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      GENITAL VITILIGO FOLLOWING USE OF IMIQUIMOD 5% CREAM

      case-report
      Author(s): , 1
      Publication date (Print):
      Journal: Indian Journal of Dermatology
      Publisher: Medknow Publications
      Keywords: Genital, imiquimod, vitiligo

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          Abstract

          Imiquimod is a small molecule with adjuvant pro-inflammatory effects that can be topically delivered as a cream for treating external genital and perianal warts. In our report, two Chinese males at the ages of 25 and 22 years were treated with imiquimod 5% cream for recurrent condyloma accuminatum, three times per week for 18 and 12. weeks, respectively. Depigmentation were noted and gradually enlarged in the treated areas after the two patients discontinued imiquimod. Therefore, clinicians should be made aware of the possible pigmentary changes associated with application of this cream.

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          Imiquimod and the imidazoquinolones: mechanism of action and therapeutic potential.

          Rebecca Stanley (2002)
          A central development of the past decade has been in our understanding of the interactions between, and interdependence of, the innate and adaptive immune responses. Innate immunity recognizes 'danger' signals and activates adaptive immunity in a targeted, appropriate and effective response. Dendritic cells and macrophages have a central role in this process, and pharmacological agents that modulate the functions of these cells could have therapeutic value. The imidazoquinolone compounds, of which imiquimod, formulated as Aldara trade mark, is the best characterized to date, are such molecules. Imiquimod and its homologues act by activating macrophages and other cells via binding to cell surface receptors, such as Toll receptor 7, thereby inducing secretion of pro-inflammatory cytokines, predominantly interferon (IFN)-alpha, tumour necrosis factor (TNF)-alpha and interleukin (IL)-12. This locally generated cytokine milieu biases towards a Th1 cell mediated immune response with the generation of cytotoxic effectors, and this has been exploited clinically in the treatment of viral infections (human papillomavirus, herpes simplex virus, molluscum contagiosum) and nonmelanoma skin cancer. Imiquimod has been shown to be significantly more effective than placebo in clearing genital warts, and mechanism of action studies indicate that this is related to the ability to generate proinflammatory cytokines and a Th1 response. Intra-epithelial neoplasms of cutaneous and mucosal surfaces are associated with human papillomavirus infection and there is some evidence that immune response modifiers may have therapeutic value for these lesions. Topical immunotherapy with immunomodulators shows potential for effective and patient-friendly treatment of cutaneous viral infections. These compounds also have adjuvant properties that could significantly enhance conventional vaccine strategies.
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            Vitiligo-like hypopigmentation associated with imiquimod treatment of genital warts.

            George Cotsarelis, Joel Gelfand, Matthew Brown … (2005)
            Article 0 comments Cited 20 times – based on 0 reviews     Review now
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              Possible mechanisms in the induction of vitiligo-like hypopigmentation by topical imiquimod.

              J Mashiah, Daniel S. Brenner (2007)
              The pathogenesis of vitiligo was examined for clues to the pigmentary changes that may occur after treatment with topical imiquimod. The literature varies on the pigmentary changes induced by topical use of imiquimod. The US Food and Drugs Administration lists 68 reports of pigmentary changes out of a total of 1257 reports related to imiquimod lodged from 1997 to 2003. Some studies describe vitiligo-like hypopigmentation associated with imiquimod treatment of genital warts (as with the patient described in this report), molluscum contagiosum, basal cell carcinoma, extramammary Paget's disease and murine melanoma. Other studies report hyperpigmentation associated with imiquimod. The possible mechanisms of hypopigmentation associated with imiquimod treatment are discussed, including antibodies found in sera of patients with vitiligo to nonpigment cell antigens, cytoplasmic pigment cell antigens and pigment cell-surface antigens; stimulation by imiquimod of both the innate immune response and cell-mediated adaptive immunity; and increased sensitivity of melanocytes to oxidative stress. The vitiligo-like hypopigmentation following topical imiquimod treatment is in line with the mode of action of this drug.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Medknow Publications (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): May-Jun 2011
                Volume: 56
                Issue: 3
                Pages: 335-336
                Affiliations
                [1] From the Department of Dermatology, The First Affiliated Hospital of Bengbu Medical College, Anhui, China.
                [1 ] Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210 029, China.
                Author notes
                Address for correspondence: Dr. Wenyuan Zhu, Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210 029, China. E-mail: zhuwenyuan@ 123456yahoo.com
                Article
                Publisher ID: IJD-56-335
                DOI: 10.4103/0019-5154.82501
                PMC ID: 3132920
                PubMed ID: 21772604
                SO-VID: af324738-dbe7-4925-993c-920c567ad6b1
                Copyright © © Indian Journal of Dermatology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : October 2009
                Date accepted : July 2010
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: imiquimod,vitiligo,genital
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: imiquimod, vitiligo, genital

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