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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Messina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "629" "paginaFinal" => "633" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19415792" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000008/v1_201409260034/S1578219014002078/v1_201409260034/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/15782190/0000010500000008/v1_201409260034/S1578219014002078/v1_201409260034/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002078?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 20 | 7 | 27 |
| 2024 Octubre | 447 | 71 | 518 |
| 2024 Septiembre | 465 | 53 | 518 |
| 2024 Agosto | 431 | 83 | 514 |
| 2024 Julio | 471 | 63 | 534 |
| 2024 Junio | 498 | 58 | 556 |
| 2024 Mayo | 366 | 59 | 425 |
| 2024 Abril | 268 | 43 | 311 |
| 2024 Marzo | 337 | 40 | 377 |
| 2024 Febrero | 368 | 45 | 413 |
| 2024 Enero | 397 | 53 | 450 |
| 2023 Diciembre | 478 | 34 | 512 |
| 2023 Noviembre | 452 | 39 | 491 |
| 2023 Octubre | 468 | 41 | 509 |
| 2023 Septiembre | 474 | 43 | 517 |
| 2023 Agosto | 339 | 32 | 371 |
| 2023 Julio | 355 | 56 | 411 |
| 2023 Junio | 458 | 41 | 499 |
| 2023 Mayo | 361 | 52 | 413 |
| 2023 Abril | 340 | 37 | 377 |
| 2023 Marzo | 335 | 60 | 395 |
| 2023 Febrero | 281 | 59 | 340 |
| 2023 Enero | 354 | 68 | 422 |
| 2022 Diciembre | 288 | 64 | 352 |
| 2022 Noviembre | 233 | 38 | 271 |
| 2022 Octubre | 179 | 54 | 233 |
| 2022 Septiembre | 152 | 93 | 245 |
| 2022 Agosto | 212 | 113 | 325 |
| 2022 Julio | 154 | 70 | 224 |
| 2022 Junio | 103 | 63 | 166 |
| 2022 Mayo | 351 | 76 | 427 |
| 2022 Abril | 455 | 105 | 560 |
| 2022 Marzo | 588 | 133 | 721 |
| 2022 Febrero | 515 | 96 | 611 |
| 2022 Enero | 409 | 103 | 512 |
| 2021 Diciembre | 272 | 92 | 364 |
| 2021 Noviembre | 282 | 91 | 373 |
| 2021 Octubre | 297 | 155 | 452 |
| 2021 Septiembre | 305 | 137 | 442 |
| 2021 Agosto | 256 | 67 | 323 |
| 2021 Julio | 217 | 92 | 309 |
| 2021 Junio | 290 | 83 | 373 |
| 2021 Mayo | 275 | 76 | 351 |
| 2021 Abril | 812 | 151 | 963 |
| 2021 Marzo | 398 | 88 | 486 |
| 2021 Febrero | 367 | 89 | 456 |
| 2021 Enero | 328 | 69 | 397 |
| 2020 Diciembre | 262 | 77 | 339 |
| 2020 Noviembre | 243 | 58 | 301 |
| 2020 Octubre | 166 | 44 | 210 |
| 2020 Septiembre | 208 | 69 | 277 |
| 2020 Agosto | 174 | 70 | 244 |
| 2020 Julio | 178 | 80 | 258 |
| 2020 Junio | 131 | 68 | 199 |
| 2020 Mayo | 127 | 124 | 251 |
| 2020 Abril | 76 | 72 | 148 |
| 2020 Marzo | 38 | 53 | 91 |
| 2020 Febrero | 1 | 41 | 42 |
| 2020 Enero | 4 | 23 | 27 |
| 2019 Diciembre | 4 | 15 | 19 |
| 2019 Noviembre | 4 | 7 | 11 |
| 2019 Octubre | 2 | 3 | 5 |
| 2019 Septiembre | 0 | 7 | 7 |
| 2019 Agosto | 4 | 12 | 16 |
| 2019 Julio | 4 | 14 | 18 |
| 2019 Junio | 12 | 22 | 34 |
| 2019 Mayo | 8 | 37 | 45 |
| 2019 Abril | 14 | 26 | 40 |
| 2019 Marzo | 4 | 9 | 13 |
| 2019 Febrero | 1 | 5 | 6 |
| 2019 Enero | 6 | 0 | 6 |
| 2018 Diciembre | 3 | 1 | 4 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 21 | 0 | 21 |
| 2018 Septiembre | 5 | 2 | 7 |
| 2018 Agosto | 0 | 13 | 13 |
| 2018 Julio | 0 | 10 | 10 |
| 2018 Junio | 0 | 11 | 11 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 4 | 5 | 9 |
| 2018 Febrero | 142 | 6 | 148 |
| 2018 Enero | 146 | 12 | 158 |
| 2017 Diciembre | 98 | 11 | 109 |
| 2017 Noviembre | 101 | 8 | 109 |
| 2017 Octubre | 85 | 3 | 88 |
| 2017 Septiembre | 59 | 15 | 74 |
| 2017 Agosto | 76 | 21 | 97 |
| 2017 Julio | 68 | 8 | 76 |
| 2017 Junio | 73 | 22 | 95 |
| 2017 Mayo | 53 | 19 | 72 |
| 2017 Abril | 40 | 13 | 53 |
| 2017 Marzo | 36 | 15 | 51 |
| 2017 Febrero | 39 | 24 | 63 |
| 2017 Enero | 30 | 16 | 46 |
| 2016 Diciembre | 41 | 22 | 63 |
| 2016 Noviembre | 48 | 17 | 65 |
| 2016 Octubre | 61 | 17 | 78 |
| 2016 Septiembre | 1 | 10 | 11 |
| 2016 Agosto | 0 | 6 | 6 |
| 2016 Julio | 5 | 5 | 10 |
| 2016 Junio | 11 | 4 | 15 |
| 2016 Mayo | 3 | 4 | 7 |
| 2016 Abril | 4 | 2 | 6 |
| 2016 Marzo | 3 | 2 | 5 |
| 2016 Febrero | 8 | 2 | 10 |
| 2016 Enero | 12 | 1 | 13 |
| 2015 Diciembre | 13 | 1 | 14 |
| 2015 Noviembre | 13 | 4 | 17 |
| 2015 Octubre | 13 | 3 | 16 |
| 2015 Septiembre | 10 | 9 | 19 |
| 2015 Agosto | 8 | 5 | 13 |
| 2015 Julio | 53 | 7 | 60 |
| 2015 Junio | 33 | 3 | 36 |
| 2015 Mayo | 32 | 10 | 42 |
| 2015 Abril | 17 | 4 | 21 |
| 2015 Marzo | 20 | 7 | 27 |
| 2015 Febrero | 14 | 2 | 16 |
| 2015 Enero | 8 | 3 | 11 |
| 2014 Diciembre | 11 | 3 | 14 |
| 2014 Noviembre | 7 | 4 | 11 |
| 2014 Octubre | 12 | 3 | 15 |
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