Imiquimod is an immune response modifier with potent antiviral and antitumour activity. The objective of this pilot study was to evaluate the efficacy of an imiquimod 5% cream (Aldaratrade mark: 3M, Saint Paul, MN, USA) as a topical treatment for equine sarcoids. Fifteen horses with a total of 19 tumours were enrolled, including mixed (7), fibroblastic (5), flat (3), verrucous (2), and nodular (2) types. Baseline data included history, physical examination, tumour location, measurement and digital photography. Imiquimod was applied by the owners three times a week until complete resolution of the tumour or 32 weeks, whichever occurred first. Tumours were measured and photographed every 4 weeks. Treatment efficacy was defined as 75% or greater reduction of tumour size by the end of the trial. Four sarcoids were withdrawn from the study. Twelve of the remaining 15 tumours (80%) showed more than 75% reduction in size and nine (60%) totally resolved between 8 and 32 weeks. The most common adverse effects of exudation, erythema, erosions, depigmentation and alopecia were limited to the tumour and adjacent areas. The results suggest that topical imiquimod is a therapeutic option for the treatment of equine sarcoids, although more detailed studies are required to corroborate these initial findings.