Rare Cutaneous Side Effects of Imiquimod: A Review on Its Mechanisms, Diagnosis, and Management

Abstract

As an immune-response modifier, imiquimod can bind to Toll-like receptors on immune cells and enhance innate and adaptive immune responses, exerting potential antitumor and antiviral effects, which led to its approval by the US Food and Drug Administration for the treatment of actinic keratosis, superficial basal cell carcinomas, and anogenital warts, and to its off-label use in treating many other benign and malignant dermatoses. Although topical administration of imiquimod has been considered well tolerated, an increasing number of cutaneous and noncutaneous side effects are being reported as its clinical applications expand. This review primarily focuses on rare cutaneous side effects. To the best of our knowledge, this is the first article to summarize the mechanism, diagnosis, and management of rare cutaneous side effects of imiquimod, which may help to heighten awareness among physicians, especially dermatologists, about potential imiquimod-induced cutaneous side effects.

Topische Immuntherapie bei aktinischer Keratose und Feldkanzerisierung

“…Dennoch ist es wichtig, bei der Verwendung von Imiquimod Vorsicht walten zu lassen, insbesondere bei Personen mit einer persönlichen oder familiären Vorgeschichte von Autoimmunerkrankungen oder entzündlichen Dermatosen wie Vitiligo, Psoriasis, Erythema multiforme und Lichen planus. Diese Vorsicht ist gerechtfertigt, da die durch Imiquimod induzierte übermäßige Freisetzung von Zytokinen und die unangemessene Unterdrückung des Immunsystems zum Auftreten oder zur Verschlechterung dieser Zustände beitragen können [15].…”

Topical Immunotherapy for Actinic Keratosis and Field Cancerization

“…Nevertheless, it is crucial to exercise caution when employing imiquimod, particularly in individuals with a personal or family history of autoimmune diseases or inflammatory dermatoses, such as vitiligo, psoriasis, erythema multiforme, and lichen planus. This caution is warranted because imiquimod-induced excessive release of cytokines and the inappropriate suppression of the immune system may contribute to the onset or worsening of these conditions [ 15 ].…”