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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Imiquimod is an antiviral drug used to treat ano-genital warts and some skin cancers. The topical cream is also used to treat actinic keratosis and superficial cell basal cell carcinoma. No studies are published of imiquimod use during pregnancy. No increased frequency of congenital anomalies was observed after pregnant rats were given up to 8 times the usual human dose during embryogenesis. However, no studies are published of human exposure to the drug during early gestation.
Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: Many nongenital warts in healthy individuals can spontaneously regress. Almost all common warts (~90%) resolve within 5 years. Treatment is initiated based on patient preference. Multiple treatment rounds or methods may be needed for a satisfactory resolution. Genital warts have high recurrence rates likely secondary to surrounding subclinical infection. Treatment modalities include two approaches: destruction and induction of local immune reactions. Destruction methods include topical treatments, cryotherapy, curettage, and light electrocautery, intralesional bleomycin, laser, and surgical removal. Topical treatments, such as salicylic acid preparations, podophyllin, cantharidin, and 5-fluorouracil (5-FU) cream, have shown success for common warts. For genital warts, topical treatments such as podophyllotoxin, imiquimod, sinecatechins, and trichloroacetic (TCA) acid are used. Immunotherapy to induce a local immune reaction in common warts includes topical dinitrochlorobenzene (DNCB), squaric acid, diphencyprone, imiquimod, and intralesional candida, mumps antigen, or bacillus Calmette Guérin (BCG). Imiquimod is Food and Drug Administration (FDA)–approved to treat genital warts.
Basal Cell Carcinoma
Published in Debjani Sahni, Adam Lerner, Bilal Fawaz, Advanced Skin Cancer, 2022
PDT is performed utilizing aminolevulinic acid (ALA) or methyl aminolevulinic acid (MAL), and is typically used for patients with multifocal superficial disease or those with extensive background actinic damage. It has a cure rate of 70%–90%. Imiquimod is a cream used once daily, 5 days a week for a total of 6–12 weeks, and has an 81% cure rate. 5-FU is a cream applied twice daily for 3–6 weeks, but treatment may be continued for up to 10–12 weeks if needed.4 A study found tumor-free survival at 3 years to be 79.7% when using imiquimod, 68.2% with 5-FU, and 58.1% with PDT-MAL.10 The main disadvantage of topical creams is erythema and excessive irritation which can lead to treatment interruption or poor compliance.2,4 Systemic therapies are usually reserved for locally advanced BCCs, metastatic BCCs, or for syndromic BCCs (e.g., Gorlin syndrome), and will be discussed further in the case descriptions that follow.
A case of topical imiquimod induced fatigue
Published in Journal of Dermatological Treatment, 2022
Justin Raman, Elizabeth Bisbee, Tricia A. Missall, Sami K. Saikaly
Imiquimod is an immunomodulator with US Food and Drug Administration approval for the treatment of superficial basal cell carcinoma (BCC), actinic keratoses (AK), and anogenital warts (1). It has also been used off-label for the treatment of many cutaneous diseases including melanoma in-situ (MIS), molluscum contagiosum, keloids, and morphea (1). Preparations include a 2.5%, 3.75% and 5% topical cream (2). As an immunomodulator, it impacts both innate and adaptive immune responses (2). Although the exact mechanism of action is unclear, it is a toll-like receptor 7 and 8 agonist, inducing proinflammatory cytokines (1). Imiquimod is considered a safe topical medication with a minor side effect profile (1). Here we present a case of severe fatigue induced by 5% imiquimod used for a pigmented lesion that was likely an early MIS, per dermoscopic findings and confocal microscopic imaging.
Intralesional immunotherapy for the treatment of anogenital warts in pediatric population
Published in Journal of Dermatological Treatment, 2022
Immunotherapeutic agents were less commonly used in anogenital warts in children. Miyata et al. (6) have successfully treated three pediatric cases with genital warts by topical DPCP 0.05–0.5% twice-weekly application for 6 months at home. DPCP forms hapten with wart proteins, which are eventually recognized by T cells resulting in wart destruction. Imiquimod is another example of immune-based therapy of warts. Although imiquimod 5% was only approved for treatment in children aged 12 years or older, some studies have reported its efficacy in younger children with cure rates up to 75% (2,8). This synthetic immunomodulator activates cellular and innate immune responses via cytokine activation but needs a long time of treatment. It is preferred in small and single lesions to avoid contact dermatitis and ulcerations if applied on a large surface area (8).
Efficacy and safety of imiquimod 5% cream for basal cell carcinoma: a meta-analysis of randomized controlled trial
Published in Journal of Dermatological Treatment, 2020
With the growing incidence in BCC worldwide, there are several treatment options that are used available for BCC, which include surgery and non-surgical treatments. Surgery is considered as the gold standard for patients with low-risk BCC (6), and it is largely done by dermatologists and plastic surgeons. However, non-surgical treatment modalities like photodynamic therapy (PDT) and imiquimod have been used as good alternatives for surgery in superficial BCC (sBCC) (6–8). As a first-line treatment by international consensus for sBCC (8), PDT is less invasive, and also has other advantages like the good cosmetic outcome according to evaluation by physicians (9). Imiquimod is a new topical treatment, and is effective in assisting in the removal of a tumor without causing collateral structural damage. Previous studies related to BCCs of the trunk or extremities have suggested that imiquimod is as effective as surgical treatment in clinical cure rates and it achieves good to excellent cosmetic outcomes (10,11). However, there was one randomized controlled trial (RCT) that reported different results, which showed that imiquimod was inferior to surgery in the treatment of low-risk sBCC (12). In order to evaluate the effects of imiquimod, we conducted this meta-analysis of RCTs to compare the efficacy and safety between imiquimod and other treatments in patients with BCC.