Cases and Research Letters
Sustained Remission of Extramammary Paget Disease Following Treatment with Imiquimod 5% Cream
Remisión mantenida de la enfermedad de Paget extramamaria tras tratamiento con imiquimod al 5% en crema
P. Herranz, E. Sendagorta
, M. Feito, C. Gómez-Fernandez
Corresponding author
Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
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Herranz, E. Sendagorta, M. Feito, C. Gómez-Fernandez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Herranz" ] 1 => array:4 [ "nombre" => "E." "apellidos" => "Sendagorta" "email" => array:1 [ 0 => "elenasendagorta@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Feito" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Gómez-Fernandez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Remisión mantenida de la enfermedad de Paget extramamaria tras tratamiento con imiquimod al 5% en crema" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 960 "Ancho" => 951 "Tamanyo" => 184966 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque with whitish patches and erosions on the right labium majus of the vulva.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The recent report by Hiraldo-Gamero et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the use of 5% imiquimod cream to treat extramammary Paget disease (EMPD) confirms the growing interest in this new nonsurgical treatment option for this disease. In 2009 we reported the results obtained in the treatment of 3 cases of EMPD of the vulva with clinical and pathologic features similar to those described by Hiraldo-Gamero.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The 3 patients, aged 66, 58, and 82 years, had vulvar lesions up to 5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In all 3 cases, the results of multiple biopsies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) revealed exclusively intraepidermal involvement, and exhaustive screening ruled out the possibility of underlying malignancy. Bearing in mind the comorbid conditions present in each case, treatment with imiquimod was chosen to avoid the risks associated with surgical excision, the approach traditionally used to treat such tumors. The regimen used was once daily application of 5% imiquimod cream for 3 weeks followed by application on alternate days for a further 13 weeks. All 3 patients completed treatment despite episodes of inflammation and moderate pain. Control biopsies were performed at 6 and 12 months. The 3 patients were followed up clinically every 3 months for 1 year after treatment and every 6 months thereafter. At the time of writing, they have completed a follow-up period of 53 months and remain in complete remission (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Green et al.,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> who recently reviewed reports in the literature on the use of imiquimod in EMPD, found complete remission of the disease in 21 of the 27 reported cases (78%). The factors that influence the success or failure of imiquimod therapy in this setting have not yet been clearly established. Factors that might explain the variability of response to treatment include the size of the lesion, its variable thickness in different areas, and the presence of extensive adnexal involvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We agree with Hiraldo-Gamero that the small number of published cases makes it difficult to draw conclusions concerning the efficacy and safety of 5% imiquimod cream in selected cases of EMPD. Our report provides additional evidence on the medium-term safety of this treatment and represents the longest follow-up period free of disease reported in the dermatologic literature.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Herranz P, Sendagorta E, Feito M, Gómez-Fernandez C. Remisión mantenida de la enfermedad de Paget extramamaria tras tratamiento con imiquimod al 5% en crema. Actas Dermosifiliogr.2012;103:742-743.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 960 "Ancho" => 951 "Tamanyo" => 184966 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque with whitish patches and erosions on the right labium majus of the vulva.</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" => 715 "Ancho" => 951 "Tamanyo" => 276745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cells with abundant clear cytoplasm and pleomorphic nuclei (Paget cells) distributed throughout the full thickness of the epidermis. Immunohistochemical stains were positive for carcinoembryonic antigen, epithelial membrane antigen, and cytokeratin 7.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1279 "Ancho" => 951 "Tamanyo" => 254468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the lesions 3 months after completion of treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extramammary Paget disease treated with 5% Imiquimod cream" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Hiraldo-Gamero" 1 => "E. Gómez-Moyano" 2 => "J.M. Segura-Palacios" 3 => "F. Sánchez-Fajardo" 4 => "A. Sanz Trelles" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "554" "paginaFinal" => "556" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod-proposal of a therapeutic schedule" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Sendagorta" 1 => "P. Herranz" 2 => "M. Feito" 3 => "P. Ramírez" 4 => "U. Floristán" 5 => "R. Feltes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2009.03451.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "490" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19840203" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Failure of extensive extramammary paget disease of the inguinal area to clear with imiquimod cream 5%, possible progression to invasive disease during therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.S. Green" 1 => "N.M. Burkemper" 2 => "S.W. Fosko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2011.121" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2011" "volumen" => "147" "paginaInicial" => "704" "paginaFinal" => "708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21690533" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000008/v1_201304241323/S1578219012002600/v1_201304241323/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000008/v1_201304241323/S1578219012002600/v1_201304241323/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012002600?idApp=UINPBA000044" ]
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| 2017 May | 31 | 7 | 38 |
| 2017 April | 23 | 9 | 32 |
| 2017 March | 22 | 6 | 28 |
| 2017 February | 21 | 10 | 31 |
| 2017 January | 25 | 15 | 40 |
| 2016 December | 27 | 20 | 47 |
| 2016 November | 36 | 10 | 46 |
| 2016 October | 45 | 12 | 57 |
| 2016 September | 39 | 12 | 51 |
| 2016 August | 48 | 14 | 62 |
| 2016 July | 43 | 18 | 61 |
| 2016 June | 21 | 23 | 44 |
| 2016 May | 12 | 9 | 21 |
| 2016 April | 10 | 3 | 13 |
| 2016 March | 8 | 1 | 9 |
| 2016 February | 7 | 2 | 9 |
| 2016 January | 13 | 1 | 14 |
| 2015 December | 23 | 4 | 27 |
| 2015 November | 17 | 5 | 22 |
| 2015 October | 20 | 2 | 22 |
| 2015 September | 18 | 3 | 21 |
| 2015 August | 16 | 1 | 17 |
| 2015 July | 232 | 12 | 244 |
| 2015 June | 201 | 6 | 207 |
| 2015 May | 214 | 15 | 229 |
| 2015 April | 178 | 10 | 188 |
| 2015 March | 209 | 13 | 222 |
| 2015 February | 185 | 8 | 193 |
| 2015 January | 119 | 20 | 139 |
| 2014 December | 106 | 9 | 115 |
| 2014 November | 111 | 12 | 123 |
| 2014 October | 154 | 25 | 179 |
| 2014 September | 96 | 6 | 102 |
| 2014 August | 93 | 5 | 98 |
| 2014 July | 87 | 6 | 93 |
| 2014 June | 98 | 5 | 103 |
| 2014 May | 118 | 10 | 128 |
| 2014 April | 121 | 4 | 125 |
| 2014 March | 106 | 8 | 114 |
| 2014 February | 75 | 8 | 83 |
| 2014 January | 91 | 7 | 98 |
| 2013 December | 103 | 2 | 105 |
| 2013 November | 74 | 13 | 87 |
| 2013 October | 86 | 6 | 92 |
| 2013 September | 74 | 6 | 80 |
| 2013 August | 62 | 6 | 68 |
| 2013 July | 13 | 13 | 26 |
| 2013 June | 7 | 7 | 14 |
| 2013 May | 7 | 6 | 13 |
| 2013 April | 22 | 18 | 40 |
| 2013 March | 17 | 6 | 23 |
| 2013 February | 63 | 10 | 73 |
| 2013 January | 112 | 9 | 121 |
| 2012 December | 53 | 7 | 60 |
| 2012 November | 6 | 6 | 12 |
| 2012 October | 1 | 7 | 8 |
Show all
