Successful treatment of multiple actinic keratoses in organ transplant patients with topical 5% imiquimod: a report of six cases.
BACKGROUND
Nonmelanoma skin cancer represents a significant cause of morbidity in organ transplant recipients (OTRs). Cutaneous malignancies, mainly invasive squamous cell carcinoma and its precursor actinic keratosis (AK), appear approximately 5-10 years after organ transplantation. Impaired wound healing and high recurrence rates in immunocompromised patients treated with destructive therapies such as cryosurgery or topical 5-fluorouracil represent frequently known complications.


OBJECTIVE
To evaluate the safety and efficacy of imiqimod 5% in the treatment of AKs in OTRs.


METHODS
Six OTRs (two kidney, two heart, one lung and one liver) with extensive AKs were treated with imiquimod 5% cream two to three times weekly in an open-label uncontrolled, nonrandomized pilot study.


RESULTS
In five of six patients treated with imiquimod 5% cream all AK lesions were cleared after 12-16 weeks. One patient showed partial response. Local adverse events at the site of application included erythema, oedema and mild erosion. No wound infection or scarring was observed in any of these patients. All graft-related laboratory parameters were stable during and after treatment. Immunosuppressive therapy remained unchanged throughout the treatment.


CONCLUSIONS
These results suggest that imiquimod 5% cream may be useful for the local treatment of precancerous AK lesions in OTRs.
Ulrich
C
C
Department of Dermatology, University of Humboldt, Schittenhelmstrasse 7, Berlin, Germany.
Busch
J O
JO
Meyer
T
T
Nindl
I
I
Schmook
T
T
Sterry
W
W
Stockfleth
E
E
D000279:Administration, Cutaneous; D000368:Aged; D000634:Aminoquinolines / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D000077271:Imiquimod; D016867:Immunocompromised Host; D007155:Immunologic Factors / Q000627:therapeutic use*; D007642:Keratosis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D019737:Transplants; D016896:Treatment Outcome
D000634:Aminoquinolines; D007155:Immunologic Factors; D000077271:Imiquimod