero I, North PE, Mihm MC Jr. Clinica las Americas, San Juan de Puerto Rico. Infantile hemangioma: clinical resolution with 5% imiquimod cream. Arch Dermatol. 2002 Jul;138(7):881- 4; discussion 884.]; followed by Hazen et al. in the journal Pediatric Dermatology [Hazen PG, Carney JF, Engstrom CW, Turgeon KL, Reep MD, Tanphaichitr A. Department of Dermatology, Case-Western Reserve University School of Medicine, Cleveland, Ohio, USA. [email protected]. Proliferating hemangioma of infancy: Successful treatment with topical 5% imiquimod cream. Pediatr Dermatol. 2005 May-Jun;22(3):254-6.]. The efficacy and precautions of imiquimod in the treatment of infantile hemangiomas were also reported by physicians from Spain and Canada at the 16th ISSVA academic meeting held in Milan in July this year. From the small number of clinical applications reported so far, imiquimod cream appears to be a safe and effective therapy for rapidly enlarging proliferating proliferating hemangioma. Topical imiquimod cream appears to be a safe and effective therapy for rapidly enlarging proliferating proliferating hemangioma, especially for small and medium-sized hemangiomas in hidden areas of the body. The main advantages are easy and controlled administration, no local irritation and no systemic adverse effects. The drug is applied once every other day, and the hemangioma disappears completely after 3-5 months of treatment, and is well tolerated by patients. 1. Pharmacological effects Imiquimod can enhance cellular immune activity, induce inflammatory response and production of various cytokines locally, and exert indirect antiviral effects through immunomodulation. Imiquimod can effectively induce a variety of cytokines including α-Interferon (IFN-α) and α-Tumor Necrosis Factor (TNF-α) in vitro and in vivo. In cellular assays, imiquimod induced the production of IFN-α, TNF-α, IL-1α, IL-1β, IL-6, 8, IL-10, GM-CSF, MCP-1α (monocyte chemotactic protein-1α), MCP-1β and other cytokines in human peripheral monocytes. The concentrations of IFN-α and TNF-α in the skin peaked after 1 h of topical application of imiquimod cream (0. 05 μg/ cm2 ). Two metabolites of imiquimod, S-26704 and S-22770, have similar immune activity. hpv can enter the body through small abrasions on the skin surface, and after a period of incubation (usually 3-8 weeks) warts are formed. small amounts of imiquimod can penetrate the skin surface and induce the production of interferon. Through interferon, an active antiviral factor, HPV virus proliferation is restricted and HPV-infected keratinocyte proliferation is inhibited. The cytokines induced by imiquimod induce monocyte nuclei and other leukocytes to converge towards the wart tissue. activated dendritic cells process the HPV antigen and present it to the lymph nodes, where HPV-specific T lymphocytes are activated and released into the blood. HPV-specific T lymphocytes enter the wart and kill HPV-infected cells, while monocytes and macrophages further engulf the cellular debris. By establishing the immune memory of HPV-specific T lymphocytes, it can rapidly treat any type of HPV infection and then significantly reduce the recurrence rate of condyloma acuminatum. 2. In vitro and in vivo experiments Imiquimod cream was administered at a maximum concentration of 18.3% at 110g/kg and the toxicity test was carried out in rabbits for 1 week. In addition, animal tests have demonstrated that imiquimod has no carcinogenic, mutagenic or teratogenic toxic effects. The skin tolerance test showed that imiquimod was not irritating to normal human skin. The absorption of imiquimod was found to be minimal in 7 patients who applied it by radiolabeling technique, and no drug was detected in the serum after application, and only 2% was measured in urine and feces. Pharmacokinetics A single topical administration of 5 mg of 14C-labeled imiquimod cream to 6 healthy subjects showed that 14C-labeled imiquimod was minimally reabsorbed percutaneously. No radioactive material was detected in serum (minimum detection limit: 1 μg/mL) and the amount of radioactive material in urine and feces was less than 0.9% of the radiolabeled amount when topical imiquimod was applied. 4, adverse reactions 5% imiquimod cream in the treatment of no systemic adverse reactions, no interferon fever, flu-like symptoms and other systemic adverse reactions, will not damage the skin tissue. However, in the mucous membrane and semi-mucous membrane areas, the tissue is tender and thus there is some mild to moderate irritation. The most common are erythema, which accounts for about 61%, vesicles, which accounts for about 30%, desquamation, which accounts for about 23%, and edema, which accounts for about 14%. Local irritation inflammatory reaction often occurs in the second to fifth week, mostly mild or moderate, with a short duration of about 4-12 d. Generally, the irritation disappears after 7-12 d of drug withdrawal. Some subjective symptoms may also occur, such as pruritus, which accounts for about 22%, burning, which accounts for about 13%, and pain and tenderness, which accounts for about 5%.