Report
Treatment of patch and plaque stage mycosis fungoides with imiquimod 5% cream

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Background

Systemic interferon is effective in the treatment of mycosis fungoides (MF). Imiquimod is effective in the treatment of some epidermal neoplasms and induces localized interferon production.

Objective

To evaluate the safety and efficacy of topical imiquimod 5% cream for the treatment of patch and plaque stage MF.

Methods

Six patients with stage IA to IIB MF were treated with topical imiquimod 5% cream 3 times per week for 12 weeks in this open label pilot study. Index lesions were biopsied pre- and post- treatment, and up to 4 additional treated lesions were monitored for 16 weeks.

Results

Three of 6 patients had histologic clearance of disease in index lesions, and also demonstrated significant improvement in the clinical scores for all treated lesions. A fourth patient had 2 of 4 lesions respond clinically. Application site reactions were limited to those patients responding to treatment.

Conclusion

In this preliminary open label study topical imiquimod 5% cream was well tolerated and associated with a histologic and clinical response rate of 50%.

Section snippets

Inclusion criteria

Patients age 18 years and older, presenting at the University of Colorado Department of Dermatology MF clinic with stage IA, IB, IIA, IIB, or IVA disease that had newly diagnosed disease or no progression to a higher stage of disease within the last year were considered eligible for entry in the study. Women of childbearing age were required to practice contraception while enrolled in the study. Patients using systemic retinoids and subcutaneous INF-α at doses of 3 mouse units (MU) 3 times per

Results

One of 7 patients withdrew from the study after two visits because of a recurrence of major depression. Demographic characteristics, disease stage, and duration as well as previous and ongoing MF treatments are summarized in Table I. Briefly, patient 1 had a history of immediate type hypersensitivity reaction to nitrogen mustard, and had not responded to a trial of isotretinoin. Patient 2 was newly diagnosed with poikilodermatous MF progressive over many years per her history. Patient 3 had

Discussion

Although several skin directed approaches for treating MF are available, new and well-tolerated treatments are desirable. As demonstrated by several of our patients, these established treatments are not uniformly effective and are not without side effects. This report adds observations in 6 MF patients treated with topical imiquimod to two anecdotal reports already in the literature demonstrating clinical use of imiquimod for the treatment of MF.12, 13 The observations presented here suggest

References (18)

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Supported by a grant from 3M Pharmaceuticals, St. Paul, Minnesota.

Conflicts of interest: None identified.

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