BACKGROUND: Morphoea is characterized by fibrosis, which is mediated by cytokines including transforming growth factor (TGF)-beta.
OBJECTIVE: Our objective was to use imiquimod 5% cream (Aldara), an inducer of interferon-gamma, known to inhibit TGF-beta, to treat morphoea.
METHODS: Patients with morphoea were treated with imiquimod and evaluated during their follow-up visits to 6 months.
RESULTS: The dyspigmentation, induration and erythema of 12 patients with morphoea lesions improved. The histology of the skin also showed a decrease in dermal thickness.
CONCLUSIONS: This is the first case series describing the successful application of imiquimod in the management of morphoea.

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The objective of this study was to assess the efficacy and tolerability of combination therapy for molluscum contagiosum (MC) with topical cantharidin and imiquimod 5%. A prospective case series of 16 paediatric patients with a mean age of 4.8 years had cantharidin applied to lesions by a dermatologist, followed by home treatment with imiquimod 5% cream nightly for an average of 5 weeks. This regimen resulted in >90% of lesions clearing in 12 patients, with half of these being totally clear. Two patients had 80-90% of lesions resolve. Two patients had 30-50% clearance of lesions at the end of the treatment period. One patient found the cantharidin reaction too strong. The mean number of imiquimod 250 mg sachets used was 4.25. In conclusion, this study suggests that combination therapy using cantharidin and imiquimod for treatment of MC in children is effective and well tolerated.

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.

We present two cases of primary limited cutaneous perineal and genital extramammary Paget\'s disease (EMPD) that were successfully treated with imiquimod 5% cream. Clinical and histologic cure was confirmed after 7.5 to 12 weeks of monotherapy. Treatment-associated morbidity is minimal compared with more invasive therapies, and self-application by the patient improves convenience and appeal. Imiquimod may offer a minimally invasive and promising therapeutic option for the treatment of limited cutaneous EMPD. The diagnosis and management of EMPD and the current literature regarding imiquimod therapy are reviewed.

A patient with widespread in situ squamous cell carcinoma of the glans penis was successfully managed with topical application of 5% imiquimod cream. Therapy with topical immune response modifiers may prove beneficial in cases of superficial cutaneous carcinoma and may, if future studies confirm our findings, play a role in settings in which more destructive techniques may result in cosmetic defects or functional impairment. The use of imiquimod for intraepithelial squamous cell carcinoma of the anogenital area seems particularly logical because of the strong correlation between this neoplasm and infection with human papillomavirus.

Imiquimod is an immunomodulator with indirect antiproliferative and antiviral properties known to be effective against anogenital warts. However, its use for common warts has not been validated in prospective, controlled trials. We present 3 anecdotal case reports illustrating one treatment approach for a spectrum of resistant, common warts with combination therapy consisting of cryosurgery followed by administration of imiquimod and salicylic acid. The efficacy of this combined destructive and immunomodulatory therapy proved to be 50% to 100% effective after 6 to 9 weeks.

Stucco keratosis is a skin disorder with papular warty lesions that usually appear on the lower limbs in elderly people. The aetiology, pathogenesis and treatment is still a matter of debate. We report a 75-year-old non-immunosuppressed man with extensive lesions all over his body, which had not responded to curettage or electrodesiccation. To determine the possible role of human papillomavirus (HPV) in stucco keratosis, we used nested polymerase chain reaction (PCR) to identify HPV DNA in the lesions. To include a broad range of both cutaneous and mucosal HPV types, PCR was performed with two sets of degenerate primers. Using this approach we detected HPV types 9, 16, 23b, DL322 and a variant of HPV type 37 in multiple stucco keratoses. Imiquimod (5% cream), a new compound that modifies the immune response by stimulating production of cytokines, applied overnight, three times a week for 5 weeks, resulted in resolution of all treated lesions.

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