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Abstract

Since its first official approval for use in external genital and perianal warts about 20 years ago, imiquimod has revolutionized not only the therapeutic protocols but also our understanding of the immunogenetic properties of some of the most frequent dermatovenereological disorders. Besides the aforementioned external genital and perianal warts, imiquimod 5% cream is officially approved for the treatment of superficial small (<2 cm) non-facial basal cell cancer (BCC) and actinic keratoses on the face and scalp. However, the list of off-label indications continues to expand offering potential cost-effective and more elegant treatment options. The most relevant updates about the use of imiquimod in Dermatology and Venereology have been briefly summarized in this chapter.

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References

  • Ahmed I, Berth-Jones J. Imiquimod: a novel treatment for lentigo maligna. Br J Dermatol. 2000;143:843–5.

    Article  CAS  PubMed  Google Scholar 

  • Ahn MY, Kwon SM, Cheong HH, et al. Toll-like receptor 7 agonist, imiquimod, inhibits oral squamous carcinoma cells through apoptosis and necrosis. J Oral Pathol Med. 2012;41(7):540–6.

    CAS  PubMed  Google Scholar 

  • Aldara Z. Imiquimod. Drug information provided by gold standard. n.d.-a. Available from: https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-2108

  • Aldara. Package insert. Revised 03/2013. n.d.-b. Available from: http://www.almp.hr/upl/lijekovi/PIL/UP-I-530-09-10-01-451.pdf

  • Arevalo I, Tulliano G, Quispe A, et al. Role of imiquimod and parenteral meglumine antimoniate in the initial treatment of cutaneous leishmaniasis. Clin Infect Dis. 2007;44:1549–4.

    Article  CAS  PubMed  Google Scholar 

  • Babel N, Eibl N, Ulrich C, et al. Development of Kaposi's sarcoma under sirolimus-based immunosuppresion and successful treatment with imiquimod. Transpl Infect Dis. 2008;10:59–62.

    Article  CAS  PubMed  Google Scholar 

  • Badgewell C, Rosen T. Treatment of limited extent extramammary Paget’s disease with 5 percent imiquimod cream. Dermatol Online J. 2006;12(1):22.

    Google Scholar 

  • Barr KL, Konia TH, Fung MA. Lupus erythematosus-like imiquimod reaction: a diagnostic pitfall. J Cutan Pathol. 2011;38(4):346–50.

    PubMed  Google Scholar 

  • Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002;47:S209–11.

    Article  PubMed  Google Scholar 

  • Berman B, Harrison-Balestra C, Perez OA, et al. Treatment of keloid scars post-shave excision with imiquimod 5% cream: a prospective, double-blind, placebo-controlled pilot study. J Drugs Dermatol. 2009;8:455–8.

    PubMed  Google Scholar 

  • Bernstein DI, Spruance SL, Arora SS, Schroeder JL, Meng TC. Evaluation of imiquimod 5% cream to modify the natural history of herpes labialis: a pilot study. Clin Infect Dis. 2005;41:808–14.

    Article  CAS  PubMed  Google Scholar 

  • Burnett TJ, English JC, Ferris LK. Development of subacute cutaneous lupus erythematosus associated with the use of imiquimod to treat actinic keratoses. J Drugs Dermatol. 2010;9(8):1022–4.

    PubMed  Google Scholar 

  • Cação FM, Tanaka V, Messina MC, et al. Failure of imiquimod 5% cream to prevent recurrence of surgically excised trunk keloids. Dermatol Surg. 2009;35:629–33.

    Article  PubMed  Google Scholar 

  • Campanelli A, Lubbe J. Erosive cheilitis after application of imiquimod 5% cream. J Eur Acad Dermatol Venereol. 2007;21:1429–30.

    Article  CAS  PubMed  Google Scholar 

  • Celestin Schartz NE, Chevret S, Paz C, et al. Imiquimod 5% cream for treatment of HIV-negative Kaposi’s sarcoma skin lesions: a phase I to II, open-label trial in 17 patients. J Am Acad Dermatol. 2008;58(4):585–91.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines 2010. MMWR. 2010;59:1–110.

    Google Scholar 

  • Chakrabarty AK, Mraz S, Geisse JK, et al. Aphtous ulcers associated with imiquimod and the treatment of actinic cheilitis. J Am Acad Dermatol. 2005;52:35–7.

    Article  PubMed  Google Scholar 

  • Chan MP, Zimarowski MJ. Lupus erythematosus-like reaction in imiquimod-treated skin: a report of 2 cases. Am J Dermatopathol. 2011;33(5):523–7.

    Article  PubMed  Google Scholar 

  • Chen B, Li H, Xia W. Imiquimod regulating Th1 and Th2 cell-related chemokines to inhibit scar hyperplasia. Int Wound J. 2019;16(6):1281–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen PR, Schulze KE, Tschen JA, et al. Treatment of extramammary Paget's disease with topical imiquimod cream: case report and literature review. South Med J. 2006;99:396–402.

    Article  PubMed  Google Scholar 

  • Daayana S, Elkord E, Winters U, et al. Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia. Br J Cancer. 2010;102(7):1129–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Deen K, Burdon-Jones D. Imiquimod in the treatment of penile intraepithelial neoplasia: an update. Australas J Dermatol. 2017;58(2):86–92.

    Article  PubMed  Google Scholar 

  • Deeths MJ, Chapman JT, Dellavalle RP, et al. Treatment of patch and plaque stage mycosis fungoides with imiquimod 5% cream. J Am Acad Dermatol. 2005;52(2):275–80.

    Article  PubMed  Google Scholar 

  • Edwards S, Boffa MJ, Janier M, Calzavara-Pinton P, Rovati C, Salavastru CM, Rongioletti F, Wollenberg A, Butacu AI, Skerlev M, Tiplica GS. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol. 2021;35(1):17–26. https://doi.org/10.1111/jdv.16856. Epub 2020 Sep 2. PMID: 32881110

    Article  CAS  PubMed  Google Scholar 

  • El Malki K, Karbach SH, Huppert J, et al. An alternative pathway of imiquimod-induced psoriasis-like skin inflammation in the absence of interleukin-17 receptor a signaling. J Invest Dermatol. 2013;133(2):441–51.

    Article  PubMed  Google Scholar 

  • Erickson C, Miller SJ. Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery. Int J Dermatol. 2010;49:482–91.

    Article  PubMed  Google Scholar 

  • Florin V, Desmedt E, Vercambre-Darras S, Mortier L. Topical treatment of cutaneous metastases of malignant melanoma using combined imiquimod and 5-fluorouracil. Invest New Drugs. 2012;30(4):1641–5.

    Article  CAS  PubMed  Google Scholar 

  • Garland SM. Imiquimod. Curr Opin Infect Dis. 2003;16(2):85–9.

    Article  CAS  PubMed  Google Scholar 

  • Gaspari AA, Tyring SK, Rosen T. Beyond a decade of 5% imiquimod topical therapy. J Drugs Dermatol. 2009;8(5):467–9.

    Google Scholar 

  • Gilliet M, Conrad C, Geiges M, et al. Psoriasis triggered by toll-like receptor 7 agonist imiquimod in the presence of dermal plasmacytoid dendritic cell precursors. Arch Dermatol. 2004;140(12):1490–5.

    Article  CAS  PubMed  Google Scholar 

  • Ho NT, Lansang P, Pope E. Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study. J Am Acad Dermatol. 2007;56(1):63–8.

    Article  PubMed  Google Scholar 

  • Huang SJ, Hijnen D, Murphy GF, et al. J Invest Dermatol. 2009;129(11):2676–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Husar K, Skerlev M. Molluscum contagiosum from infancy to maturity. Clin Dermatol. 2002;20(2):170–2.

    Article  PubMed  Google Scholar 

  • Jackson JM, Callen JP. Immunomodulators. In: Bolognia JL, Jorizzo JL, Schaeffer JV, editors. Dermatology, vol. 128. 3rd ed. Elsevier; 2012. p. 2131–52.

    Google Scholar 

  • Martínez-González MC, Verea-Hernando MM, Yebra-Pimentel MT, Del Pozo J, Mazaira M, Fonseca E. Imiquimod in mycosis fungoides. Eur J Dermatol. 2008;18(2):148–52.

    PubMed  Google Scholar 

  • Micali G, Dall’Oglio F, Nasca MR. An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts. J Dermatolog Treat. 2003;14(4):233–6.

    Article  CAS  PubMed  Google Scholar 

  • Miller RL, Gerster JF, Owens ML, et al. Imiquimod applied topically: a novel immune response modifier and new class of drug. Int J Immunopharmacol. 1999;21:1–14.

    Article  CAS  PubMed  Google Scholar 

  • Myhre PE, Levy ML, Eichenfield LF, et al. Pharmacokinetics and safety of imiquimod 5% cream in the treatment of molluscum contagiosum in children. Pediatr Dermatol. 2008;25(1):88–95.

    Article  PubMed  Google Scholar 

  • Naylor MF, Crowsen N, Kuwahara R, et al. Treatment of lentigo maligna with topical imiquimod. Br J Dermatol. 2003;149(Suppl 66):66–70.

    Article  CAS  PubMed  Google Scholar 

  • O’Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras-Alonso ME, Majewski S. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol. 2019;33(6):1006–19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Odyakmaz Demirsoy E, Bayramgürler D, Çağlayan Ç, Bilen N, Şikar Aktürk A, Kıran R. Imiquimod 5% cream versus cryotherapy in classic Kaposi Sarcoma. J Cutan Med Surg. 2019 Oct;23(5):488–95.

    Article  CAS  PubMed  Google Scholar 

  • O'Mahony C, Yesudian PD, Stanley M. Imiquimod use in the genital area and development of lichen sclerosus and lichen planus. Int J STD AIDS. 2010;21(3):219–21.

    Article  CAS  PubMed  Google Scholar 

  • Papanikolaou M, Lawrence CM. Long-term outcomes of imiquimod-treated lentigo maligna. Clin Exp Dermatol. 2019;44(6):631–6.

    Article  CAS  PubMed  Google Scholar 

  • Patel GK, Goodwin R, Chawla M, et al. Imiquimod 5% cream monotherapy for cutaneous squamous cell carcinoma in situ (Bowen’s disease): a randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2006;54:1025–32.

    Article  PubMed  Google Scholar 

  • Peris K, Micantonio T, Fargnoli MC, et al. Imiquimod 5% cream in the treatment of Bowen’s disease and invasive squamous cell carcinoma. J Am Acad Dermatol. 2006;55(2):324–7.

    Article  PubMed  Google Scholar 

  • Powell AM, Russell-Jones R, Barlow RJ. Topical imiquimod immunotherapy in the management of lentigo maligna. Clin Exp Dermatol. 2004;29:15–21.

    Article  CAS  PubMed  Google Scholar 

  • Prins RM, Craft N, Bruhn KW, et al. The TLR-7 agonist, imiquimod, enhances dendritic cell survival and promotes tumor antigen-specific T cell priming: relation to central nervous system antitumor immunity. J Immunol. 2006;176(1):157–64.

    Article  CAS  PubMed  Google Scholar 

  • Rajpar SF, Marsden JR. Imiquimod in the treatment of lentigo maligna. Br J Dermatol. 2006;155:653–6.

    Article  CAS  PubMed  Google Scholar 

  • Rosen T, Harting M, Gibson M. Treatment of Bowen’s disease with topical 5% imiquimod cream: retrospective study. Dermatol Surg. 2007;33(4):427–31.

    CAS  PubMed  Google Scholar 

  • Schacker TW, Conant M, Thoming C, et al. Imiquimod 5-percent cream does not alter the natural history of recurrent herpes genitalis: a phase II, randomized, double-blind, placebo-controlled study. Antimicrob Agents Chemother. 2002;46:3243–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schön MP, Schön M. The small-molecule immune response modifier imiquimod-its mode of action and clinical use in the treatment of skin cancer. Expert Opin Ther Targets. 2006;10(1):69–76.

    Article  PubMed  Google Scholar 

  • Schön MP, Schön M. Imiquimod: mode of action. Br J Dermatol. 2007;157(Suppl 2):8–13.

    Article  PubMed  Google Scholar 

  • Sheth PB, Landis MN. Topical and intralesional antiviral drugs. In: Wolverton SE, Arlook T, editors. Comprehensive dermatologic drug therapy, vol. 38. 3rd ed. Elsevier Inc.; 2013. p. 473–80.e3.

    Chapter  Google Scholar 

  • Shibata S, Tada Y, Asano Y, et al. IL-27 activates Th1-mediated responses in imiquimod-induced psoriasis-like skin lesions. J Invest Dermatol. 2013;133(2):479–88.

    Article  CAS  PubMed  Google Scholar 

  • Skerlev M, Husar K. Mollusca Contagiosa. In: Gross G, Tyring SK, editors. Sexually transmitted infections and sexually transmitted diseases. 1st ed. Berlin: Springer; 2011. p. 547–52.

    Chapter  Google Scholar 

  • Suchin KR, Junkins-Hopkins JM, Rook AH, et al. Treatment of stage IA cutaneous T-cell lymphoma with topical application of the immune response modifier imiquimod. Arc Dermatol. 2002;138:1137–9.

    Article  Google Scholar 

  • Suzuki H, Wang B, Shivji GM, et al. Imiquimod, a topical immune response modifier, induces migration of Langerhans cells. J Invest Dermatol. 2000;114:135–41.

    Article  CAS  PubMed  Google Scholar 

  • Theos AM, Cummings R, Silverberg NB, et al. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis. 2004;74:141–2.

    Google Scholar 

  • Tio DCKS, van Montfrans C, Ruijter CGH, Hoekzema R, Bekkenk MW. Effectiveness of 5% topical imiquimod for lentigo Maligna treatment. Acta Derm Venereol. 2019;99(10):884–8.

    Article  PubMed  Google Scholar 

  • Vacarro M, Barbuzza O, Guarneri B, et al. Erosive pustular dermatosis of the scalp following treatment with topical imiquimod for actinic keratosis. Arch Dermatol. 2009;145:1340–1.

    Article  Google Scholar 

  • van Seters M, van Beurden M, ten Kate F, et al. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med. 2008;358:1465–73.

    Article  PubMed  Google Scholar 

  • Vidal D, Matías-Guiu X, Alomar A. Efficacy of imiquimod for the expression of Bcl-2, Ki67, p53 and basal cell carcinoma apoptosis. Br J Dermatol. 2004;151(3) Available from: http://www.medscape.com/viewarticle/489949

  • Wolf IH, Smolle J, Binder B, et al. Topical imiquimod in the treatment of metastatic melanoma to skin. Arch Dermatol. 2003;139:273–6.

    Article  PubMed  Google Scholar 

  • Zyclara. Package insert. n.d. Revised 02/2012. Available from: http://www.zyclaracream.com/files/zyclara_pi.pdf

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Skerlev, M., Košćak, I.Č., Hadžavdić, S.L., Sirotković-Skerlev, M. (2023). Imiquimod. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D'Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Cham. https://doi.org/10.1007/978-3-031-15130-9_149

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