Case and Research Letters
Efficacy of Topical Imiquimod 5% in a Patient with Chronic Radiodermatitis on the Hands
Eficacia de imiquimod tópico al 5% en paciente con radiodermitis crónica en las manos
Servicios de Dermatología, Hospital Clínico Universitario, Valencia, Spain
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López, V. Alonso, E. Jordá" "autores" => array:3 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "López" "email" => array:1 [ 0 => "veronica_17@live.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Alonso" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Jordá" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Dermatología, Hospital Clínico Universitario, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia de imiquimod tópico al 5% en paciente con radiodermitis crónica en las manos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 127916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical image after treatment with imiquimod cream, 5%.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic radiodermatitis is defined as a chronic inflammation of the skin associated with exposure to ionizing radiation. It usually presents in individuals who, because of their profession, have been repeatedly exposed to low doses of radiation over a long period of time without appropriate protection.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several treatments have been described, including topical 5-fluorouracil, dermabrasion, ablative laser, photodynamic therapy, and surgery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2006 Sachse et al. described the use of imiquimod in a 60-year-old patient with chronic thoracic radiodermatitis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a 69-year-old male radiologist referred to our clinic for assessment of skin lesions that had appeared 2 years earlier on the dorsum of the fingers of both hands. The patient had performed fluoroscopy in clinical practice for 25 years without wearing gloves or using other recommended protective measures.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed skin atrophy, poikiloderma, loss of skin adnexa, ulcerations, and hyperkeratotic lesions on the dorsum of several fingers of both hands with nail involvement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Several of the lesions were biopsied. Histologic findings in the specimen taken from the third finger of the left hand were compatible with actinic keratosis, and the changes observed in the specimen taken from the third finger of the right hand were conclusive for squamous cell carcinoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After informing the patient of the treatment options, a 4-week cycle of imiquimod cream, 5% was prescribed to reduce the number of lesions, with application 3 times a week. Tolerance was good and the number of lesions had decreased significantly by the end of the cycle (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Because the lesion on the third finger of his left hand persisted, the patient was referred to the traumatology department, where the distal phalanx of the affected finger was amputated.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Imiquimod (Aldara) is an immune response modulator belonging to the family of imidazoquinolines. Topical imiquimod stimulates the innate and acquired immune responses.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> By binding to toll-like receptor 7, this drug activates immune cells, inducing the secretion of numerous cytokines with a potential antitumor effect, such as interferon α, tumor necrosis factor α, and interleukin 12.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In vitro studies have shown that, in addition to its antitumor activity, imiquimod also has anti-inflammatory, proapoptotic, and antiangiogenic properties.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Topical imiquimod has been approved for the treatment of actinic keratosis, some subtypes of basal cell carcinoma, and papillomavirus infections.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, in clinical practice it has been reported to be effective in Bowen disease, in situ squamous cell carcinoma, lentigo maligna, Kaposi sarcoma, skin metastases of melanoma, and keloids of the ear.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–10</span></a> Recently, Sachse et al. reported the efficacy of imiquimod in a patient with chronic radiodermatitis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Chronic radiodermatitis, a chronic inflammation of the skin associated with exposure to ionizing radiation, is most common in patients who have not used the recommended protection measures. The progression and degree of chronic radiodermatitis is determined by the quality and intensity of the radiation. Generally, a dose higher than 12 to 15<span class="elsevierStyleHsp" style=""></span>Gy will cause chronic radiodermatitis<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but repeated exposure to lower doses may also produce lesions of this type.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The first clinical sign of radiodermatitis is skin atrophy: the skin becomes thin, dry, and often hyperkeratotic. Partial or complete loss of skin adnexa may also be observed. However, the most serious problem of chronic exposure to ionizing radiation is the development of precancerous lesions and skin cancers such as squamous cell carcinoma.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Several types of treatment have been described, including topical 5-fluorouracil, dermabrasion, ablative laser therapy, photodynamic therapy, surgery, and topical imiquimod.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Because of the nature of the site, the treatment of the dorsal surfaces of the hands may be problematic. Imiquimod may therefore offer a good alternative for treating or reducing the number of lesions prior to other treatments because it is easy to apply, is well tolerated by patients, and has few adverse effects. In conclusion, we present the case of a patient with chronic radiodermatitis on the dorsum of both hands which responded well to treatment with topical imiquimod.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López V, et al. Eficacia de imiquimod tópico al 5% en paciente con radiodermitis crónica en las manos. Actas Dermosifiliogr. 2012;103:441-2.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 136507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image before treatment with imiquimod, showing hyperkeratosis and ulcerations on the fingers of both hands.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 951 "Tamanyo" => 127916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical image after treatment with imiquimod cream, 5%.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic X-ray dermatitis treated by topical 5-aminolaevulinic acid-photodynamic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 13 | 23 |
| 2024 October | 59 | 40 | 99 |
| 2024 September | 67 | 23 | 90 |
| 2024 August | 87 | 63 | 150 |
| 2024 July | 79 | 31 | 110 |
| 2024 June | 78 | 34 | 112 |
| 2024 May | 78 | 31 | 109 |
| 2024 April | 71 | 22 | 93 |
| 2024 March | 74 | 24 | 98 |
| 2024 February | 68 | 31 | 99 |
| 2024 January | 49 | 30 | 79 |
| 2023 December | 66 | 11 | 77 |
| 2023 November | 67 | 28 | 95 |
| 2023 October | 69 | 23 | 92 |
| 2023 September | 88 | 34 | 122 |
| 2023 August | 67 | 19 | 86 |
| 2023 July | 70 | 34 | 104 |
| 2023 June | 53 | 23 | 76 |
| 2023 May | 87 | 28 | 115 |
| 2023 April | 65 | 15 | 80 |
| 2023 March | 88 | 21 | 109 |
| 2023 February | 49 | 19 | 68 |
| 2023 January | 39 | 27 | 66 |
| 2022 December | 63 | 32 | 95 |
| 2022 November | 28 | 24 | 52 |
| 2022 October | 32 | 17 | 49 |
| 2022 September | 39 | 32 | 71 |
| 2022 August | 45 | 31 | 76 |
| 2022 July | 54 | 33 | 87 |
| 2022 June | 53 | 28 | 81 |
| 2022 May | 76 | 36 | 112 |
| 2022 April | 71 | 46 | 117 |
| 2022 March | 55 | 53 | 108 |
| 2022 February | 50 | 29 | 79 |
| 2022 January | 59 | 45 | 104 |
| 2021 December | 43 | 33 | 76 |
| 2021 November | 55 | 39 | 94 |
| 2021 October | 63 | 49 | 112 |
| 2021 September | 60 | 46 | 106 |
| 2021 August | 56 | 34 | 90 |
| 2021 July | 51 | 26 | 77 |
| 2021 June | 68 | 43 | 111 |
| 2021 May | 66 | 49 | 115 |
| 2021 April | 100 | 60 | 160 |
| 2021 March | 102 | 26 | 128 |
| 2021 February | 78 | 33 | 111 |
| 2021 January | 48 | 23 | 71 |
| 2020 December | 45 | 35 | 80 |
| 2020 November | 26 | 19 | 45 |
| 2020 October | 31 | 12 | 43 |
| 2020 September | 26 | 16 | 42 |
| 2020 August | 33 | 26 | 59 |
| 2020 July | 24 | 15 | 39 |
| 2020 June | 29 | 30 | 59 |
| 2020 May | 16 | 20 | 36 |
| 2020 April | 39 | 30 | 69 |
| 2020 March | 29 | 22 | 51 |
| 2020 February | 8 | 0 | 8 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 5 | 3 | 8 |
| 2019 November | 4 | 4 | 8 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 10 | 2 | 12 |
| 2019 August | 4 | 1 | 5 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 3 | 21 | 24 |
| 2019 May | 6 | 36 | 42 |
| 2019 April | 2 | 17 | 19 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 2 | 3 | 5 |
| 2018 December | 5 | 0 | 5 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 8 | 0 | 8 |
| 2018 April | 0 | 1 | 1 |
| 2018 February | 38 | 7 | 45 |
| 2018 January | 128 | 9 | 137 |
| 2017 December | 110 | 11 | 121 |
| 2017 November | 45 | 8 | 53 |
| 2017 October | 40 | 8 | 48 |
| 2017 September | 35 | 12 | 47 |
| 2017 August | 67 | 16 | 83 |
| 2017 July | 44 | 4 | 48 |
| 2017 June | 57 | 9 | 66 |
| 2017 May | 65 | 9 | 74 |
| 2017 April | 60 | 42 | 102 |
| 2017 March | 50 | 8 | 58 |
| 2017 February | 71 | 5 | 76 |
| 2017 January | 43 | 4 | 47 |
| 2016 December | 52 | 13 | 65 |
| 2016 November | 78 | 8 | 86 |
| 2016 October | 106 | 8 | 114 |
| 2016 September | 196 | 8 | 204 |
| 2016 August | 111 | 8 | 119 |
| 2016 July | 43 | 6 | 49 |
| 2016 June | 11 | 15 | 26 |
| 2016 May | 11 | 3 | 14 |
| 2016 April | 11 | 10 | 21 |
| 2016 March | 12 | 7 | 19 |
| 2016 February | 12 | 3 | 15 |
| 2016 January | 9 | 1 | 10 |
| 2015 December | 15 | 0 | 15 |
| 2015 November | 19 | 6 | 25 |
| 2015 October | 29 | 2 | 31 |
| 2015 September | 23 | 5 | 28 |
| 2015 August | 14 | 7 | 21 |
| 2015 July | 112 | 8 | 120 |
| 2015 June | 75 | 5 | 80 |
| 2015 May | 71 | 9 | 80 |
| 2015 April | 78 | 8 | 86 |
| 2015 March | 70 | 6 | 76 |
| 2015 February | 77 | 6 | 83 |
| 2015 January | 75 | 16 | 91 |
| 2014 December | 59 | 6 | 65 |
| 2014 November | 66 | 11 | 77 |
| 2014 October | 89 | 17 | 106 |
| 2014 September | 70 | 7 | 77 |
| 2014 August | 89 | 13 | 102 |
| 2014 July | 96 | 17 | 113 |
| 2014 June | 68 | 12 | 80 |
| 2014 May | 56 | 5 | 61 |
| 2014 April | 59 | 2 | 61 |
| 2014 March | 52 | 12 | 64 |
| 2014 February | 44 | 7 | 51 |
| 2014 January | 45 | 9 | 54 |
| 2013 December | 47 | 8 | 55 |
| 2013 November | 45 | 14 | 59 |
| 2013 October | 25 | 11 | 36 |
| 2013 September | 34 | 12 | 46 |
| 2013 August | 42 | 9 | 51 |
| 2013 July | 18 | 39 | 57 |
| 2013 June | 9 | 32 | 41 |
| 2013 May | 14 | 18 | 32 |
| 2013 April | 11 | 17 | 28 |
| 2013 March | 22 | 9 | 31 |
| 2013 February | 46 | 10 | 56 |
| 2013 January | 48 | 5 | 53 |
| 2012 December | 17 | 5 | 22 |
| 2012 November | 1 | 2 | 3 |
| 2012 October | 0 | 2 | 2 |
| 2012 August | 2 | 1 | 3 |
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