Case and Research Letter
Hypertrophic and Keloid Scars After the Application of 5% Imiquimod Cream: A Report of 2 Cases
Cicatriz hipértrofica y queloide después de la aplicación de imiquimod 5% crema. A propósito de 2 casos
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A propósito de 2 casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "795" "paginaFinal" => "797" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hypertrophic and Keloid Scars After the Application of 5% Imiquimod Cream: A Report of 2 Cases" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 532 "Ancho" => 1500 "Tamanyo" => 97220 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Primera revisión del paciente después de aplicar imiquimod, donde se aprecia una lesión lineal sobreelevada. B y C. 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Márquez García, T. Ojeda Vila, L. Ferrándiz Pulido, J.J. Ríos Martín" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Márquez García" "email" => array:1 [ 0 => "ana_marquez54@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "T." "apellidos" => "Ojeda Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Ferrándiz Pulido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.J." "apellidos" => "Ríos Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cicatriz hipértrofica y queloide después de la aplicación de imiquimod 5% crema. A propósito de 2 casos" ] ] "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" => 1437 "Ancho" => 1801 "Tamanyo" => 327696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Basal cell carcinoma; image taken before starting treatment. B, Large, indurated plaque with 3 linear elastic elements; image taken 2 months after starting imiquimod treatment. C, The lesion persists, but with reduced erythema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Imiquimod 5% is a drug approved by the US Food and Drug Administration (FDA) for the topical treatment of genital warts, actinic keratosis, and basal cell carcinoma (BCC). While this drug is commonly used in daily clinical practice, no reports to date have associated its administration with alterations in scar formation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe 2 cases of abnormal scar formation after treatment with imiquimod 5% cream.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Patient 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 32-year-old man with no drug allergies and no relevant past medical or surgical history. He presented with a lesion in the right pectoral region that had developed 2 years previously and had been treated with antifungals for a suspected fungal infection. Examination revealed an erythematous desquamative plaque of 2<span class="elsevierStyleHsp" style=""></span>cm in diameter consistent with Bowen disease. The patient was treated with imiquimod 5% cream once daily, Monday through Friday, for 6 weeks. Sixty days after starting treatment the patient developed in the treated area a raised, pearly, linear lesion with superficial telangiectasias, surrounded by a halo of atrophic and hypopigmented skin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Based on these findings it was decided to perform a skin biopsy of the lesion for histopathological analysis. This revealed a focally granulomatous, nonspecific, chronic inflammatory process, with fibrotic scarring and the absence of malignant neoplastic elements, ruling out a tumoral process and leading to a diagnosis of hypertrophic scarring.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment with topical corticosteroids and silicone gel sheets resulted in flattening of the lesion and a reduction in both pruritus and telangiectasias, but hypochromia and atrophy persisted 9 months after treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1</a>B and 3C).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was a 71-year-old woman with no known drug allergies and a medical history of dyslipidemia, osteoarthritis, and pollinosis. She had no past surgical history. She presented with a pearly lesion of 1<span class="elsevierStyleHsp" style=""></span>cm in diameter in the left pectoral region that had developed 2 years previously. Dermoscopy revealed central keratosis and thick telangiectasias (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A diagnosis of superficial BCC was established and treatment was initiated with imiquimod 5% cream once daily, Monday through Friday, for 6 weeks.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Two months later the patient developed an erythematous, indurated, and slightly painful plaque containing 3 branched linear elements of elastic consistency. The plaque was 7<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>cm in diameter, extending beyond the area of the initial tumor. A clinical diagnosis of keloid after application of imiquimod 5% cream was established (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment with topical corticosteroids for 2 months resulted only in a reduction in erythema (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Imiquimod 5% cream is indicated for genital warts, superficial BCC, and actinic keratosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, its off-label use in numerous dermatologic conditions has produced favorable results.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The most common local secondary effects are erythema, pruritus, burning, ulceration, erosion, crusting, and flaking, and the most commonly described systemic symptoms are headache, fatigue, fever, malaise, pains, nausea, diarrhea, and joint pain.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Imiquimod has been proposed as an alternative treatment in areas in which surgery is technically difficult, specifically because of the better aesthetic results obtained. It has even been proposed for the treatment of hypertrophic scars and keloids.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> However, it is important to be aware that inflammation is often associated with imiquimod administration. This inflammatory reaction, which varies in intensity and nature, can even cause hypertrophic scars or keloids in anatomic areas that are prone to scarring (pectoral region, sternum, clavicle, etc.)</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the cases described here the lesions were located on the anterior surface of the chest. This area is prone to hypertrophic scarring and keloids, which should be borne in mind when prescribing imiquimod in these locations.</p><p id="par0060" class="elsevierStylePara elsevierViewall">As neither of the patients had any relevant history of surgery or trauma, it was impossible to ascertain their predisposition to impaired scar formation. However, both patients developed severe inflammation in keloid-prone areas, which may account for the observed clinical course.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Márquez García A, Ojeda Vila T, Ferrándiz L, Ríos Martín JJ. Cicatriz hipértrofica y queloide después de la aplicación de imiquimod 5% crema. A propósito de 2 casos. Actas Dermosifiliogr. 2014;105:795–797.</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" => 532 "Ancho" => 1501 "Tamanyo" => 100598 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, First examination of the patient after imiquimod administration. A raised linear lesion can be seen. B and C, Examination of the patient at 6 and 9 months, respectively. Note the improvement after treatment.</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" => 1437 "Ancho" => 1801 "Tamanyo" => 327696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Basal cell carcinoma; image taken before starting treatment. B, Large, indurated plaque with 3 linear elastic elements; image taken 2 months after starting imiquimod treatment. C, The lesion persists, but with reduced erythema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical imiquimod: A review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. Wagstaff" 1 => "C.M. Perry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Drugs" "fecha" => "2007" "volumen" => "67" "paginaInicial" => "2187" "paginaFinal" => "2210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17927284" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002939410003089" "estado" => "S300" "issn" => "00029394" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imiquimod 5 percent cream and the treatment of cutaneous malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Navi" 1 => "A. 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Calvieri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Recent Pat Inflamm Allergy Drug Discov" "fecha" => "2012" "volumen" => "6" "paginaInicial" => "65" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22185454" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of keloid scars post-shave excision with imiquimod 5% cream: A prospective, double-blind, placebo-controlled pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Berman" 1 => "C. Harrison-Balestra" 2 => "O.A. Perez" 3 => "M. Viera" 4 => "A. Villa" 5 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 45 | 10 | 55 |
| 2024 October | 447 | 71 | 518 |
| 2024 September | 465 | 53 | 518 |
| 2024 August | 431 | 83 | 514 |
| 2024 July | 471 | 63 | 534 |
| 2024 June | 498 | 58 | 556 |
| 2024 May | 366 | 59 | 425 |
| 2024 April | 268 | 43 | 311 |
| 2024 March | 337 | 40 | 377 |
| 2024 February | 368 | 45 | 413 |
| 2024 January | 397 | 53 | 450 |
| 2023 December | 478 | 34 | 512 |
| 2023 November | 452 | 39 | 491 |
| 2023 October | 468 | 41 | 509 |
| 2023 September | 474 | 43 | 517 |
| 2023 August | 339 | 32 | 371 |
| 2023 July | 355 | 56 | 411 |
| 2023 June | 458 | 41 | 499 |
| 2023 May | 361 | 52 | 413 |
| 2023 April | 340 | 37 | 377 |
| 2023 March | 335 | 60 | 395 |
| 2023 February | 281 | 59 | 340 |
| 2023 January | 354 | 68 | 422 |
| 2022 December | 288 | 64 | 352 |
| 2022 November | 233 | 38 | 271 |
| 2022 October | 179 | 54 | 233 |
| 2022 September | 152 | 93 | 245 |
| 2022 August | 212 | 113 | 325 |
| 2022 July | 154 | 70 | 224 |
| 2022 June | 103 | 63 | 166 |
| 2022 May | 351 | 76 | 427 |
| 2022 April | 455 | 105 | 560 |
| 2022 March | 588 | 133 | 721 |
| 2022 February | 515 | 96 | 611 |
| 2022 January | 409 | 103 | 512 |
| 2021 December | 272 | 92 | 364 |
| 2021 November | 282 | 91 | 373 |
| 2021 October | 297 | 155 | 452 |
| 2021 September | 305 | 137 | 442 |
| 2021 August | 256 | 67 | 323 |
| 2021 July | 217 | 92 | 309 |
| 2021 June | 290 | 83 | 373 |
| 2021 May | 275 | 76 | 351 |
| 2021 April | 812 | 151 | 963 |
| 2021 March | 398 | 88 | 486 |
| 2021 February | 367 | 89 | 456 |
| 2021 January | 328 | 69 | 397 |
| 2020 December | 262 | 77 | 339 |
| 2020 November | 243 | 58 | 301 |
| 2020 October | 166 | 44 | 210 |
| 2020 September | 208 | 69 | 277 |
| 2020 August | 174 | 70 | 244 |
| 2020 July | 178 | 80 | 258 |
| 2020 June | 131 | 68 | 199 |
| 2020 May | 127 | 124 | 251 |
| 2020 April | 76 | 72 | 148 |
| 2020 March | 38 | 53 | 91 |
| 2020 February | 1 | 41 | 42 |
| 2020 January | 4 | 23 | 27 |
| 2019 December | 4 | 15 | 19 |
| 2019 November | 4 | 7 | 11 |
| 2019 October | 2 | 3 | 5 |
| 2019 September | 0 | 7 | 7 |
| 2019 August | 4 | 12 | 16 |
| 2019 July | 4 | 14 | 18 |
| 2019 June | 12 | 22 | 34 |
| 2019 May | 8 | 37 | 45 |
| 2019 April | 14 | 26 | 40 |
| 2019 March | 4 | 9 | 13 |
| 2019 February | 1 | 5 | 6 |
| 2019 January | 6 | 0 | 6 |
| 2018 December | 3 | 1 | 4 |
| 2018 November | 6 | 0 | 6 |
| 2018 October | 21 | 0 | 21 |
| 2018 September | 5 | 2 | 7 |
| 2018 August | 0 | 13 | 13 |
| 2018 July | 0 | 10 | 10 |
| 2018 June | 0 | 11 | 11 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 4 | 5 | 9 |
| 2018 February | 142 | 6 | 148 |
| 2018 January | 146 | 12 | 158 |
| 2017 December | 98 | 11 | 109 |
| 2017 November | 101 | 8 | 109 |
| 2017 October | 85 | 3 | 88 |
| 2017 September | 59 | 15 | 74 |
| 2017 August | 76 | 21 | 97 |
| 2017 July | 68 | 8 | 76 |
| 2017 June | 73 | 22 | 95 |
| 2017 May | 53 | 19 | 72 |
| 2017 April | 40 | 13 | 53 |
| 2017 March | 36 | 15 | 51 |
| 2017 February | 39 | 24 | 63 |
| 2017 January | 30 | 16 | 46 |
| 2016 December | 41 | 22 | 63 |
| 2016 November | 48 | 17 | 65 |
| 2016 October | 61 | 17 | 78 |
| 2016 September | 1 | 10 | 11 |
| 2016 August | 0 | 6 | 6 |
| 2016 July | 5 | 5 | 10 |
| 2016 June | 11 | 4 | 15 |
| 2016 May | 3 | 4 | 7 |
| 2016 April | 4 | 2 | 6 |
| 2016 March | 3 | 2 | 5 |
| 2016 February | 8 | 2 | 10 |
| 2016 January | 12 | 1 | 13 |
| 2015 December | 13 | 1 | 14 |
| 2015 November | 13 | 4 | 17 |
| 2015 October | 13 | 3 | 16 |
| 2015 September | 10 | 9 | 19 |
| 2015 August | 8 | 5 | 13 |
| 2015 July | 53 | 7 | 60 |
| 2015 June | 33 | 3 | 36 |
| 2015 May | 32 | 10 | 42 |
| 2015 April | 17 | 4 | 21 |
| 2015 March | 20 | 7 | 27 |
| 2015 February | 14 | 2 | 16 |
| 2015 January | 8 | 3 | 11 |
| 2014 December | 11 | 3 | 14 |
| 2014 November | 7 | 4 | 11 |
| 2014 October | 12 | 3 | 15 |
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