Vulval Intraepithelial Neoplasia (VIN)
Date issued: May 2025
For review: May 2027
Ref: B-534/HF/Gynae/Vulval Intraepithelial Neoplasia (VIN)
PDF: Vulval Intraepithelial Neoplasia (VIN).pdf [pdf] 212KB
Treatment of Vulval Intraepithelial Neoplasia (VIN) with Imiquimod (Aldara™)
You have been prescribed Imiquimod (Aldara™) cream to treat your Vulval Intraepithelial Neoplasia (VIN).
VIN means that there are some abnormal cells in the skin of your vulva.
These cells ARE NOT cancer, but in a small number of women they may develop into cancer over many years.
What is imiquimod cream and what will it do?
We hope that the use of this cream will result in the clearance of your abnormal cells or a reduction in the size of the lesion or its severity. You should use it three times a week over twelve weeks.
We know from extensive research that many cases of VIN are caused by some strains of the Human Papillomavirus (HPV) which is a very common virus that lives on the skin. These cells may develop in to cancer in a very small number of cases. Instead of cutting away the area of tissue, we can use Imiquimod cream. It is an immune response modifier, which means that it stimulates your immune system to fight the HPV infection and reverse the changes to the cells caused by HPV.
Imiquimod is already used in conditions with similar factors to VIN - on genital warts which are caused by a different type of HPV, and for the treatment of common sun induced skin lesions. Research suggests imiquimod may be effective in the treatment of VIN.
Imiquimod stimulates an immune system reaction at the site of application this is often in the form of inflammation (redness and swelling) of the skin. The area can be itchy and sore due to the abnormal cells dying and is a sign the treatment is working. The more red and sore the area becomes, the greater the immune response. However, the degree of inflammation will vary from person to person. So do not think that the cream is not working because you have little or no response.
What can I expect?
Imiquimod is not a simple treatment to use because it causes inflammation, but can provide good results. You are very likely to get some reactions during the course of the treatment. The skin may weep, peel, crack or even blister and then scab over. The area may be itchy or sore, painful and burn.
All symptoms decline in severity with less frequent use and so we recommend you reduce applications or take treatment breaks if the reaction becomes too much.
A few women also complain of ‘flu’ like symptoms such as headache, fatigue and occasionally diarrhoea. These symptoms clear when treatment is stopped.
How do I use Imiquimod?
We recommend the cream is used three times a week, overnight and washed off in the morning. You can start by using the cream for an hour or two at a time and build up your exposure gradually.
The skin reaction tends to be worst in week 2 to 3 of application. For most people, the more sore and red the skin becomes, the better the treatment works. It is normal for redness and some crusting to persist for around 2 weeks after the treatment course has finished. If it is very uncomfortable after the first use, wait until the symptoms ease before using it again. Be guided by how severely you react.
If you can manage overnight, three times a week, do so, but if not use it as often and for as long as you can manage. If the skin or general reaction becomes too severe to tolerate, it is helpful to stop the cream for a week or so before restarting it again once the skin is more comfortable
Squeeze imiquimod onto your fingertip. Use a mirror to identify the area to be treated. Rub in the cream gently until it has vanished. Use just enough to cover the area, this is unlikely be the whole sachet. You may use the remaining contents of the sachet on the next application as long as you seal the sachet to prevent it drying out.
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Wash your hands after using Imiquimod.
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DO NOT have sex on the night you use the cream.
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DO NOT take by mouth or allow the cream to come into contact with your eyes.
As imiquimod works with your immune system it can take time to work.
Try and persevere. The following tips may help you:
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Paracetamol based pain killers will help with mild symptoms. However, do not take anti-inflammatory medication such as aspirin or Ibuprofen as it will reduce the effect.
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You can use a moisturiser such as Hydromol or Diprobase in between Imiquimod treatments. Keep a tub in the fridge and apply cold to soothe any irritation.
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Maintain the usual care for vulval skin, for example, don’t use perfumed soap or wash underwear in biological powder, wear loose cotton underwear.
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Stop using Imiquimod if your reaction is severe and you are unable to tolerate it. Contact the colposcopy clinic on the number below
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If you need to visit your GP for any reason, do remind them of your treatment.
Contact details
Colposcopy
University Hospitals Plymouth NHS Trust
Lancaster Suite
Level 6
Plymouth
PL6 8DH
01752 245211
