ReportTreatment of patch and plaque stage mycosis fungoides with imiquimod 5% cream
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
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2022, Presse MedicaleCitation Excerpt :Of note, some patients were concurrently treated with PUVA, systemic interferon, and systemic retinoids, suggesting that imiquimod may act synergistically with other systemic or SDTs. When applied on lesions of MF, imiquimod may create erosions or ulcerations, presumably by triggering an exuberant immune response with significant depth [34,36,39]. Based on this observation, it was assumed that this inflammatory response triggered by imiquimod may be of sufficient depth to target the deeper folliculotropic lymphocytes in folliculotropic MF, a variant known to be less responsive to SDTs [32].
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2021, Clinics in Plastic SurgeryCitation Excerpt :Imiquimod, through activation of immune cells via the toll-like receptor 7 (TLR7)-MyD88-dependent signaling pathway, induces the production of antitumor cytokines including IFN-α, TNF, and IL-12.110–115 Several neoplasms have been successfully treated with imiquimod including basal cell carcinoma, squamous cell carcinoma, extramammary Paget’s disease, lymphoma, and melanoma113,114,116–124 However, it has been shown that subcutaneous and dermal melanomas are often resistant to imiquimod, likely due to developed resistance to apoptotic pathways, poor drug penetration, or another yet to be identified mechanism.116,125–130 While it is not recommended as monotherapy, systematic reviews have concluded that imiquimod can lead to locoregional control and may be beneficial for patients in whom conventional therapies have failed.124,131
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Supported by a grant from 3M Pharmaceuticals, St. Paul, Minnesota.
Conflicts of interest: None identified.