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 cytokin...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.展开更多
Background: Non- melanoma skin cancers (NMSCs) are increased in organ transplant recipients, but transplant and immunocompetent squamous and basal cell carcinomas (SCCs, BCCs) have not been compared previously in a si...Background: Non- melanoma skin cancers (NMSCs) are increased in organ transplant recipients, but transplant and immunocompetent squamous and basal cell carcinomas (SCCs, BCCs) have not been compared previously in a single- center study. Objective: To compare clinicopathologic features of transplant and immunocompetent NMSCs. Methods: Consecutive transplant NMSCs (60 SCCs, 100 BCCs) and immunocompetent NMSCs (40 SCCs, 125 BCCs) presenting between 1995- 1997. Results: Transplant patients were 15 years younger at time of NMSC diagnosis compared with immunocompetent individuals, and transplant tumors were often more multiple and extra cephalic. Spindle cell morphology was more common in transplant SCCs, a superficial component was more common in transplant BCCs, and histologic features of HPV infection were overrepresented in transplant tumors. Outcome was worse for transplant SCCs but not transplant BCCs. Limitations: Histologic features required to identify HPV infection have not been validated. Conclusions: These findings have direct implications for clinical care. The increased frequency and distribution of transplant NMSCs underscore the importance of whole- body surveillance. Transplant SCCs, particularly those with diffuse spindle cell change, may require more aggressive management, whereas transplant BCCs do not. Finally, our data support differences in the pathogenesis of transplant NMSC, which may influence future preventive and therapeutic strategies.展开更多
文摘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.
文摘Background: Non- melanoma skin cancers (NMSCs) are increased in organ transplant recipients, but transplant and immunocompetent squamous and basal cell carcinomas (SCCs, BCCs) have not been compared previously in a single- center study. Objective: To compare clinicopathologic features of transplant and immunocompetent NMSCs. Methods: Consecutive transplant NMSCs (60 SCCs, 100 BCCs) and immunocompetent NMSCs (40 SCCs, 125 BCCs) presenting between 1995- 1997. Results: Transplant patients were 15 years younger at time of NMSC diagnosis compared with immunocompetent individuals, and transplant tumors were often more multiple and extra cephalic. Spindle cell morphology was more common in transplant SCCs, a superficial component was more common in transplant BCCs, and histologic features of HPV infection were overrepresented in transplant tumors. Outcome was worse for transplant SCCs but not transplant BCCs. Limitations: Histologic features required to identify HPV infection have not been validated. Conclusions: These findings have direct implications for clinical care. The increased frequency and distribution of transplant NMSCs underscore the importance of whole- body surveillance. Transplant SCCs, particularly those with diffuse spindle cell change, may require more aggressive management, whereas transplant BCCs do not. Finally, our data support differences in the pathogenesis of transplant NMSC, which may influence future preventive and therapeutic strategies.
