Erythema multiforme induced by imiquimod 5% cream

Abstract

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

Erythema multiforme caused by topical imiquimod 3.75%

“…This reaction is probably due to disproportionated systemic absorption and imiquimod immunomodulatory effects triggering a hypersensitivity reaction (type III or IV) 2 . An intense local inflammatory response to imiquimod, such as that experienced by our patient, was already proposed as a potential risk factor for systemic absorption, predisposing patients to EM 3 .…”

“…César Magalhães 1,a *, André Coelho 2 , Miguel Costa 1 , and Nuno Menezes 1 anticonvulsants, and allopurinol), but few with topical treatments [1][2][3] . We found under 10 cases of EM associated with topical imiquimod, all with imiquimod 5%.…”

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

“…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.…”

“…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.…”

Erythema Ab Igne Caused By Laptop Computer

“…Finally, chronic pain and persistent systemic symptoms in EAI have to be carefully checked as a possible sign of occult internal malignancies. A total of 11 cases have been reviewed in a recent paper by Bunick and Ibrahim [ 21 ], with gastrointestinal (colorectal, pancreatic, gastric) cancer being the most represented tumour; lung, renal breast and hematologic malignancies have also been reported thus underlines the importance of complete assessment of this otherwise benign condition [ 21 , 22 ].…”