Aldara
Clinical and molecular responses in high-grade intraepithelial neoplasia treated with topical imiquimod 5%.

Diaz-Arrastia C, Arany I, Robazetti SC, Dinh TV, Gatalica Z, Tyring SK, Hannigan E.

Department of Obstetrics and Gynecology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA. carrasti utmb.edu

OBJECTIVE: To assess the clinical and molecular response of patients with recurrent high-grade vulvar, vaginal, or cervical intraepithelial neoplasia treated with topical 1-2(2-methylpropyl)-1H-imidazo [4,5-c] quinolin-4-amine (imiquimod) cream 5%, an immune response modifier with known efficacy in the treatment of external genital warts. METHODS: This is the first case series in the peer-reviewed literature reporting the use of imiquimod in high-grade intraepithelial neoplasia of the lower genital tract. Eight patients with high-grade intraepithelial neoplasia were treated with imiquimod in the gynecological oncology clinic and the HIV gynecology clinic at The University of Texas Medical Branch at Galveston. Frozen biopsies were available for RNA extraction on four patients before and after therapy. Using semiquantitative reverse transcription-PCR, we measured RNA levels of IFNs alpha and gamma, 2',5'-oligoadenylate synthetase, as well as CD4 and CD8 lymphocyte markers. RESULTS: Of the patients treated, four had complete responses, two had partial responses, one progressed, and one did not tolerate the therapy. Of the four complete responders, two remained disease-free (mean follow-up, 33 months). 2',5'-Oligoadenylate synthetase RNA expression showed an increased trend after therapy. CONCLUSIONS: These results obtained in this small and heterogeneous group merit further study in the use of topical 5% imiquimod use in the treatment of intraepithelial neoplasia. An important mechanism of action of imiquimod may involve 2',5'-oligoadenylate synthetase antiviral activity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11595691&dopt=Abstract imiquimod Aldara



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Treatment of anogenital warts in children with topical 0.05% podofilox gel and 5% imiquimod cream.

Moresi JM, Herbert CR, Cohen BA.

Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

A retrospective analysis of 25 infants and young children with anogenital warts was performed by chart review and telephone interview. Fifteen of 17 patients treated with podofilox 0.5% gel and 6 of 8 patients treated with imiquimod 5% cream improved or cleared with therapy. Only one patient stopped treatment because of irritation. Our experience suggests that these agents can be used safely and effectively in young children. Controlled prospective studies should be undertaken to further evaluate the use of podofilox and imiquimod in the treatment of symptomatic anogenital warts in children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11737696&dopt=Abstract imiquimod Aldara



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Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin.

Solis RR, Diven DG, Colome-Grimmer MI, Snyder N 4th, Wagner RF Jr.

University of Texas Medical Branch at Galveston, Department of Dermatology, 77555-0783, USA.

BACKGROUND: Tattoo removal is a common request in dermatologic surgery practices. Conventional tattoo removal modalities consist of mechanical, chemical, and thermal methods, but these interventions may result in undesirable dermal damage, disfiguring scars, and pigmentary changes. OBJECTIVE: To evaluate the efficacy of topical imiquimod and tretinoin for the removal of tattoos in a guinea pig model. METHODS: Five albino guinea pigs (A-E) were tattooed with black, red, green, and yellow. Beginning 6 hours after tattooing, A received no treatment, B was treated with petrolatum, C had imiquimod cream alternating with tretinoin gel, D had imiquimod cream alone, and E received tretinoin gel alone. The animals were treated for 7 days. Biopsies of the tattoos were taken at 6 hours, 7 days, and 28 days. RESULTS: Control guinea pig B had normal-appearing tattoos with consistent histopathology on day 28. Guinea pig D, treated with imiquimod cream clinically, had no visible tattoo, consistent with greatly diminished or no dye evident on histopathology. Guinea pig E, treated with tretinoin gel, and guinea pig C, treated with combination tretinoin gel and imiquimod cream, had faded tattoos and moderate clearance of pigment on histopathology. CONCLUSION: In the guinea pig, the use of imiquimod was successful as a nonsurgical method of acute-phase tattoo removal, but was associated with fibrosis and the loss of dermal appendages.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11998793&dopt=Abstract imiquimod Aldara



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Efficacy of imiquimod 5% cream in the treatment of recalcitrant warts in children.

Grussendorf-Conen EI, Jacobs S.

Department of Dermatology, University Hospital RWTH Aachen, Aachen, Germany. elke.grussendorfconen post.rwth-aachen.de

Long-lasting cutaneous warts are a therapeutic challenge, especially widespread or symptomatic recalcitrant warts in children. It can be speculated that natural immunity to these human papillomavirus (HPV)- induced lesions is extremely poor. Therefore ideally treatment should focus on increasing local immune response. Recently imiquimod, a topical immune modifier, has been successfully used in the treatment of external genital warts. Our purpose is to report on our experiences with imiquimod 5% cream applied to therapy-resistant, long-lasting (duration 2-7 years) common warts in children. In 18 children, imiquimod cream was self-applied by the patients or by their parents to the warts twice a day. Assessment for response and occurrence of adverse effects was performed every 4 weeks until clinical cure. Follow-ups could be arranged in 14 of the 18 patients 1-2 years after total clearance. Sixteen of 18 patients experienced total clearance of their warts; 2 showed partial improvement but were lost to follow-up. The mean duration of treatment was 5.8 months. Two of the 14 patients in whom a follow-up was performed showed a small number of new warts after a period of at least 1 year without recurrence. Our data demonstrate that the topical application of imiquimod 5% cream is an effective treatment for long-lasting cutaneous warts in children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12047649&dopt=Abstract imiquimod Aldara



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Treatment of vulvar intraepithelial neoplasia 2/3 with imiquimod.

Jayne CJ, Kaufman RH.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

OBJECTIVE: To retrospectively review the charts of 13 women diagnosed with vulvar intraepithelial neoplasia (VIN) 2/3 treated with imiquimod and to evaluate the efficacy of this treatment. STUDY DESIGN: Retrospective review. All 13 women were treated and evaluated by a single gynecologist. The extent of the lesions prior to treatment and the extent and degree of improvement were documented. Biopsy confirmation of disease was obtained for each individual. Response to treatment was categorized as complete regression, at least 75% regression or not improved. RESULTS: The mean duration of treatment was 3.3 months, and follow-up after completion of therapy was 5.5 months. Eight of the 13 women had complete regression of the VIN. Four patients demonstrated 75% regression of disease, and in one diabetic woman no improvement was seen. In two women demonstrating 75% lesion regression, invasive carcinoma of the vulva was found in the area of residual disease. In one instance this was determined to be superficially invasive squamous cell carcinoma (1 mm of invasion), and in the second an anal tag was found to have invasive squamous cell carcinoma. CONCLUSION: Medical management of VIN 2/3 with imiquimod is worth considering. However, careful evaluation of the patient must be carried out prior to the institution of therapy to exclude the presence of invasive squamous cell carcinoma.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12063878&dopt=Abstract imiquimod Aldara



Aldara
Imiquimod 5% cream in the treatment of anogenital warts in female patients.

Buck HW, Fortier M, Knudsen J, Paavonen J.

Watkins Memorial Health Center, University of Kansas, USA. hbuck ku.edu

OBJECTIVE: To investigate the efficacy and safety of imiquimod 5% cream in the treatment of anogenital warts in a female population. METHODS: In two open-label studies, female patients with anogenital warts applied imiquimod 5% cream three times a week for up to 16 weeks. Patients who cleared their warts were monitored for a 6-month follow-up period. Patients could be re-treated with imiquimod 5% cream for up to an additional 16 weeks if their warts recurred or new warts developed during the follow-up period. The treatment period could also be extended for up to an additional 16 weeks if patients only experienced partial clearance during the initial 16-week treatment period. RESULTS: Of the female patients who applied imiquimod 5% cream, 75% (449/600) experienced complete clearance of their warts (treatment failure analysis). This includes 46 patients who experienced total clearance when they applied imiquimod for longer than 16 weeks as their warts had only partially cleared in the initial 16 weeks of therapy. During the 6 months of follow-up after the initial treatment period, 15% of patients had recurrent warts. Thirty-nine (75%) of those patients experienced total clearance again after they re-applied imiquimod for up to an additional 16 weeks. The most frequently observed local skin reaction was erythema. CONCLUSION: In these studies, imiquimod 5% cream was an effective and well-tolerated treatment for anogenital warts in females and continued to be safe and effective in the small proportion of patients who needed to re-apply imiquimod after wart recurrence.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12065134&dopt=Abstract imiquimod Aldara