title: Treatment of Imiquimod Resistant Epidermodysplasia Verruciformis With Ingenol Mebutate.
abstract: BACKGROUND
  Epidermodysplasia verruciformis (EV) is a rare genetic disorder characterized by widespread human papillomavirus (HPV) associated lesions and an increase susceptibility to cutaneous malignancies. A host of medications traditionally used to treat warty lesions have been used with variable results and limited success. To our knowledge, we describe the first reported case of a patient with Imiquimod resistant EV successfully treated with topical ingenol mebutate (Picato).
  
  
  METHODS
  A patient with a 5 year history of EV failed to respond to a 6 week course of 5% imiquimod on the forehead and was subsequently treated with a 3 day course of 0.015% Picato gel which resulted in significant clinical improvement. A one month follow-up examination showed no reoccurrence of the lesions with the patient reporting continued satisfaction of the outcome.
  
  
  CONCLUSIONS
  Our case provides insight into the potential use of ingenol mebutate for EV patients unresponsive to traditional medical treatments.
authors.forename: Carey
authors.initials: C
authors.lastname: Kim
authors.forename: Pantea
authors.initials: P
authors.lastname: Hashemi
authors.forename: Michael
authors.initials: M
authors.lastname: Caglia
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
mesh_terms: D017255:Acitretin / Q000627:therapeutic use; D000328:Adult; D000634:Aminoquinolines / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D004224:Diterpenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004819:Epidermodysplasia Verruciformis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005782:Gels; D006801:Humans; D000077271:Imiquimod; D007641:Keratolytic Agents / Q000627:therapeutic use; D035583:Rare Diseases / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use
chemical_list: C486592:3-ingenyl angelate; D000634:Aminoquinolines; D000970:Antineoplastic Agents; D004224:Diterpenes; D005782:Gels; D007641:Keratolytic Agents; D014212:Tretinoin; D017255:Acitretin; D000077271:Imiquimod