We studied the usefulness of imiquimod cream in the treatment of 3 patients with actinic keratoses. One patient was treated 3 times per week for 4 weeks and had a marked inflammatory response with nearly complete resolution of actinic keratoses. Two subsequent patients were treated in a bilateral paired comparison study. Both patients had similar numbers of actinic keratoses on symmetric areas and treated only one side with imiquimod cream 2 to 3 times per week with frequent rest periods to avoid inflammation. Both experienced marked reductions in actinic keratoses. After 8 weeks, both patients applied imiquimod cream twice per week for 9 months with continued reduction in actinic keratoses on both sides. Treatments were well tolerated. Imiquimod cream appears to be effective in the treatment of actinic keratoses. The main adverse effect is local inflammation, which can be avoided by reducing the frequency of application. (J Am Acad Dermatol 2002;47:S236-9.)