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Imiquimod for Actinic Keratoses

Actinic keratoses responded well to a course of imiquimod treatment marked by strong local effects.

Imiquimod 5% cream has shown promise as a treatment for superficial basal cell carcinomas and, in pilot studies, for actinic keratoses (AKs). In this manufacturer-supported, randomized, double-blind, vehicle-controlled study from Germany, imiquimod was used to treat AKs in 25 patients; another 11 patients received vehicle only. Three to 10 lesions in each patient were treated up to 3 times per week for 12 weeks. Biopsy specimens of representative lesions were taken before and 2 weeks after treatment.

By 2 weeks after the 12-week course, 84% of imiquimod recipients had complete clinical clearance of all treated AKs. The clinical results were confirmed by examination of biopsy specimens. Partial clearance was achieved in 8% of patients, and no change was seen in 8%. No AKs cleared in the vehicle recipients. All imiquimod recipients experienced local adverse effects, including erythema, vesicles, erosions, flaking, ulceration, scabbing, and induration. One patient required a rest period because of adverse reactions; 48% of patients had to reduce treatment to twice weekly and 24% to once weekly. Local reactions peaked in the sixth week of treatment. Interestingly, all patients who decreased treatment frequency experienced 100% clearance, compared with only 60% of patients who kept to the full treatment course throughout. The AK recurrence rate at 1 year was 10%.

Comment: Imiquimod treatment is effective for AKs, yielding a recurrence rate similar to that of other modalities. The 12-week treatment course, however, is far longer than the courses of established therapies, and the severity of local reactions makes treatment of the head and neck difficult. For AKs, as for basal cell carcinomas, therapeutic effectiveness seems to require a brisk local inflammatory response.

— George J. Hruza, MD

Published in Journal Watch Dermatology December 17, 2002

Citation(s):

Stockfleth E et al. A randomized, double-blind, vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses. Arch Dermatol 2002 Nov; 138:1498-502.

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