Aldara
Treatment of non-genital warts with topical imiquimod 5% cream.

Muzio G, Massone C, Rebora A.

Department of Endocrinologic and Metabolic Diseases, Section of Dermatology, University of Genoa, Viale Benedetto XV 7, 16100 Genoa, Italy. rebdermo unige.it

Common warts (verrucae vulgaris) are associated with human papillomavirus infection and are routinely treated by ablative procedures such as cryotherapy, electrodessiccation and salicylic acid. We report 10 cases of recurrent warts treated with a potential new topical therapy, imiquimod 5% cream. Nine of the 10 patients were successfully treated with imiquimod 5% cream applied, under occlusion, once daily for 4 weeks. No recurrences were reported during 3 months of follow up.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12095879&dopt=Abstract imiquimod Aldara



Aldara
Topical imiquimod treatment of superficial and nodular basal cell carcinomas in patients affected by basal cell nevus syndrome: a preliminary report.

Micali G, De Pasquale R, Caltabiano R, Impallomeni R, Lacarrubba F.

Dermatology Clinic, University of Catania, Italy. cldermct nti.it

BACKGROUND: Imiquimod 5% cream has been shown to be effective in the treatment of superficial basal cell carcinomas (sBCCs). OBJECTIVE: To evaluate the efficacy, safety and compliance of imiquimod 5% cream for the treatment of sBCCs and nodular BCCs (nBCCs) in patients affected by basal cell nevus syndrome. PATIENTS/METHODS: Three patients (two male, one female) were enrolled in the study. Nine tumors (five sBCCs and four nBCCs), all ranging in size from 0.5 cm to 1 cm, were treated. Treatment consisted for sBCCs of three weekly applications and for nBCCs of five weekly applications for 8 weeks. Histological examination was performed at the beginning and at the end of the study. For small tumors, similar-appearing lesions were removed for baseline histological confirmation. Follow-up was performed at 1-week intervals in order to carefully detect any change. RESULTS: Three sBCCs cleared clinically after 4 weeks of treatment and two nBCCs after 8 weeks. The remaining four lesions showed excellent clinical responses with evident (>50%) size reduction at 6 weeks, but no further improvement. Histological examination with multiple-step sections confirmed complete clearing for those lesions showing clinical resolution, except for one nBCC that showed scant tumor remnants. Local adverse effects (itching, erythema and bleeding) were mild and did not prompt discontinuation of treatment. No systemic side effects were noted. CONCLUSIONS: Imiquimod 5% cream is an effective therapeutic option for both sBCC and nBCC in patients with basal cell nevus syndrome. The treatment was very well received by all patients engaged in the study, who stated their appreciation for a topical treatment rather than multiple surgical excisions. A higher number of applications and longer treatment periods are required for nBCCs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12227875&dopt=Abstract imiquimod Aldara



Aldara
Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids.

Berman B, Kaufman J.

Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida 33136, USA.

New adjunctive treatments are needed to reduce the high recurrence rates (50%) of excised keloids. Interferon alfa injections have been shown to decrease the size of stable keloids. This study examined the effects of postoperative imiquimod 5% cream on the recurrence of 13 keloids excised surgically from 12 patients. Starting on the night of surgery, imiquimod 5% cream was applied for 8 weeks. Patients were examined at weeks 4, 8, 16, and 24 for local erythema, edema, erosions, pigment alteration, and/or recurrence of keloids. Of the 11 keloids evaluated at 24 weeks, none (0%) recurred. Incidences of hyperpigmentation were 63.6%. Two cases of mild irritation and superficial erosion cleared with temporary discontinuation of imiquimod. Both patients completed the 8 weeks of topical therapy and the final 24-week assessment. At 24 weeks, the recurrence rate of excised keloids treated with postoperative imiquimod 5% cream was lower than recurrence rates previously reported in the literature.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12271279&dopt=Abstract imiquimod Aldara



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An open case series of patients with basal cell carcinoma treated with topical 5% imiquimod cream.

Cowen E, Mercurio MG, Gaspari AA.

Department of Dermatology, University of Rochester School of Medicine and Dentistry, New York, USA.

In an open-label study we assessed the response rate and posttreatment follow-up of topical imiquimod 5% cream in 5 patients with basal cell carcinoma (BCC) who were not treated with surgical excision after topical immunotherapy. All patients received imiquimod 5% cream 3 times a week for up to 16 weeks, at which time treatment was stopped. Patients were examined at regular intervals for signs of recurrence. All patients experienced resolution of their BCC. In all cases, there was a local inflammatory response during therapy, which resolved after treatment. Recurrences were not observed in any of the 5 patients during the posttreatment observation interval, which ranged from 5 to 13 months. Our experience with imiquimod 5% cream in the treatment of BCC is consistent with clinical efficacy previously reported. With the exception of one severe application site reaction, treatment was well tolerated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12271286&dopt=Abstract imiquimod Aldara



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Topical 5% imiquimod for the therapy of actinic cheilitis.

Smith KJ, Germain M, Yeager J, Skelton H.

Department of Dermatology, University of Alabama at Birmingham, 35294, USA.

BACKGROUND: Tissue-destructive and more selective cytotoxic therapies are the main methods used to treat actinic cheilitis. A topical immune stimulant, 5% imiquimod cream, has recently been used for treatment of cutaneous epithelial malignancies including squamous cell carcinoma in situ and basal cell carcinoma. OBJECTIVE: Our aim was to review the results in patients who had been treated for actinic cheilitis with imiquimod cream. METHODS: A review identified 15 patients with biopsy-proven actinic cheilitis who had been treated with topical imiquimod 3 times weekly for 4 to 6 weeks. All patients with histories consistent with facial herpes simplex or documented prior facial herpes simplex eruptions were treated with oral valcyclovir, 1 g/d, during imiquimod therapy. RESULTS: All 15 patients showed clinical clearing of their actinic cheilitis at 4 weeks after discontinuation of the topical imiquimod. Sixty percent of the patients experienced a moderate to marked increased local reaction consisting of increased erythema, induration, and erosions or ulcerations, which in some cases continued through the period of therapy. CONCLUSION: Imiquimod appears to have a role in the treatment of actinic cheilitis. However, the dose and duration of therapy, as well as the long-term efficacy, need to be established; and local reactions are to be expected and may not improve during therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12271290&dopt=Abstract imiquimod Aldara



Aldara
Treatment of primary herpes simplex virus infection in guinea pigs by imiquimod.

Miller RL, Imbertson LM, Reiter MJ, Gerster JF.

3M Pharmaceuticals, St. Paul, MN 55144, USA.

Imiquimod (also known as R-837 and S-26308) is an imidazoquinoline immune response modifier and is available in the US and several other countries for the treatment of external genital warts. Imiquimod has no direct antiviral activity but demonstrates efficacy in several animal models of virus infection. The drug is recognized by antigen presenting cells including monocytes, macrophages, B-cells and dendritic cells and induces these cells to produce cytokines including interferon-alpha (IFN-alpha) and others. Imiquimod's ability to inhibit primary lesion development in the guinea pig model of Herpes simplex virus (HSV) intravaginal infection was studied. Imiquimod given intravaginally reduced primary lesions, reduced virus shedding and reduced virus content of spinal cords from HSV infected guinea pigs. A single drug application of 0.5 mg/kg reduced lesion frequency when given between 24 h before inoculation to 16 h after inoculation. A single drug application of 5 mg/kg reduced lesion frequency and severity when administered between 72 h before inoculation to 24 h after inoculation. The antiviral effect resulting from interferon induction in the animal lasts much longer than the drug itself, thus imiquimod is different than drugs having direct antiviral activity. Twice daily drug application for 4 days was effective when initiated up to 72 h after inoculation, however, once lesions began to appear, imiquimod treatment was not able to stop lesion development. Imiquimod treatment inhibited lesion development and/or virus shedding in guinea pigs inoculated with HSV-1, HSV-2 or virus isolates resistant to acyclovir. Imiquimod is currently in clinical trials for treating human HSV infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10588331&dopt=Abstract imiquimod Aldara