Imiquimod cream 5% for recalcitrant cutaneous warts in immunosuppressed individuals.
BACKGROUND
Viral warts may cause significant morbidity in individuals unable to mount an adequate T-helper 1 cell-mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established.


OBJECTIVE
To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals.


METHODS
Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks).


RESULTS
Twelve (80%) patients completed the study protocol. Benefit was seen in five patients [36% in the intent-to-treat analysis (14 patients)], including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29%) patients and were usually mild. A transient rise in creatinine (11-29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure.


CONCLUSIONS
This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.
Harwood
C A
CA
Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, 2 Newark Street, London, E1 2AT, UK. caharwood@doctors.org.uk
Perrett
C M
CM
Brown
V L
VL
Leigh
I M
IM
McGregor
J M
JM
Proby
C M
CM
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000634:Aminoquinolines / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006229:Hand Dermatoses / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006801:Humans; D000077271:Imiquimod; D016867:Immunocompromised Host; D007369:Interferon Inducers / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012646:Self Administration; D016896:Treatment Outcome; D014860:Warts / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology
D000634:Aminoquinolines; D000998:Antiviral Agents; D007369:Interferon Inducers; D000077271:Imiquimod