Pemphigus-like lesions induced by imiquimod

Abstract

Imiquimod is an immunomodifier recently approved for the treatment of superficial basal cell carcinomas (sBCC). Although local adverse events (AEs) are the most commonly reported, systemic AEs have also been described. We present the case of a 60-year-old woman who, after the application of two sachets of imiquimod cream per day for 5 days/week to two large sBCCs, developed pemphigus-like lesions both at and distant from the application site. Histological examination of a skin biopsy found intraepidermal acantholytic blistering but results of direct immunofluorescence examination were negative. The lesions resolved after cessation of imiquimod. Two previous cases of imiquimod-induced pemphigus have been reported, but this is the first case with lesions distant from the site of application. We suggest that systemic absorption of the drug or greatly increased synthesis of cytokines could explain this reaction and recommend the use of low doses of imiquimod in the treatment of large or multiple sBCCs.

Pemphigus foliaceus induced by topical imiquimod treatment

“…first described pemphigus at locations that were local and distant from a topical contact site (contact pemphigus). Some chemicals can induce pemphigus, but little is known about pemphigus induced by imiquimod . The present report describes the third known instance of PF induced by imiquimod.…”

Acantholytic Pityriasis Rubra Pilaris Associated with Imiquimod 3.75% Application

“…Imiquimod 5% cream has been previously reported to cause localized or systemic “pemphigus-like” acantholytic dermatitis, with negative DIF studies [8–11]. In other reports, imiquimod 5% use in patients with preexisting PRP has been linked to exacerbation with features of acantholysis [12, 13].…”

Pharmacotherapy of Basal Cell Carcinoma, Anogenital Warts, and Actinic Keratoses: Focus on Topical Imiquimod

“…77 Several adverse events have been reported with the use of imiquimod, including pigmentary changes, superficial scarring, alopecia, 78 and rare induction of other dermatologic disorders such as pemphigus foliaceus, 79,80 aphthous ulcers, 81 vitiligo, 82-84 angioedema, 85 and eruptive epidermoid cysts. 86 Reports of induction of psoriasis associated with imiquimod have also been made.…”