Aldara
Imiquimod 5 percent cream and the treatment of cutaneous malignancy.

Navi D, Huntley A.

School of Medicine, University of California Davis, USA.

Imiquimod is a novel synthetic compound that is a member of the imidazoquinolone family of drugs. This class of drugs, which also includes a more potent member, resimiquimod (R-848), is unique having the properties of topical immune response modifiers and stimulators. Imiquimod resembles a nucleoside analogue and is known for its potent induction of endogenous antiviral pro-inflammatory mediators. This article is a review of the relevant literature as it relates to the off-label applications of imiquimod 5 percent cream for treatment of cutaneous preneoplastic and neoplastic conditions including its recently approved indication for treating actinic keratoses.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15347486&dopt=Abstract imiquimod Aldara



Aldara
Imiquimod 5% cream for actinic keratosis.

Perras C.

Imiquimod 5% cream has been available since 1997 for the treatment of genital warts. Health Canada has expanded the indication to include actinic keratosis (AK). There are no trials comparing imiquimod 5% cream to standard AK therapy; placebo-controlled trials have shown an increased lesion clearance rate of 30% to 55% eight weeks post-treatment. Side effects include local skin reactions that can be severe and require discontinuation of treatment in 2% to 4% of patients. Imiquimod has shown a great potential for use in unapproved indications.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15382379&dopt=Abstract imiquimod Aldara



Aldara
Selective impairment of TLR-mediated innate immunity in human newborns: neonatal blood plasma reduces monocyte TNF-alpha induction by bacterial lipopeptides, lipopolysaccharide, and imiquimod, but preserves the response to R-848.

Levy O, Zarember KA, Roy RM, Cywes C, Godowski PJ, Wessels MR.

Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA. ofer.levy childrens.harvard.edu

Newborns are at increased risk of overwhelming infection, yet the mechanisms underlying this susceptibility are incompletely defined. In this study we report a striking 1- to 3-log decrease in sensitivity of monocytes in human neonatal cord blood, compared with monocytes in adult peripheral blood, to the TNF-alpha-inducing effect of multiple TLR ligands, including bacterial lipopeptides (BLPs), LPS, and the imidazoquinoline compound, imiquimod. In marked contrast, TNF-alpha release in response to R-848, a TLR ligand that is a congener of imiquimod, was equivalent in newborn and adult blood. Differences in ligand-induced TNF-alpha release correlated with divergent ligand-induced changes in monocyte TNF-alpha mRNA levels. Newborn and adult monocytes did not differ in basal mRNA or protein expression of TLRs or mRNA expression of functionally related molecules. Newborn monocytes demonstrated diminished LPS-induced, but equivalent R-848-induced, phosphorylation of p38 mitogen-activated protein kinase and altered BLP- and LPS-induced acute modulation of cognate receptors, suggesting that the mechanism accounting for the observed differences may be localized proximal to ligand recognition by surface TLRs. Remarkably, newborn plasma conferred substantially reduced BLP-, LPS-, and imiquimod-induced TNF-alpha release on adult monocytes without any effect on R-848-induced TNF-alpha release, reflecting differences in a plasma factor(s) distinct from soluble CD14. Impaired response to multiple TLR ligands may significantly contribute to immature neonatal immunity. Conversely, relative preservation of responses to R-848 may present unique opportunities for augmenting innate and acquired immunity in the human newborn.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15383597&dopt=Abstract imiquimod Aldara



Aldara
Imiquimod 5% cream for the treatment of actinic keratosis: results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology.

Szeimies RM, Gerritsen MJ, Gupta G, Ortonne JP, Serresi S, Bichel J, Lee JH, Fox TL, Alomar A.

Klinikum der Universitat Regensburg, Klinik und Poliklinik fur Dermatologie, Regensburg, Germany.

BACKGROUND: Increasing evidence suggests imiquimod may be a safe therapeutic option for the treatment of actinic keratosis (AK). The diagnosis and assessment of most AK lesions is made clinically, without histologic confirmation. OBJECTIVE: A phase III, randomized, double-blind, parallel group, vehicle-controlled study evaluated the efficacy of imiquimod 5% cream compared with vehicle in the treatment of AK lesions on the face and balding scalp including pretreatment and posttreatment biopsy specimens. METHODS: A total of 286 patients at 18 centers in 6 European countries with histologically confirmed AK were randomized to either imiquimod 5% cream or vehicle cream. Study cream was applied once per day, 3 days per week, for 16 weeks. Clearance of AK lesions was clinically and histologically assessed at an 8-week posttreatment visit. RESULTS: The complete clearance rate for the imiquimod group was 57.1% versus 2.2% for the vehicle group (P <.001). The partial clearance rate (> or =75% reduction in baseline lesions) for the imiquimod group was 72.1% versus 4.3% for the vehicle group (P <.001). The most common side effects were erythema, scabbing/crusting, and erosions/ulceration. For the imiquimod group the incidence of severe erythema, scabbing/crusting, or erosions/ulceration was 30.6%, 29.9%, and 10.2%, respectively. CONCLUSION: Imiquimod 5% cream used 3 times per week for 16 weeks is an effective treatment for AK. Clinical clearance was established by both clinical observation and histologic analysis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15389189&dopt=Abstract imiquimod Aldara



Aldara
Topical imiquimod treatment of lentigo maligna: clinical and histologic evaluation.

Kupfer-Bessaguet I, Guillet G, Misery L, Carre JL, Leroy JP, Sassolas B.

Department of Dermatology, Laboratory of Pathology, University Hospital Morvan, Brest, France.

We have treated extensive lentigo maligna in two elderly patients with Imiquimod 5% (Aldara). It was applied 3 times weekly, for 3 to 5 months. Clinical and histological remission was observed over 13 months of follow-up care. Tolerance was good. We suggest that topical imiquimod could be an interesting therapeutic alternative.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15389205&dopt=Abstract imiquimod Aldara



Aldara
Treatment of infantile hemangiomas with short-term application of imiquimod 5% cream.

Welsh O, Olazaran Z, Gomez M, Salas J, Berman B.

Department of Dermatology at the University Hospital UANL Madero y Gonzalitos, Col. Mitras Centro Monterrey, Monterrey, NL, Mexico.owelsh yahoo.com

Ten patients with superficial infantile hemangiomas were treated with imiquimod 5% cream for up to 16 weeks. Four patients achieved complete clinical resolution, 3 had excellent improvement, one showed moderate improvement, and one patient did not respond to therapy. Imiquimod may be an effective alternative for the treatment of superficial hemangiomas.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15389206&dopt=Abstract imiquimod Aldara