Extramammary Paget's disease treated with topical imiquimod 5% cream

Extramammary Paget's disease (EMPD) is a rare cutaneous, intraepithelial adenocarcinoma usually found in the apocrine gland bearing areas. It is traditionally treated with surgery but has a high rate of recurrence. Of late, topical imiquimod 5% cream has come into use as another treatment option. We present two cases of EMPD in Asian skin treated successfully with topical imiquimod 5% cream.     

Successful treatment of perianal warts in a child with 5% imiquimod cream

Treatment of anogenital warts in children is difficult. Commonly used therapeutic regimes can be painful, variably effective and recurrence rates are high. Imiquimod is a recently developed imidazoquinolin heterocyclic amine that is an immune response modifier. Topical imiquimod has been used successfully to treat anogenital warts in adults. This case documents the effective use of topical imiquimod in the treatment of perianal warts in children.     

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.     

Disseminated superficial actinic porokeratosis treated effectively with topical imiquimod 5% cream

A 68-year-old man presented with a 3-year history of asymptomatic red marks on his limbs. On physical examination, he was found to have numerous circular, erythematous macules with a fine peripheral rim of scale on his upper arms and legs. A clinical diagnosis of disseminated superficial actinic porokeratosis (DSAP) was made. On histopathological examination of the lesional skin on the hands, an angulated parakeratotic tier was seen extending up through the epidermis. The patient was offered a trial of topical imiquimod 5% cream. He was instructed to apply it five times weekly for 6 weeks to the right forearm. This produced a dramatic inflammatory response with painful superficial ulceration of the affected skin after 4 weeks. At follow-up a further 4 weeks later, the treated areas were noted to have healed with slight superficial scarring and residual erythema, but no evidence of the original condition. DSAP is a disorder affecting areas exposed to sunlight, appearing mainly on the distal surfaces of the limbs. Treatment of DSAP is often difficult. Therapies such as cryotherapy with liquid nitrogen or use of topical 5-fluorouracil cream are generally either impractical or unsuccessful. Topical imiquimod 5% cream may prove to be a useful treatment option for DSAP. Our limited experience suggests that treatment should be introduced cautiously to avoid excessive inflammation. Further study is needed to confirm whether imiquimod should have a place in the management of DSAP.     

Proliferating hemangioma of infancy: successful treatment with topical 5% imiquimod cream

A 4-month-old girl had a proliferating hemangioma of infancy (infantile hemangioma) affecting the chest wall. The lesion had appeared 1 week after birth, demonstrating both superficial and deep components, and was rapidly enlarging. It had become painful and superficially eroded. Treatment with topical 5% imiquimod cream three times a week was associated with signs of involution after 10 days, and complete resolution after 10 weeks of therapy. The treatment was well tolerated.     

Successful treatment of malignant melanoma in situ with topical 5% imiquimod cream

BACKGROUND: Current treatment recommendations for malignant melanoma in situ include surgical excision with at least 0.5 cm margins. On the head or neck, obtaining adequate surgical margins for melanoma can be challenging and often disfiguring. In addition, some elderly patients may not be good surgical candidates and may request less aggressive interventions. METHODS: We report herein three cases of malignant melanoma in situ on the face treated with topical imiquimod cream. RESULTS: Complete regression of malignant melanoma in situ was observed on treatment with 5% topical imiquimod cream. The varied treatment regimens, rationale for using imiquimod rather than performing surgery, and the possible mechanisms of action are discussed. CONCLUSIONS: Topical imiquimod can be used successfully for the treatment of malignant melanoma in situ on the face.     

Successful treatment of a therapy-resistant pyogenic granuloma with topical imiquimod 5% cream

A 58-year-old man was referred to our department for evaluation and treatment of a therapy-resistant pyogenic granuloma on his right third digit. This biopsy-confirmed lesion was unsuccessfully treated with shave excision and base electrocautery on two separate occasions before the patient presented to our clinic. After completing a 14-week course of twice-weekly imiquimod 5% topical application, this patient's pyogenic granuloma completely resolved. A satisfactory cosmetic outcome was also achieved, with virtually no scarring.