摘要
Background: Viral warts may cause significant morbidity in individuals unable to mount an adequate T- helper 1 cell- mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established. Objectives: To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals. Methods: Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks). Results: Twelve (80% ) patients completed the study protocol. Benefit was seen in five patients [36% in the intent- to- treat analysis (14 patients)] , including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29% ) patients and were usually mild. A transient rise in creatinine (11- 29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure. Conclusions: This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.
Background: Viral warts may cause significant morbidity in individuals unable to mount an adequate T- helper 1 cell- mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established. Objectives: To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals. Methods: Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks). Results: Twelve (80% ) patients completed the study protocol. Benefit was seen in five patients [36% in the intent- to- treat analysis (14 patients)] , including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29% ) patients and were usually mild. A transient rise in creatinine (11- 29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure. Conclusions: This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.
