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Letter to the Editor
Genital Warts, Lymphangioma, and Treatment with Imiquimod
Verrugas genitales, linfangioma y tratamiento con imiquimod
B. Monteagudo
Corresponding author
, O. Figueroa, A. Varela-Veiga, O. Suárez-Amor
Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Xerencia de Xestión Integrada de Ferrol, SERGAS, Ferrol, A Coruña, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article &#8220;Pseudoverrucous Lesions of Recent Appearance on the Vulva&#8221; in which the authors report the case of an adult woman with acquired vulvar lymphangioma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> In their article they stress the need to correctly diagnose the condition and to avoid confusion with other disorders&#44; such as genital warts&#44; in order to identify the appropriate treatment and the underlying cause &#40;lymphadenectomy&#44; radiation therapy for pelvic carcinoma&#44; Crohn disease&#44; or tuberculosis&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the clinical history&#44; the authors note as an interesting fact that the patient had been diagnosed 5 years earlier with genital warts&#44; which were treated successfully with imiquimod 5&#37; cream&#46; In our opinion&#44; the value of the article would have been even greater if the authors had analyzed the possible role of imiquimod therapy in the pathogenesis of the lymphangioma&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is possible that the imiquimod therapy may&#44; while resolving the infectious process&#44; have given rise to lymphedema and that this condition then favored the development of the lymphangioma&#46; Edema and lymphedema are adverse effects reported to be associated with imiquimod treatment&#46; These conditions may resolve rapidly &#40;for example&#44; in the genital area&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> or persist for months or even years &#40;reported in 1 case on the cheek following prolonged use of imiquimod to treat lentigo maligno melanoma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> The influence of lymphedema on the development of lymphangiomas is also well known&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We do not know whether the initial diagnosis of genital warts was confirmed by histopathology&#46; If that diagnosis was not confirmed&#44; it is possible that the earlier lesions were&#44; in fact&#44; lymphangioma&#46; In that event&#44; the interest of the case would be in the partial response to treatment with imiquimod&#46; Imiquimod has been shown to be an effective therapy in some cases of lymphangioma circumscriptum&#46; Occasionally&#44; as occurred in this case&#44; the lesion recurs months later&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> It is thought that imiquimod has an antiangiogenic effect and induces apoptosis of the tumor cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; we found this recent report of a cases of acquired lymphangioma circumscriptum very interesting&#46; It would be important to know what imiquimod regimen was used and the duration of treatment&#44; as this information could be used to hypothesize about the possible role of imiquimod in the development of the lymphangioma&#46;</p></span>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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