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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 13 | 22 |
| 2024 Octubre | 59 | 40 | 99 |
| 2024 Septiembre | 67 | 23 | 90 |
| 2024 Agosto | 87 | 63 | 150 |
| 2024 Julio | 79 | 31 | 110 |
| 2024 Junio | 78 | 34 | 112 |
| 2024 Mayo | 78 | 31 | 109 |
| 2024 Abril | 71 | 22 | 93 |
| 2024 Marzo | 74 | 24 | 98 |
| 2024 Febrero | 68 | 31 | 99 |
| 2024 Enero | 49 | 30 | 79 |
| 2023 Diciembre | 66 | 11 | 77 |
| 2023 Noviembre | 67 | 28 | 95 |
| 2023 Octubre | 69 | 23 | 92 |
| 2023 Septiembre | 88 | 34 | 122 |
| 2023 Agosto | 67 | 19 | 86 |
| 2023 Julio | 70 | 34 | 104 |
| 2023 Junio | 53 | 23 | 76 |
| 2023 Mayo | 87 | 28 | 115 |
| 2023 Abril | 65 | 15 | 80 |
| 2023 Marzo | 88 | 21 | 109 |
| 2023 Febrero | 49 | 19 | 68 |
| 2023 Enero | 39 | 27 | 66 |
| 2022 Diciembre | 63 | 32 | 95 |
| 2022 Noviembre | 28 | 24 | 52 |
| 2022 Octubre | 32 | 17 | 49 |
| 2022 Septiembre | 39 | 32 | 71 |
| 2022 Agosto | 45 | 31 | 76 |
| 2022 Julio | 54 | 33 | 87 |
| 2022 Junio | 53 | 28 | 81 |
| 2022 Mayo | 76 | 36 | 112 |
| 2022 Abril | 71 | 46 | 117 |
| 2022 Marzo | 55 | 53 | 108 |
| 2022 Febrero | 50 | 29 | 79 |
| 2022 Enero | 59 | 45 | 104 |
| 2021 Diciembre | 43 | 33 | 76 |
| 2021 Noviembre | 55 | 39 | 94 |
| 2021 Octubre | 63 | 49 | 112 |
| 2021 Septiembre | 60 | 46 | 106 |
| 2021 Agosto | 56 | 34 | 90 |
| 2021 Julio | 51 | 26 | 77 |
| 2021 Junio | 68 | 43 | 111 |
| 2021 Mayo | 66 | 49 | 115 |
| 2021 Abril | 100 | 60 | 160 |
| 2021 Marzo | 102 | 26 | 128 |
| 2021 Febrero | 78 | 33 | 111 |
| 2021 Enero | 48 | 23 | 71 |
| 2020 Diciembre | 45 | 35 | 80 |
| 2020 Noviembre | 26 | 19 | 45 |
| 2020 Octubre | 31 | 12 | 43 |
| 2020 Septiembre | 26 | 16 | 42 |
| 2020 Agosto | 33 | 26 | 59 |
| 2020 Julio | 24 | 15 | 39 |
| 2020 Junio | 29 | 30 | 59 |
| 2020 Mayo | 16 | 20 | 36 |
| 2020 Abril | 39 | 30 | 69 |
| 2020 Marzo | 29 | 22 | 51 |
| 2020 Febrero | 8 | 0 | 8 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 5 | 3 | 8 |
| 2019 Noviembre | 4 | 4 | 8 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 10 | 2 | 12 |
| 2019 Agosto | 4 | 1 | 5 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 3 | 21 | 24 |
| 2019 Mayo | 6 | 36 | 42 |
| 2019 Abril | 2 | 17 | 19 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 2 | 3 | 5 |
| 2018 Diciembre | 5 | 0 | 5 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 8 | 0 | 8 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 38 | 7 | 45 |
| 2018 Enero | 128 | 9 | 137 |
| 2017 Diciembre | 110 | 11 | 121 |
| 2017 Noviembre | 45 | 8 | 53 |
| 2017 Octubre | 40 | 8 | 48 |
| 2017 Septiembre | 35 | 12 | 47 |
| 2017 Agosto | 67 | 16 | 83 |
| 2017 Julio | 44 | 4 | 48 |
| 2017 Junio | 57 | 9 | 66 |
| 2017 Mayo | 65 | 9 | 74 |
| 2017 Abril | 60 | 42 | 102 |
| 2017 Marzo | 50 | 8 | 58 |
| 2017 Febrero | 71 | 5 | 76 |
| 2017 Enero | 43 | 4 | 47 |
| 2016 Diciembre | 52 | 13 | 65 |
| 2016 Noviembre | 78 | 8 | 86 |
| 2016 Octubre | 106 | 8 | 114 |
| 2016 Septiembre | 196 | 8 | 204 |
| 2016 Agosto | 111 | 8 | 119 |
| 2016 Julio | 43 | 6 | 49 |
| 2016 Junio | 11 | 15 | 26 |
| 2016 Mayo | 11 | 3 | 14 |
| 2016 Abril | 11 | 10 | 21 |
| 2016 Marzo | 12 | 7 | 19 |
| 2016 Febrero | 12 | 3 | 15 |
| 2016 Enero | 9 | 1 | 10 |
| 2015 Diciembre | 15 | 0 | 15 |
| 2015 Noviembre | 19 | 6 | 25 |
| 2015 Octubre | 29 | 2 | 31 |
| 2015 Septiembre | 23 | 5 | 28 |
| 2015 Agosto | 14 | 7 | 21 |
| 2015 Julio | 112 | 8 | 120 |
| 2015 Junio | 75 | 5 | 80 |
| 2015 Mayo | 71 | 9 | 80 |
| 2015 Abril | 78 | 8 | 86 |
| 2015 Marzo | 70 | 6 | 76 |
| 2015 Febrero | 77 | 6 | 83 |
| 2015 Enero | 75 | 16 | 91 |
| 2014 Diciembre | 59 | 6 | 65 |
| 2014 Noviembre | 66 | 11 | 77 |
| 2014 Octubre | 89 | 17 | 106 |
| 2014 Septiembre | 70 | 7 | 77 |
| 2014 Agosto | 89 | 13 | 102 |
| 2014 Julio | 96 | 17 | 113 |
| 2014 Junio | 68 | 12 | 80 |
| 2014 Mayo | 56 | 5 | 61 |
| 2014 Abril | 59 | 2 | 61 |
| 2014 Marzo | 52 | 12 | 64 |
| 2014 Febrero | 44 | 7 | 51 |
| 2014 Enero | 45 | 9 | 54 |
| 2013 Diciembre | 47 | 8 | 55 |
| 2013 Noviembre | 45 | 14 | 59 |
| 2013 Octubre | 25 | 11 | 36 |
| 2013 Septiembre | 34 | 12 | 46 |
| 2013 Agosto | 42 | 9 | 51 |
| 2013 Julio | 18 | 39 | 57 |
| 2013 Junio | 9 | 32 | 41 |
| 2013 Mayo | 14 | 18 | 32 |
| 2013 Abril | 11 | 17 | 28 |
| 2013 Marzo | 22 | 9 | 31 |
| 2013 Febrero | 46 | 10 | 56 |
| 2013 Enero | 48 | 5 | 53 |
| 2012 Diciembre | 17 | 5 | 22 |
| 2012 Noviembre | 1 | 2 | 3 |
| 2012 Octubre | 0 | 2 | 2 |
| 2012 Agosto | 2 | 1 | 3 |
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