The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions

Cannon, Paul S.; O’Donnell, Brett A; Huilgol, Shyamala C.; Selva, Dinesh

doi:10.1136/bjo.2009.178202

Cited by 39 publications

(34 citation statements)

References 19 publications

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“…Erythema, itching, and scaling at application site were the most common side effects seen in patients. Mild to severe conjunctivitis, ocular stinging, diffuse punctate keratitis, preseptal cellulitis, microbial keratitis (Staphylococcus aureus keratitis, which responded to topical antibiotics), and cicatricial ectropion were reported by Cannon et al (16). Erythema and crusting were seen in our patient, but were tolerable and healed after cessation of therapy.…”

Section: Resultsmentioning

confidence: 42%

“…Because lesion in our case was diffuse over the upper eyelid, our patient treated lesion once a day, 5 times per week for 6 weeks. Drug manufacturer does not recommend use of IMQ in periocular area as cream base includes stearyl and benzyl alcohol (6,15,16). However, several studies in recent years have reported beneficial IMQ treatment of eyelid.…”

Section: Resultsmentioning

confidence: 99%

“…However, several studies in recent years have reported beneficial IMQ treatment of eyelid. Cannon et al described ophthalmic side effects of IMQ therapy in patients with AK, Bowen's disease, and BCC (16). Erythema, itching, and scaling at application site were the most common side effects seen in patients.…”

Section: Resultsmentioning

confidence: 99%

“…Erythema and crusting were seen in our patient, but were tolerable and healed after cessation of therapy. Discontinuing treatment for rest period has been recommended to manage ophthalmic side effects (16). Rest periods were permitted when side effects were severe in our patient.…”

Section: Resultsmentioning

confidence: 99%

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Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Karabulut¹

2017

Beyoglu Eye J

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A 61-year-old male presented with 20 x 15 mm diffuse, hyperpigmented lesion that covered the right upper eyelid and which had been present for 2 years. Lesion was diagnosed as actinic keratosis (AK). Since the patient refused surgery and reconstruction, he was treated with imiquimod (IMQ) 5% cream once a day, 5 times per week for 6 weeks. Lesion gradually reduced in size and no clinically evident residual keratosis was observed after treatment. No post-therapy excision was performed to assess histological clearance of AK for cosmetic reasons. Although surgery is first-line treatment for these lesions, in case of refusal to undergo surgery, when lesion is superficial and diffuse and in region where reconstruction would be difficult, treatment with IMQ may be preferred.

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Section: Resultsmentioning

confidence: 42%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Karabulut¹

2017

Beyoglu Eye J

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“…Thus, a detailed discussion with the patient regarding the treatment procedure and the expected self-limiting adverse events improves confidence and ensures compliance. This is further secured by unrestricted access of the patient to the physician during treatment [18,19]. It is worth noting that contact of imiquimod with the ocular surface is generally safe and the substance has been successfully applied directly on conjunctival actinic keratoses for their treatment [20].…”

Section: Discussionmentioning

confidence: 99%

Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative

Gaitanis

Kalogeropoulos²,

Bassukas³

2015

Dermatology

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Background/Aim: Periocular basal cell carcinomas (pBCC) remain a treatment challenge. Our aim was to retrospectively evaluate the feasibility and efficacy of immunocryosurgery for the treatment of pBCC. Methods: Immunocryosurgery is given in 5-week cycles of daily imiquimod, with cryosurgery on day 14. Patients treated between 1/1/2008 and 31/12/2014 were included in this study. Results: Immunocryosurgery was offered to 19 patients. Of these, 16 (i.e. 6 males and 10 females, average age 74.9 years, median tumor diameter 15 mm, range 5-60 mm), with 1 tumor each, were treated. Six tumors (37.5%) were relapses after surgery and 2 were of metatypical histology. All BCC were high risk for recurrence after treatment; 10 tumors had 2 risk factors for relapse, 5 had 3, and 1 had 4. The follow-up period ranged between 3 and 60 months (average 25.6 months). Of the 16 tumors treated, 14 (all with a diameter <40 mm) cleared with immunocryosurgery (total efficacy 87.5%); 7 out of 16 tumors (44%; all with a diameter ≤20 mm) cleared with 1 conventional 5-week immunocryosurgery treatment cycle. Seven additional tumors (including 2 with a diameter >20 mm) required intensified treatment schemes (of up to 10 weeks) for clearance. The 2 tumors that did not clear responded partially and were also the 2 largest ones (diameter 40 and 60 mm). Of the 14 cleared tumors, 2 relapsed during follow-up; 1 cleared with immunocryosurgery. At the last examination during follow-up, 13 out of 16 (81%) patients were in sustained clinical remission. Conclusions: For most pBCC, immunocryosurgery is a feasible and efficacious alternative to surgical excision.

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Topical rather than intradermal application of the TLR7 ligand imiquimod leads to human dermal dendritic cell maturation and CD8⁺ T‐cell cross‐priming

et al. 2014

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Toll-like receptor (TLR) ligands are attractive candidate adjuvants for therapeutic cancer vaccines, since TLR signaling stimulates and tunes both humoral and cellular immune responses induced by dendritic cells (DCs).Given that human skin contains a dense network of DCs, which are easily accessible via (intra-)dermal delivery of vaccines, skin is actively explored as an antitumor vaccination site. Here we used a human skin explant model to explore the potential of TLR ligands as adjuvants for DC activation in their complex microenvironment. We show that topical application of Aldara skin cream, 5% of which comprises the TLR7 agonist imiquimod, significantly enhanced DC migration as compared with that resulting from intradermal injection of the TLR7/8 ligand R848 or the soluble form of imiquimod. Moreover, Aldara-treated DCs showed highest levels of the costimulatory molecules CD86, CD83, CD40, and CD70. Topical Aldara induced the highest production of pro-inflammatory cytokines in skin biopsies. When combined with intradermal peptide vaccination, Aldara-stimulated DCs showed enhanced crosspresentation of the melanoma antigen MART-1, which resulted in increased priming and activation of MART-1-specific CD8 + T cells. These results point to advantageous effects of combining the topical application of Aldara with antitumor peptide vaccination.Keywords: Adjuvants r Aldara r Cross-presentation r DCs r Human skin r T-cell priming Additional supporting information may be found in the online version of this article at the publisher's web-site IntroductionVaccination is used to generate strong and specific immune responses against target antigens with minimal side effects. In particular, cancer vaccines aim to generate an efficient immune Correspondence: Prof. Yvette van Kooyk e-mail: y.vankooyk@vumc.nl response against tumor-associated antigens (TAAs), which will depend on the instruction of CD8 + T cells that can effectively eradicate the tumor [1]. However, cancer vaccines often show poor immunogenicity, making them dependent on adjuvants to induce an immune response and to avoid the generation of tolerance.Adjuvants consist of compounds that boost the potency, quality, or longevity of specific immune responses to antigens, but should cause minimal toxicity on their own [2]. They accomplish C 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu 2416 Cynthia M. Fehres et al. Eur. J. Immunol. 2014. 44: 2415-2424 these effects via the generation of antigen depots, attraction of an immune infiltrate, enhancement of antigen presentation through the activation of antigen-presenting cells (APCs) including the induction of appropriate costimulatory molecules and cytokines [3]. Toll-like receptor (TLR) ligands have been extensively studied as the latest generation of adjuvants [4]. These receptors are widely expressed by both immune cells such as dendritic cells (DCs), and nonimmune cells such as keratinocytes and fibroblasts [5]. TLRs represent a receptor family that recognizes a broad spectrum of conserved m...

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The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions

Abstract: Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy.

Cited by 39 publications

References 19 publications

Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative

Topical rather than intradermal application of the TLR7 ligand imiquimod leads to human dermal dendritic cell maturation and CD8⁺ T‐cell cross‐priming

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The ophthalmic side-effects of imiquimod therapy in the management of periocular skin lesions

Abstract: Conjunctivitis and ocular stinging were the commonest ophthalmic side-effects encountered with the application of imiquimod for periocular skin lesions. These effects were temporary and resolved on terminating the imiquimod therapy.

Cited by 39 publications

References 19 publications

Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Imiquimod 5% Cream for The Treatment of Actinic Keratosis of The Eyelid

Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative

Topical rather than intradermal application of the TLR7 ligand imiquimod leads to human dermal dendritic cell maturation and CD8+ T‐cell cross‐priming

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Product

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About

Topical rather than intradermal application of the TLR7 ligand imiquimod leads to human dermal dendritic cell maturation and CD8⁺ T‐cell cross‐priming