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Imiquimod

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1821. Nudging epidermal field cancerogenesis by imiquimod. (Abstract)

Nudging epidermal field cancerogenesis by imiquimod. The coexistence of malignancies close to each other on the skin has been occasionally reported. The concept of field cancerogenesis applies to such cases. Given the purported mechanism of action of imiquimod, it should not be surprising that this treatment could inhibit epidermal field cancerogenesis.To assess the effect of imiquimod applied twice weekly on incipient bowenoid changes disclosed in the vicinity of basal cell carcinomas.Biopsies (...) were taken before treatment and after 4-6 weeks and 12 weeks of imiquimod treatment.Large atypical bowenoid keratinocytes and dyskeratotic cells were cleared in time while factor-XIIIa-positive dermal dendrocytes appeared boosted and admixed with a brisk lymphocytic infiltration.Epidermal field cancerogenesis appears to be controlled by imiquimod. Dermal dendrocytes might play a pivotal role in this regression phenomenon.Copyright 2003 S. Karger AG, Basel

2003 Dermatology

1822. Prolonged imiquimod treatment and graft-versus-host reaction: histological mimicry in the skin infiltration pattern of the monocyte-macrophage-dendrocyte lineage. (Abstract)

Prolonged imiquimod treatment and graft-versus-host reaction: histological mimicry in the skin infiltration pattern of the monocyte-macrophage-dendrocyte lineage. Factor-XIIIa-positive dendrocytes belong to the monocyte-macrophage-dendrocyte (MMD) lineage which is considered to play a pivotal role in the skin response to the immune response modifier imiquimod. The same cells are also boosted in low-grade graft-versus-host reaction (GVHR) with skin manifestations. Both conditions (...) are characterized by specific epidermal damage. The aim of the present study was to compare them using immunohistochemistry to identify MMD subsets and other inflammatory cells in the dermis. We compared 3 cases of long-term (4, 9 and 11 months) imiquimod topical applications on normal skin, 25 low-grade GVHR controlled by immunosuppressive therapy and 25 control cases with normal skin. Compared to the normal dermis, cells of the MMD lineage were considerably boosted in the dermis of GVHR and at the imiquimod

2003 Dermatology

1823. Imiquimod induces complete clearance of a PUVA-resistant plaque in mycosis fungoides. (Abstract)

Imiquimod induces complete clearance of a PUVA-resistant plaque in mycosis fungoides. Imiquimod is a topical immune response modifier that binds to Toll-like receptors 7 and 8 and induces alpha-interferon. We locally applied imiquimod 5% cream (Aldara) daily for 2 weeks on a PUVA- and retinoid-resistant plaque on the face of a patient with mycosis fungoides. The diagnosis was based on clinical appearance, histology and molecular studies. Most of the disease manifestations showed a clear (...) remission during PUVA therapy combined with low-dose retinoids. However, the plaque on the face was PUVA resistant. Local imiquimod treatment resulted in the complete clearance of the plaque. The patient has now been in complete remission for 12 months.Copyright 2003 S. Karger AG, Basel

2003 Dermatology

1824. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. (Abstract)

Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. An 82-year-old female patient presented with a large perianal hyperkeratotic tumor extending into the anal canal. Staging did not reveal any metastatic spread. Diagnosis of verrucous carcinoma or Buschke-Löwenstein tumor, respectively, was based on typical clinical and histologic features. Moreover, human papillomavirus 6b DNA sequences could be detected by PCR. Surgical excision could not be performed due to the general (...) health status of the patient; thus, alternative therapy methods were necessary. Treatment with imiquimod cream 5% (Aldara), a topical immune response modifier applied once a day and left for 12 h, led to significant partial tumor regression and clear demarcation of the tumor. The remaining tumor, now feasible for treatment with CO2 laser, was removed in two sessions in local anesthesia. In a third session, tumor parts in the anal canal were vaporized. This case demonstrates that the combination

2003 Dermatology

1825. Successful treatment of multiple filiform facial warts with imiquimod 5% cream in a patient infected by human immunodeficiency virus. (Abstract)

Successful treatment of multiple filiform facial warts with imiquimod 5% cream in a patient infected by human immunodeficiency virus. Imiquimod, an imidazoquinoline amine, is approved for the topical treatment of external anogenital warts induced by human papilloma virus. Several clinical trials have shown imiquimod to be an effective and safe drug for treatment of anogenital warts. Consequently, it was considered that imiquimod might be effective on warts caused by the same aetiological agent (...) located on other skin areas. We describe the favourable outcome of a case of multiple facial verrucae in a human immunodeficiency virus (HIV)-infected patient treated with imiquimod 5% cream. This is a promising finding which supports those of two previous reports. We feel that imiquimod could be used in HIV-infected patients with multiple facial warts in whom conventional therapies are ineffective or produce significant side-effects.

2003 Clinical & Experimental Dermatology

1826. Imiquimod and the imidazoquinolones: mechanism of action and therapeutic potential. (Abstract)

Imiquimod and the imidazoquinolones: mechanism of action and therapeutic potential. A central development of the past decade has been in our understanding of the interactions between, and interdependence of, the innate and adaptive immune responses. Innate immunity recognizes 'danger' signals and activates adaptive immunity in a targeted, appropriate and effective response. Dendritic cells and macrophages have a central role in this process, and pharmacological agents that modulate (...) the functions of these cells could have therapeutic value. The imidazoquinolone compounds, of which imiquimod, formulated as Aldara trade mark, is the best characterized to date, are such molecules. Imiquimod and its homologues act by activating macrophages and other cells via binding to cell surface receptors, such as Toll receptor 7, thereby inducing secretion of pro-inflammatory cytokines, predominantly interferon (IFN)-alpha, tumour necrosis factor (TNF)-alpha and interleukin (IL)-12. This locally

2002 Clinical & Experimental Dermatology

1827. Topical treatment of intraepithelial penile carcinoma with imiquimod. (Abstract)

Topical treatment of intraepithelial penile carcinoma with imiquimod. Intraepithelial penile carcinoma (IPC) is an in situ carcinoma of the penis, which can be difficult to diagnose. Current treatments include excisional surgery, Mohs' micrographic surgery, cryotherapy, carbon dioxide laser therapy and topical 5-fluorouracil. We report two cases of men with 12-18 month histories of IPC (Bowen's disease, squamous cell carcinoma in situ) that were previously unsuccessfully treated (...) with antifungals and antibiotics. Treatment with imiquimod 5% cream for 8-10 weeks was effective in both cases with no clinical evidence of relapse at 4 and 6 months. Both patients experienced adverse effects, resulting in temporary discontinuation of treatment.

2003 Clinical & Experimental Dermatology

1828. Treatment of Bowen's disease of the penis with imiquimod 5% cream. (Abstract)

Treatment of Bowen's disease of the penis with imiquimod 5% cream. We present a case of persistent and progressive Bowen's disease (squamous cell carcinoma in situ) of the penis, in an otherwise healthy 56-year-old man. Treatment with imiquimod 5% cream was effective when applied once a day for 3 consecutive days followed by 4 days without treatment, over a period of 5 weeks.

2003 Clinical & Experimental Dermatology

1829. Treatment of Bowen's disease using a cycle regimen of imiquimod 5% cream. (Abstract)

Treatment of Bowen's disease using a cycle regimen of imiquimod 5% cream. Bowen's disease (BD; intraepithelial squamous cell carcinoma) is a challenging condition to treat because lesions, which can be multiple, are often located at sites that heal poorly, such as the shin. The disease is usually persistent and progressive and appears as an enlarging, demarcated erythematous plaque. Two elderly female patients with Bowen's disease of the lower leg are presented. Imiquimod 5% cream was applied

2003 Clinical & Experimental Dermatology

1830. Treatment of facial superficial basal cell carcinomas with imiquimod 5% cream. (Abstract)

Treatment of facial superficial basal cell carcinomas with imiquimod 5% cream. Basal cell carcinoma (BCC) is the most common form of skin cancer and occurs predominantly as two forms, nodular or superficial. We report cases of two females who presented with facial BCCs, one with a 2-month history of superficial BCC with a dual growth pattern (superficial BCC overlying a deep micronodular pattern BCC), and the other with a 4-year history of superficial BCC. Both patients had undergone previous (...) unsuccessful treatments. Differing responses of facial superficial BCCs were observed following daily treatment with imiquimod 5% cream over 6 weeks. This included a treatment failure in the BCC with a dual growth pattern and complete clearance of the other superficial BCC.

2003 Clinical & Experimental Dermatology

1831. The use of imiquimod 5% cream for the treatment of basal cell carcinoma as observed in Gorlin's syndrome. (Abstract)

The use of imiquimod 5% cream for the treatment of basal cell carcinoma as observed in Gorlin's syndrome. Gorlin's syndrome (naevoid basal cell carcinoma) is an autosomal dominant tumour-predisposition syndrome. It typically consists of multiple basal cell carcinomas (BCCs) of the skin, odontogenic keratocysts of the jaw, various skeletal abnormalities and lamellar falx calcifications. Four patients with multiple facial and trunk BCCs (superficial and nodular) consistent with Gorlin's syndrome (...) are reported. Imiquimod 5% cream was topically applied to the lesions 3-5 times a week for 8-14 weeks. Two of the patients suffered mild to severe erythema and developed superficial erosions but did not discontinue treatment. Imiquimod 5% cream successfully treated 13 out of 17 BCCs in these patients with Gorlin's syndrome, with no patient suffering a relapse at the follow-up visit.

2003 Clinical & Experimental Dermatology

1832. Imiquimod-responsive basal cell carcinomas and factor XIIIa-enriched dendrocytes. (Abstract)

Imiquimod-responsive basal cell carcinomas and factor XIIIa-enriched dendrocytes. Dermal dendrocytes (DDs) are dendritic cells that exhibit immunoreactivity for factor XIIIa, and are frequently found in conjunction with basal cell carcinomas (BCCs). Imiquimod was applied to 12 superficial BCCs every 3 days for 8 weeks. One week after completion of treatment, seven lesions appeared to have resolved, while five displayed evidence of residual BCC. Prior to initiation of treatment, the seven (...) imiquimod-responsive BCCs were surrounded by numerous DDs, whereas the five imiquimod-resistant BCCs had fewer DDs next to them at the time of entry into the study. It appears that the pretreatment density in DDs may affect the efficacy of imiquimod in eradicating skin tumours.

2003 Clinical & Experimental Dermatology

1833. The treatment of basal cell carcinomas in a patient with xeroderma pigmentosum with a combination of imiquimod 5% cream and oral acitretin. (Abstract)

The treatment of basal cell carcinomas in a patient with xeroderma pigmentosum with a combination of imiquimod 5% cream and oral acitretin. Xeroderma pigmentosum (XP) is a rare autosomal recessive photosensitive disorder, which results in multiple face, neck and head basal cell carcinomas (BCCs), squamous cell carcinomas and melanomas. A 15-year-old boy with XP presented with multiple facial BCCs previously treated by surgical excision. Standard BCC treatments such as surgery are not ideal (...) for patients with several facial BCCs because of the risk of scarring, and the patient refused further surgery. As an alternative, three times weekly application of imiquimod 5% cream in combination with oral acitretin (20 mg daily) was prescribed for 4-6 weeks. No adverse events were reported during treatment and all tumours had resolved at the 6-month follow up visit, highlighting the therapeutic potential of imiquimod 5% cream.

2003 Clinical & Experimental Dermatology

1834. Successful treatment of extramammary Paget's disease of the scrotum with imiquimod 5% cream. (Abstract)

Successful treatment of extramammary Paget's disease of the scrotum with imiquimod 5% cream. Extramammary Paget's disease (EMPD) of the skin is an uncommon malignancy involving the epidermis, which sometimes extends into the dermis. Current treatments for EMPD are surgical excision, Mohs' micrographic surgery or laser ablation. We report a case of a 68-year-old male who presented with recurrent EMPD. The patient refused to have surgery and, as an alternative, he applied imiquimod 5% cream (...) , an immune response modifier, daily for a total of 6 weeks. During the initial weeks of therapy, he experienced moderate erythema. Imiquimod treatment resulted in clinical and histological eradication of EMPD, with no recurrence observed during 6 months of follow-up.

2003 Clinical & Experimental Dermatology

1835. Successful treatment of butcher's warts with imiquimod 5% cream. (Abstract)

Successful treatment of butcher's warts with imiquimod 5% cream. A unique correlation has been shown to exist between frequent occupational handling of raw meat and development of warts on the hands, leading to the designation of 'butcher's warts'. Numerous treatments are available for warts including cryotherapy, laser therapy and surgical excision. We present a case of a 31-year-old-butcher with a 4-year history of warts on his fingers. Imiquimod 5% cream was applied once daily to the warts

2003 Clinical & Experimental Dermatology

1836. Topical treatment of common warts in an HIV-positive patient with imiquimod 5% cream. (Abstract)

Topical treatment of common warts in an HIV-positive patient with imiquimod 5% cream. Human immunodeficiency virus (HIV) infects and destroys crucial components of the immune system, leaving patients susceptible to a number of viral, bacterial and fungal diseases. Viral warts are caused by human papillomavirus infection and are a common skin disease that afflicts HIV-infected patients. Treatment modalities currently rely on destruction of the infected tissue or interruption of cell division (...) ; however, frequent recurrence is a particular challenge in HIV-infected patients. We report the case of a 41-year-old HIV-positive man with multiple common warts located on his hands and feet. Following 5 months of treatment with imiquimod, an immune response modifier, as a 5% cream, complete clearance of all warts was achieved. Mild erythma, itching and burning at the application site was observed in the early stages of treatment. The patient showed no relapse of warts at the 30-month follow-up visit.

2003 Clinical & Experimental Dermatology

1837. Extensive condyloma acuminata treated with imiquimod 5% cream: a case report. (Abstract)

Extensive condyloma acuminata treated with imiquimod 5% cream: a case report. Genital warts are one of the most common sexually transmitted infections, and are caused by human papillomavirus (HPV) types 6 and 11. Standard treatments for genital warts include cryotherapy, laser therapy, trichloroacetic acid and podophyllotoxin. We report the case of a 21-year-old female with extensive genital warts. A patient-applied, non-destructive therapy was considered to be the most appropriate treatment (...) in this case, due to the extent of the disease and the resulting psychological distress experienced by the patient. She applied imiquimod 5% cream three times per week for a period of 5 weeks, which resulted in complete clearance of all the warts. Minor inflammatory changes were observed during treatment; however, no significant pain was by reported the patient. No recurrences were reported during 2 years of follow-up.

2003 Clinical & Experimental Dermatology

1838. Treatment of Bowen's disease and basal cell carcinoma of the nose with imiquimod 5% cream. (Abstract)

Treatment of Bowen's disease and basal cell carcinoma of the nose with imiquimod 5% cream. We report the successful use of topical imiquimod 5% cream for extensive multifocal, recurrent (post cryotherapy), biopsy-proven Bowen's disease of the nose. Treatment was applied on a once-a-day regimen, and a total of 32 applications over 9 weeks were used. A florid local skin reaction occurred early in the treatment, necessitating a rest period and decreasing the frequency of application. The Bowen's

2003 Australasian Journal of Dermatology

1839. Porokeratosis of Mibelli: successful treatment with topical 5% imiquimod cream. (Abstract)

Porokeratosis of Mibelli: successful treatment with topical 5% imiquimod cream. A 77-year-old woman with a large porokeratosis of Mibelli on the left shin was successfully treated with topical 5% imiquimod cream applied to the entire lesion once daily without occlusion three times a week. A strong inflammatory reaction was achieved in 6 weeks of treatment. The lesion had been present for approximately 6 years and prior treatments included curettage and electrocautery, cryotherapy and topical 5 (...) -fluorouracil under occlusion. At the end of treatment with topical 5% imiquimod cream, punch biopsy was negative for porokeratosis. The lesion healed without scarring. At 24-month follow up there had been no sign of clinical recurrence.

2003 Australasian Journal of Dermatology

1840. Resolution of vulvitis circumscripta plasmacellularis with topical imiquimod: two case reports. (Abstract)

Resolution of vulvitis circumscripta plasmacellularis with topical imiquimod: two case reports. Vulvitis circumscripta plasmacellularis (VCP) is a rare but well-described entity. It is notorious for its recalcitrant nature to various modalities of treatment. Intralesional interferon-alpha showed some promise, with complete resolution, but is coupled with the side-effect of myelosuppression. Topical imiquimod is a novel immune response modifier with the ability to induce the production (...) of interferon-alpha. In this paper, we report two cases of VCP whose lesions were resistant to antibiotics, topical and oral corticosteroids, but resolved after a treatment trial with imiquimod.

2003 British Journal of Dermatology

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