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Imiquimod

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1741. Characterization of the cellular infiltrate during successful topical treatment of lentigo maligna with imiquimod. (Abstract)

Characterization of the cellular infiltrate during successful topical treatment of lentigo maligna with imiquimod. Lentigo maligna (LM) is an in situ melanoma which usually occurs in sun-damaged skin on the head and neck of elderly patients. Depending on the anatomical site and its size treatment of LM can be problematic and usually includes surgical excision or radiotherapy. Recent reports indicate that topical imiquimod may be an effective treatment. However, no data on the underlying immune (...) response in the skin during treatment of LM with topical imiquimod are available so far. We report a 62-year-old caucasian woman with a histologically verified LM which was successfully treated with topical imiquimod 5% cream. Skin biopsy specimens were obtained before, during (at week 10) and 4 weeks after cessation of topical treatment with imiquimod 5% cream. Histological and immunohistochemical examination was performed in order to detect residual atypical melanocytes and to characterize

2004 British Journal of Dermatology

1742. Gene expression in actinic keratoses: pharmacological modulation by imiquimod. (Abstract)

Gene expression in actinic keratoses: pharmacological modulation by imiquimod. Actinic keratoses (AKs) are premalignant lesions that can progress into squamous cell carcinoma. Imiquimod, which belongs to the new class of immune-response modifiers, was recently shown to be effective in the treatment of AKs. The underlying mechanisms are not fully understood.To study the expression of individual genes in uninvolved skin and AKs before therapy and to elucidate the way in which the expression (...) of these genes is influenced by imiquimod therapy.We treated 13 patients with AK with imiquimod and compared gene expression before, during (five patients) and after (eight patients) therapy with that in uninvolved skin. We analysed genes coding for inflammatory cytokines or their receptors, adhesion molecules, anti-apoptotic proteins, p53 and toll-like receptors (TLRs) by reverse-transcriptase polymerase chain reaction.Comparing uninvolved skin and untreated AK, we found significant differences

2004 British Journal of Dermatology

1743. Primary cutaneous CD30+ T-cell lymphoma responsive to topical imiquimod (Aldara). (Abstract)

Primary cutaneous CD30+ T-cell lymphoma responsive to topical imiquimod (Aldara). CD30+ anaplastic large cell lymphoma is a primary cutaneous lymphoproliferative disorder with a high rate of spontaneous regression (almost 25%). The suggested therapies are radiation, surgery and methotrexate. We describe two patients with nonregressing primary cutaneous CD30+ T-cell lymphoma that was successfully treated with topical imiquimod 5% cream (Aldara, 3M) three times weekly for 6 weeks. In both cases (...) we obtained complete clinical remission, confirmed by histology. No recurrences were observed during the following 8 months. We consider that topical application of an immune response modifier, such as imiquimod, could be a good alternative to other potentially more dangerous or aggressive treatments.

2004 British Journal of Dermatology

1744. p16ink4a expression decreases during imiquimod treatment of anal intraepithelial neoplasia in human immunodeficiency virus-infected men and correlates with the decline of lesional high-risk human papillomavirus DNA load. (Abstract)

p16ink4a expression decreases during imiquimod treatment of anal intraepithelial neoplasia in human immunodeficiency virus-infected men and correlates with the decline of lesional high-risk human papillomavirus DNA load. Human papillomavirus (HPV)-associated anogenital cancers and their precursor lesions occur in excess in human immunodeficiency virus (HIV)-infected patients despite the initiation of highly active antiretroviral therapy. In this context, a drastically increased relative risk (...) for anal intraepithelial neoplasia (AIN) exists in HIV-infected men having sex with men (MSM). In a pilot study, imiquimod, a topical immune response modifier, has been reported to be beneficial in the treatment of AIN.To investigate the role of several biomarkers as potential adjuncts in the course of imiquimod treatment for AIN, and to determine whether these markers correlate with the course of high-risk HPV DNA load during imiquimod therapy.Immunohistochemical staining was performed for p16(ink4a

2007 British Journal of Dermatology

1745. Psoriasis induced by topical imiquimod. (Abstract)

Psoriasis induced by topical imiquimod. We report the provocation of localized psoriasis at the sites of application of topical imiquimod, possibly evolving into a generalized flare. A patient with pre-existing psoriasis that had been stable for 14 years was treated with imiquimod 5% cream daily for 6 weeks to three superficial basal cell carcinomas. During treatment one of the lesions developed severe local skin reactions necessitating rest periods, and received only 18 applications in 6 weeks

2004 Australasian Journal of Dermatology

1746. Combination topical treatment of molluscum contagiosum with cantharidin and imiquimod 5% in children: a case series of 16 patients. (Abstract)

Combination topical treatment of molluscum contagiosum with cantharidin and imiquimod 5% in children: a case series of 16 patients. The objective of this study was to assess the efficacy and tolerability of combination therapy for molluscum contagiosum (MC) with topical cantharidin and imiquimod 5%. A prospective case series of 16 paediatric patients with a mean age of 4.8 years had cantharidin applied to lesions by a dermatologist, followed by home treatment with imiquimod 5% cream nightly (...) for an average of 5 weeks. This regimen resulted in >90% of lesions clearing in 12 patients, with half of these being totally clear. Two patients had 80-90% of lesions resolve. Two patients had 30-50% clearance of lesions at the end of the treatment period. One patient found the cantharidin reaction too strong. The mean number of imiquimod 250 mg sachets used was 4.25. In conclusion, this study suggests that combination therapy using cantharidin and imiquimod for treatment of MC in children is effective

2004 Australasian Journal of Dermatology

1747. Imiquimod: potential risk of an immunostimulant. (Abstract)

Imiquimod: potential risk of an immunostimulant. A 19-year-old woman with severe HLA B27 spondyloarthropathy whose disease was controlled on cyclosporin, methotrexate and prednisolone had human papillomavirus infection and developed cervical dysplasia and a large number of cutaneous and vulval warts. These were not responsive to cryotherapy, salicylic acid or cimetidine, so she was treated with topical imiquimod 5% cream. Two weeks after starting this treatment she had a significant flare (...) of her spondyloarthropathy. She was so ill that she stopped using the imiquimod cream. She had full resolution of her warts after 3 weeks' treatment with imiquimod cream, but her spondyloarthropathy took more than 3 months to improve, despite significant augmentation of her immunosuppression. This case highlights the potential risk of using imiquimod cream (an immunostimulant) in a patient who has a condition requiring immunosuppression, such as autoimmune disease or an organ transplant.

2004 Australasian Journal of Dermatology

1748. Psoriasis triggered by toll-like receptor 7 agonist imiquimod in the presence of dermal plasmacytoid dendritic cell precursors. Full Text available with Trip Pro

Psoriasis triggered by toll-like receptor 7 agonist imiquimod in the presence of dermal plasmacytoid dendritic cell precursors. It has been proposed that the innate immune system plays a central role in driving the autoimmune T-cell cascade leading to psoriasis; however, there is no direct evidence for this.We observed aggravation and spreading of a psoriatic plaque when treated topically with the toll-like receptor (TLR) 7 agonist imiquimod. The exacerbation of psoriasis was accompanied (...) by a massive induction of lesional type I interferon activity, detected by MxA expression after imiquimod therapy. Since imiquimod induces large amounts of type I interferon production from TLR7-expressing plasmacytoid dendritic cell precursors (PDCs), the natural interferon-producing cells of the peripheral blood, we asked whether PDCs are present in psoriatic skin. We identified high numbers of PDCs in psoriatic skin lesions (up to 16% of the total dermal infiltrate) based on their coexpression of BDCA2

2004 Archives of Dermatology

1749. Treatment of undifferentiated vulvar intraepithelial neoplasia with 5% imiquimod cream: a prospective study of 12 cases. Full Text available with Trip Pro

Treatment of undifferentiated vulvar intraepithelial neoplasia with 5% imiquimod cream: a prospective study of 12 cases. To assess the efficacy of 5% imiquimod cream on undifferentiated vulvar intraepithelial neoplasia (VIN), a disease caused by high-risk human papillomavirus.Prospective, uncontrolled study.University hospital vulvar clinic. Patients Twelve consecutive patients treated with 5% imiquimod cream for undifferentiated VIN between March 1, 1999, and May 31, 2001.Self-application of 5 (...) % imiquimod cream, initially 3 times a week, then adjusted according to tolerance, for up to 7 months according to clinical response.Therapeutic response, clinically assessed by successive photographs and histologically confirmed for complete responders, was scored as complete, partial (> or =50% decrease in lesion size), or failure. Tolerance was evaluated at each visit.A total of 3, 4, and 5 patients achieved complete response, partial response (> or =75% reduction in lesion size for all such cases

2004 Archives of Dermatology

1750. Treatment of lentigo maligna (melanoma in situ) with the immune response modifier imiquimod. Full Text available with Trip Pro

Treatment of lentigo maligna (melanoma in situ) with the immune response modifier imiquimod. Surgical excision is the treatment of choice for lentigo maligna (LM), or melanoma in situ. Topical application of imiquimod, a local immune response modifier, is a novel therapeutic approach that leads to LM tumor clearance. This pilot, open-label, nonrandomized study evaluates the efficacy of imiquimod in patients with LM and other systemic problems that make them poor surgical risks.Six biopsy-proven (...) cases of LM from 5 patients (age range, 67-80 years) in whom standard surgical therapy was contraindicated were enrolled in the study. Five tumors were located on the face and 1 on the right shoulder. Imiquimod was used as a 5% cream once a day for a maximum of 13 weeks. Immediate clinical responses and follow-up, as well as histopathologic changes and immunohistologic parameters (in 2 patients), were analyzed. The complete response rate for all LM cases was 100%. Time to complete clearing varied

2005 Archives of Dermatology

1751. Imiquimod treatment of anal intraepithelial neoplasia in HIV-positive men. Full Text available with Trip Pro

Imiquimod treatment of anal intraepithelial neoplasia in HIV-positive men. To evaluate the treatment of anal intraepithelial neoplasia (AIN) with the local immune response modifier imiquimod in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM).Prospective, nonrandomized, open-label pilot study, with a mean follow-up time of 9(1/2) months.Dermatology department of a university hospital. Patients Twenty-eight consecutive HIV-positive MSM with histologically confirmed (...) perianal (n = 23) or intra-anal (n = 5) AIN. Intervention Overnight treatment with self-applied imiquimod cream (perianal AIN) or suppositories (intra-anal AIN) 3 times a week for 16 weeks.Response to treatment was documented using clinical, cytologic, and histologic criteria. Human papillomavirus (HPV) typing and HPV DNA load determination for the high-risk HPV types 16, 18, 31, and 33 were performed.Seventeen (61%) of all 28 patients included in the study and 17 (77%) of the 22 patients with AIN, who

2006 Archives of Dermatology

1752. Treatment of atypical nevi with imiquimod 5% cream. Full Text available with Trip Pro

Treatment of atypical nevi with imiquimod 5% cream. 5% Imiquimod cream is a topical immune response modifier that has been used off-label to treat malignant melanocytic proliferations such as lentigo maligna. To our knowledge, imiquimod has not been previously used to treat atypical nevi (AN).Three patients each with 1 selected clinically AN were treated with imiquimod 5 nights per week for 12 weeks. The lesions were subsequently excised and sent for routine histologic and immunohistochemical (...) and for a surrogate marker of interferon alpha expression.Twelve weeks of imiquimod treatment failed to cause lesional resolution. A differential inflammatory response was observed between the AN and the congenital-like nevus. The character of the inflammatory infiltrate was similar to that observed with halo nevi. Uncertainties remain concerning imiquimod use for chemoprevention of AN, and the posttreatment histologic features may be misinterpreted as severe melanocytic atypia or melanoma.

2007 Archives of Dermatology

1753. Combined treatment with intratumoral injection of dendritic cells and topical application of imiquimod for murine melanoma. (Abstract)

Combined treatment with intratumoral injection of dendritic cells and topical application of imiquimod for murine melanoma. The maturation state of dendritic cells is one of the factors that affect their capacity to induce antigen-specific cytotoxic T lymphocytes. Topical cutaneous application of imiquimod can induce the maturation and migration of cutaneous dendritic cells.To evaluate the synergistic effect of topical application of imiquimod plus intratumoral injection of syngeneic bone (...) marrow-derived dendritic cells in the treatment of melanoma.For the B16F10 melanoma model, naive C57BL/6 mice were inoculated intradermally with 2x10(3) B16F10 melanoma cells in the right upper flank. Four groups (untreated control, dendritic cells alone, imiquimod alone and imiquimod plus dendritic cells) were included in the animal study, with five mice in each group. Tumour size was measured every 2 weeks, and histochemical and immunohistochemical staining carried out. ELISpot and PKH assays were

2007 Clinical & Experimental Dermatology

1754. Solitary plaque mycosis fungoides on the penis responding to topical imiquimod therapy. (Abstract)

Solitary plaque mycosis fungoides on the penis responding to topical imiquimod therapy. Mycosis fungoides (MF) presenting in the genitalia is rare. We report a case of long-standing penile MF in a young man. Commonly used treatments for limited plaque MF include topical corticosteroids and ultraviolet light therapy. There are a few anecdotal reports on the use of topical imiquimod in MF. Our patient responded well and remained in complete remission after treatment with topical imiquimod.

2007 British Journal of Dermatology

1755. Imiquimod in the treatment of lentigo maligna. (Abstract)

Imiquimod in the treatment of lentigo maligna. Lentigo maligna (LM) is treated to prevent progression to lentigo maligna melanoma (LMM). Surgery remains the treatment of choice, although topical immunotherapy with imiquimod has recently become a popular alternative.In this review, we have analysed the published literature relating to the use of imiquimod for LM, in order to understand better the utility of this treatment.All English language studies relating to the use of imiquimod for LM were (...) analysed up to January 2006.Eleven case reports and four open-label studies were identified, comprising a total of 67 patients who completed treatment with imiquimod for LM. There was significant variability in treatment schedules and regimens. Eight patients failed to respond, with LMM developing in two of these. In certain cases there were discrepancies between clinical and histological response with some patients clearing clinically but not histologically, and vice versa. Follow-up periods were

2006 British Journal of Dermatology

1756. Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma. (Abstract)

Phase I/II study of topical imiquimod and intralesional interleukin-2 in the treatment of accessible metastases in malignant melanoma. Patients with metastatic skin disease in malignant melanoma can be difficult to treat effectively, often requiring repeated treatments with different modalities in an attempt to control their disease. Treatment of nonsurgically resectable melanoma deposits is unsatisfactory, as they are often multiple and recurring. Anecdotal evidence from individual use (...) of imiquimod in superficial metastases and intralesional interleukin (IL)-2 in subcutaneous deposits suggests that the combination may be more effective in bulky subcutaneous disease.To investigate the combination of topical imiquimod and, for selected lesions, intralesional IL-2, to treat a small cohort of patients with accessible melanoma metastases resistant to other treatments.Thirteen patients were recruited: all had evidence of multiple cutaneous and/or subcutaneous metastases. Imiquimod was applied

2007 British Journal of Dermatology

1757. Determination of the area of skin capable of being covered by the application of 250 mg of 5% imiquimod cream. (Abstract)

Determination of the area of skin capable of being covered by the application of 250 mg of 5% imiquimod cream. Five percent imiquimod cream is FDA-approved for the treatment of genital and perianal warts and actinic Keratosis. The manufacturer recommends that a single sachet containing 250 mg of 5% imiquimod cream (12.5 mg of imiquimod) is adequate for a single use and is sufficient to cover a wart area of up to 20 cm(2).To determine the maximal area of skin that can be evenly covered by 250 mg (...) of 5% imiquimod cream that is contained in one single-use sachet.The contents of one 250-mg single-use sachet of 5% imiquimod cream were mixed with less than 1 mg of fluorescein sodium. The cream was applied evenly onto the abdomen of two Yorkshire female pigs and onto the medial and lateral aspects of the upper left arm of a human subject. The area of application was then measured.The average area obtained on the pig skin was 196 cm(2). The area covered on the human subject was 386 cm(2).We have

2004 Dermatologic Surgery

1758. Successful treatment of persistent melanoma in situ with 5% imiquimod cream. (Abstract)

Successful treatment of persistent melanoma in situ with 5% imiquimod cream. Five percent imiquimod cream, a topically applied immune response modifier with potent antiviral and antitumor activity, has been reported to be effective in the management of lentigo maligna and cutaneous metastases from melanoma.We report a case in which 5% imiquimod cream was effective in the management of a persistent melanoma in situ.Five percent imiquimod cream was applied to the affected area twice to three (...) times a week, as tolerated.After 4 months of treatment, repeated biopsies of the previously affected areas showed complete regression of the melanoma.Treatment of melanoma in situ of sun-damaged areas with 5% imiquimod cream certainly appears warranted in selected cases where surgical procedures have failed or are not feasible owing to factors such as size and/or localization of the lesion, advanced age, or deteriorated medical status of the patient. Rigorous posttreatment follow-up is mandatory

2004 Dermatologic Surgery

1759. Imiquimod: an effective alternative for the treatment of invasive cutaneous squamous cell carcinoma. (Abstract)

Imiquimod: an effective alternative for the treatment of invasive cutaneous squamous cell carcinoma. Some patients with invasive cutaneous squamous cell carcinoma are either not adequate surgical candidates or present with lesions in cosmetically sensitive areas in which a surgical procedure might result in an apparent and/or a cosmetically unacceptable scar.To evaluate the effectiveness of imiquimod 5% cream in the treatment of an invasive squamous cell carcinoma in the nose of a young (...) man.Imiquimod 5% cream was applied to the lesion five times a week for 12 weeks.Complete clinicopathologic tumor clearance and an excellent cosmetic result were achieved after 12 weeks of imiquimod treatment.Imiquimod 5% cream may represent a reasonably effective alternative for the management of invasive squamous cell carcinoma in selected patients.

2005 Dermatologic Surgery

1760. Eruptive epidermoid cysts resulting from treatment with imiquimod. (Abstract)

Eruptive epidermoid cysts resulting from treatment with imiquimod. Because of its unique mechanism of action and safety profile, imiquimod, a topical immune response modifier, is used for many benign and malignant dermatologic conditions. Adverse effects are typically limited to treatment site erythema and erosion.To describe a newly recognized adverse effect of imiquimod.A 79-year-old woman being treated with imiquimod 5 days per week for a nodular basal cell developed a verrucous plaque over (...) the treatment area after 7 weeks of therapy.Scouting biopsies demonstrated multiple comedones and ruptured epidermoid cysts. There was no evidence of residual basal cell carcinoma.Imiquimod is a new and novel treatment option for cutaneous malignancies. We report its successful use in the treatment of a nodular basal cell carcinoma. The multiple comedones and ruptured epidermoid cysts are newly reported adverse effects of imiquimod therapy.

2005 Dermatologic Surgery

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