Erythema Multiforme Due to 5% Imiquimod Cream

Rodríguez-Vázquez, María; Portela, M. Delgado; Iglesias, Elena Vera

doi:10.1016/s1578-2190(10)70842-8

Cited by 7 publications

(8 citation statements)

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“…Cases of EM have been notified post‐authorization and also severe cases of Stevens‐Johnson syndrome, although the number of patients affected and their clinical details are not reported. However, there is only one previous report of EM due to 5% imiquimod in the literature . As in our case, the patient developed an intense local reaction at the sites of application before the EM.…”

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confidence: 99%

Erythema multiforme induced by imiquimod 5% cream

et al. 2014

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CorrespondenceErythema multiforme induced by imiquimod 5% cream Erythema multiforme (EM) is an acute self-limited immune-mediated reaction manifested by target skin lesions with mucous membrane involvement. Topical medication is considered a rare cause of EM and EM-like eruptions 1 . We report one patient with EM due to systemic reaction to imiquimod 5% cream.A 70-year-old man with a medical history of hypertension presented with multiple actinic keratoses on the scalp and nose. He was instructed to apply imiquimod cream 5% three times per week to his multiple actinic keratoses. A progressive local cutaneous reaction was observed at the application site of imiquimod accompanied by an intense flu-like syndrome during this treatment. On the third week of treatment, he also developed a symmetrically distributed eruption, with erythematous round maculopapules and bullae on the elbows, knees, palms, and soles (Fig. 1). Oral and ocular mucosae were not affected. A skin punch biopsy showed keratinocyte necrosis and intraepidermal vesiculation affecting the epidermis, accompanied by an inflammatory lymphohistiocytic infiltrate in the papillary dermis, all such findings being consistent with EM (Fig. 2). Treatment was discontinued, and the eruption resolved within two weeks. In this case, other well established causes of EM were ruled out; in particular, no evidence of herpes simplex infection and no past history of similar infection were observed, and no other drugs were introduced at that time. It was therefore assumed that the imiquimod induced the EM.A large number of topical medications 2,3 can induce EM and EM-like eruptions, including antibiotics, 4 nonsteroidal anti-inflammatory drugs, 5,6 corticosteroids, promethazine, balsam of Peru, econazole, pyrrolnitrin, vitamin E, nitroglycerin patch, ethylenediamine, mephenesin, and scopolamine ophthalmic drops. Serious systemic reactions

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confidence: 99%

Erythema multiforme induced by imiquimod 5% cream

et al. 2014

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“…3,4 In addition, imiquimod 5% cream has been reported to induce erythema multiforme. 5,6 Interestingly, distant inflammatory mucosal reactionsa side effect not declared in the medicinal product information-may also occur according to a few case reports [7][8][9][10][11][12] and our own experience. In order to further elucidate this largely unknown phenomenon, Betül Parlar shared first-authorship.…”

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confidence: 64%

“…However, as mentioned in the Swiss medicinal product information (http://www.swissmedicinfo.ch) imiquimod‐associated adverse effects at non‐application sites including fever, nausea, vertigo or myalgia among others may rarely be seen 3,4 . In addition, imiquimod 5% cream has been reported to induce erythema multiforme 5,6 . Interestingly, distant inflammatory mucosal reactions—a side effect not declared in the medicinal product information—may also occur according to a few case reports 7‐12 and our own experience.…”

Section: Introductionmentioning

confidence: 77%

Mucosal side effects in patients treated with topical imiquimod—A scoping review of the literature

Hammerl

Parlar

Navarini

et al. 2020

Dermatologic Therapy

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Imiquimod 5% is approved for topical treatment of actinic keratosis (AKs), superficial basal cell carcinoma and condylomata acuminata, the 3.75% formulation for the treatment of AKs and genital warts. Imiquimod has also been used off‐label in various other skin conditions (eg, Bowen's disease, lentigo maligna, vulvar intraepithelial neoplasia). As a toll‐like receptor 7/8 (TLR7/8) agonist imiquimod induces a local inflammatory response by increased production of cytokines, co‐stimulatory molecules, activation of Nk‐cells and antigen‐specific T‐cells. In addition to imiquimod‐associated adverse effects at non‐application sites such as fever, vertigo or myalgia there have been anecdotal reports of distant inflammatory mucosal reactions—a side effect not declared in the medicinal product information. In this scoping review we collected a total of seven cases of patients with lesions of the oral mucosa and lips and summarized pathophysiological hypotheses to explain this type of side effect. The review is complemented with an illustrated report of a 87‐year‐old female patient of ours suffering from chronic lymphocytic leukemia (CLL) who developed severe oral mucosal and labial reactions following application of imiquimod 3.75% for treatment of AKs. She denied accidental transfer of imiquimod and was tested negative for herpes simplex virus (PCR) and bacteria (culture) from lesional swabs.

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“…Various topicals allergens cause erythema multiforme, including topical drugs such as corticosteroids, nonsteroidal anti-inflammatory drugs, iodine povidone, imiquimod; rubber gloves; nickel and herbicides. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Erythema multiforme-like secondary to paraphenylenediamine due to henna tattoo plus residual hypopigmentation

et al. 2015

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Temporary henna tattoos or pseudotattoos have become increasingly widespread among children and adolescent. A generalized skin reaction, type erythema multiforme-like reaction is unusual, and rarely reported. We describe the case of a 7-year-old boy who reported erythematous papular bull’s-eye shaped lesions and consolidated edema primarily in the upper and lower extremities. These lesions were compatibles with erythema multiforme-like reaction. He also showed an erythematous-eczematous lesion on his leg, shaped like a dolphin. In this area, a temporary henna tattoo was painted 1-month earlier. Patch test was positive for paraphenylenediamine (PPD). Skin reactions due to henna are rare. Most of the reactions are due to additives, especially PPD, an aniline derivative, which is added to speed up the process of skin dyeing and to give a darker brown to black color (“black” henna). As henna tattoos are becoming increasingly popular, prevention requires the annual provision of information to consumers, especially young people and their parents.

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Erythema Multiforme Due to 5% Imiquimod Cream

Cited by 7 publications

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Erythema multiforme induced by imiquimod 5% cream

Erythema multiforme induced by imiquimod 5% cream

Mucosal side effects in patients treated with topical imiquimod—A scoping review of the literature

Erythema multiforme-like secondary to paraphenylenediamine due to henna tattoo plus residual hypopigmentation

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