摘要
To the editor： The main side effects of topical imiquinaod are dose-dependent application-site reactions. Recently, we founda Chinese couple developed vitiligo-like depigmentation lesions and lichen planus with genital warts after treatment with 5% imiquimod cream, respectively. The wife, 36 years old. was diagnosed with genital warts based on acetic acid white test. Numerous warty lesions were located on both sides of the labia minora and majora, perineal, perianal areas and external cervical orifice. One week after CO2 laser treatment, 5% imiquimod cream （AldaraTM, 3M Pharmaceuticals, USA） was applied to the external genital area every other night to prevent recurrence. Six weeks later, the patient noticed a few spots of slight hypopigmentation at the imiquimod-applied areas and then stopped using the imiquimod cream. But the hypopigmentation gradually became worse and spread to the perineum and perianal areas. Three months later complete depigmentation occurred on the perineum and perianal skin （Figure IA）. Pigment loss in pubic hairs in the imiquimod-applied areas was also visible. The lesions showed clear demarcation lines and did not extend to the areas that had not been treated with imiquimod. The patient had no personal or family history ofvitiligo. She was diagnosed with localized vitiligo. The husband, 37 years old, was also diagnosed with genital warts distributed in the coronal and foreskin areas. One week after the completion of two-session of CO2 laser treatment, 5% imiquimod cream was applied in the same way as his wife for 3 months. One month later, the patient noticed some papular lesions in the imiquimod-applied areas. Three months later, dermatological examination revealed nmltiple purple-red specks （Figure IB）. The patient denied any trauma or history of drug allergy. Histopathological examination revealed hyperkeratosis of the epidermis, local and wedge-type thickening of granular layer, irregular thickening of the cell layer, liquefied degeneration of basal cells, and lymphocyte infiltration in the upper dermis （Figure 1C）. He was diagnosed with lichen planus. The wile with localized vitiligo was treated by topical application of 0.1% Tacrolimus ointment twice daily. After 4 months, 〉70% repigmentation in the vulva, perineum and perianal areas was achieved （Figure ID）. The husband with lichen planus was treated by topical photodynamic therapy （PDT） with 20% 5-Aminolevulinc acid （ALA） cream and a 635 nm diode laser （100 J/cm2, 100 mW/cm-＇）, once a week for 5 weeks till the complete remission was achieved. Figure 1E and l F shows fluorescence images of lesions betbre PDT and gross views after PDT treatment. The mode of action of ilniquimod involves both natural immune responses and cell-mediated immune responses. Topical application of imiquimod can affect Toll-like receptors, activate immune cells, induce Thl responses, and ultimately activate cytotoxic T cells, which is useful for the treatment of certain diseases, but can also induce inflammatory skin diseases.
To the editor： The main side effects of topical imiquinaod are dose-dependent application-site reactions. Recently, we founda Chinese couple developed vitiligo-like depigmentation lesions and lichen planus with genital warts after treatment with 5% imiquimod cream, respectively. The wife, 36 years old. was diagnosed with genital warts based on acetic acid white test. Numerous warty lesions were located on both sides of the labia minora and majora, perineal, perianal areas and external cervical orifice. One week after CO2 laser treatment, 5% imiquimod cream （AldaraTM, 3M Pharmaceuticals, USA） was applied to the external genital area every other night to prevent recurrence. Six weeks later, the patient noticed a few spots of slight hypopigmentation at the imiquimod-applied areas and then stopped using the imiquimod cream. But the hypopigmentation gradually became worse and spread to the perineum and perianal areas. Three months later complete depigmentation occurred on the perineum and perianal skin （Figure IA）. Pigment loss in pubic hairs in the imiquimod-applied areas was also visible. The lesions showed clear demarcation lines and did not extend to the areas that had not been treated with imiquimod. The patient had no personal or family history ofvitiligo. She was diagnosed with localized vitiligo. The husband, 37 years old, was also diagnosed with genital warts distributed in the coronal and foreskin areas. One week after the completion of two-session of CO2 laser treatment, 5% imiquimod cream was applied in the same way as his wife for 3 months. One month later, the patient noticed some papular lesions in the imiquimod-applied areas. Three months later, dermatological examination revealed nmltiple purple-red specks （Figure IB）. The patient denied any trauma or history of drug allergy. Histopathological examination revealed hyperkeratosis of the epidermis, local and wedge-type thickening of granular layer, irregular thickening of the cell layer, liquefied degeneration of basal cells, and lymphocyte infiltration in the upper dermis （Figure 1C）. He was diagnosed with lichen planus. The wile with localized vitiligo was treated by topical application of 0.1% Tacrolimus ointment twice daily. After 4 months, 〉70% repigmentation in the vulva, perineum and perianal areas was achieved （Figure ID）. The husband with lichen planus was treated by topical photodynamic therapy （PDT） with 20% 5-Aminolevulinc acid （ALA） cream and a 635 nm diode laser （100 J/cm2, 100 mW/cm-＇）, once a week for 5 weeks till the complete remission was achieved. Figure 1E and l F shows fluorescence images of lesions betbre PDT and gross views after PDT treatment. The mode of action of ilniquimod involves both natural immune responses and cell-mediated immune responses. Topical application of imiquimod can affect Toll-like receptors, activate immune cells, induce Thl responses, and ultimately activate cytotoxic T cells, which is useful for the treatment of certain diseases, but can also induce inflammatory skin diseases.
