An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts.
BACKGROUND
Periungual and subungual warts are very difficult to eradicate with current therapies. Most are destructive in nature (liquid nitrogen, cantharidin, vascular lesion laser) and inflammation, pain and pigment dyschromia are common side effects. Furthermore, failure to respond or appearance of new lesions often leads to even more destructive treatments (CO(2) laser, excisional surgery) and can lead to more pain and scarring.


METHODS
In an open trial, the efficacy, safety, and tolerability of topical imiquimod 5% cream was assessed in 15 patients with resistant and recurrent periungual and subungual warts over a 16 week period.


RESULTS
Twelve patients (80%) completed therapy, showing complete resolution after a mean time of three weeks (range 1-6 weeks), with the remaining three patients (20%) being classified as non-responders. Local side effects (erythema, pruritus, burning and pain) were generally mild and well-tolerated. No relapses occurred during a 6-month follow-up.


CONCLUSIONS
Topical imiquimod is an interesting novel treatment for multiple periungual and subungual warts. Tolerability is excellent when compared to other commonly used modalities and there are few side effects. This trial suggests a high clinical response rate. This treatment is applicable to patients who have failed conventional therapies before embarking on potentially scarring approaches such as excisional surgery.
Micali
G
G
Dermatology Clinic, University of Catania, Piazza S. Agata La Vetere 6, 95124 Catania, Italy. cldermct@nti.it
Dall'Oglio
F
F
Nasca
M R
MR
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000634:Aminoquinolines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004643:Emollients; D005260:Female; D005500:Follow-Up Studies; D006229:Hand Dermatoses / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000175:diagnosis / Q000188:drug therapy*; D016879:Salvage Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014860:Warts / Q000175:diagnosis / Q000188:drug therapy*
D000634:Aminoquinolines; D004643:Emollients; D000077271:Imiquimod