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
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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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| 2018 Mayo | 0 | 7 | 7 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 25 | 1 | 26 |
| 2018 Enero | 31 | 7 | 38 |
| 2017 Diciembre | 37 | 15 | 52 |
| 2017 Noviembre | 23 | 10 | 33 |
| 2017 Octubre | 28 | 11 | 39 |
| 2017 Septiembre | 27 | 6 | 33 |
| 2017 Agosto | 25 | 14 | 39 |
| 2017 Julio | 17 | 7 | 24 |
| 2017 Junio | 38 | 13 | 51 |
| 2017 Mayo | 31 | 7 | 38 |
| 2017 Abril | 23 | 9 | 32 |
| 2017 Marzo | 22 | 6 | 28 |
| 2017 Febrero | 21 | 10 | 31 |
| 2017 Enero | 25 | 15 | 40 |
| 2016 Diciembre | 27 | 20 | 47 |
| 2016 Noviembre | 36 | 10 | 46 |
| 2016 Octubre | 45 | 12 | 57 |
| 2016 Septiembre | 39 | 12 | 51 |
| 2016 Agosto | 48 | 14 | 62 |
| 2016 Julio | 43 | 18 | 61 |
| 2016 Junio | 21 | 23 | 44 |
| 2016 Mayo | 12 | 9 | 21 |
| 2016 Abril | 10 | 3 | 13 |
| 2016 Marzo | 8 | 1 | 9 |
| 2016 Febrero | 7 | 2 | 9 |
| 2016 Enero | 13 | 1 | 14 |
| 2015 Diciembre | 23 | 4 | 27 |
| 2015 Noviembre | 17 | 5 | 22 |
| 2015 Octubre | 20 | 2 | 22 |
| 2015 Septiembre | 18 | 3 | 21 |
| 2015 Agosto | 16 | 1 | 17 |
| 2015 Julio | 232 | 12 | 244 |
| 2015 Junio | 201 | 6 | 207 |
| 2015 Mayo | 214 | 15 | 229 |
| 2015 Abril | 178 | 10 | 188 |
| 2015 Marzo | 209 | 13 | 222 |
| 2015 Febrero | 185 | 8 | 193 |
| 2015 Enero | 119 | 20 | 139 |
| 2014 Diciembre | 106 | 9 | 115 |
| 2014 Noviembre | 111 | 12 | 123 |
| 2014 Octubre | 154 | 25 | 179 |
| 2014 Septiembre | 96 | 6 | 102 |
| 2014 Agosto | 93 | 5 | 98 |
| 2014 Julio | 87 | 6 | 93 |
| 2014 Junio | 98 | 5 | 103 |
| 2014 Mayo | 118 | 10 | 128 |
| 2014 Abril | 121 | 4 | 125 |
| 2014 Marzo | 106 | 8 | 114 |
| 2014 Febrero | 75 | 8 | 83 |
| 2014 Enero | 91 | 7 | 98 |
| 2013 Diciembre | 103 | 2 | 105 |
| 2013 Noviembre | 74 | 13 | 87 |
| 2013 Octubre | 86 | 6 | 92 |
| 2013 Septiembre | 74 | 6 | 80 |
| 2013 Agosto | 62 | 6 | 68 |
| 2013 Julio | 13 | 13 | 26 |
| 2013 Junio | 7 | 7 | 14 |
| 2013 Mayo | 7 | 6 | 13 |
| 2013 Abril | 22 | 18 | 40 |
| 2013 Marzo | 17 | 6 | 23 |
| 2013 Febrero | 63 | 10 | 73 |
| 2013 Enero | 112 | 9 | 121 |
| 2012 Diciembre | 53 | 7 | 60 |
| 2012 Noviembre | 6 | 6 | 12 |
| 2012 Octubre | 1 | 7 | 8 |
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