Topical Imiquimod 5% cream therapy for external anogenital warts in pregnant women: report of four cases and review of the literature.

Imiquimod 5% cream (Aldara, Meda Farm, Milan, Italy) is largely used for the treatment of anogenital warts. However, its use during pregnancy is not consolidated with only a small number of patients worldwide that have been treated. The aim of this study is to assess the first line therapeutic efficacy and safety of Imiquimod 5% cream in pregnant women with external anogenital warts, including extensive condylomata. Four pregnant women's with external anogenital warts were treated with Imiquimod 5% cream, three times a week for four weeks. Mean number of warts treated per patient was 4.5 (5 SD) and mean area treated was 3.2 cm(2) (1.7 SD). A complete response was observed in two women, while two women had a partial response with a rate of clearing of 70% and 84% respectively. No cases of severe adverse local effects were observed in the sites of Imiquimod application. No adverse fetal outcomes or fetal and neonatal abnormalities were observed. No complications were observed in the postpartum and follow-up period. Anogenital warts treatment with Imiquimod in pregnancy seems to be promising and not compromise a good pregnancy outcome, in extensive condylomata too. These preliminary data need to be confirmed by larger studies. Similarly, no definitive conclusion may be obtained form a systematic review of the English literature.