Topical imiquimod treatment of cutaneous vascular disorders in pediatric patients: clinical evaluation on the efficacy and safety

Abstract

Abstract:Objective: To evaluate the clinical effect of topical imiquimod treatment on cutaneous vascular disorders in pediatric patients. Methods: A retrospective investigation was conducted in 25 pediatric patients with cutaneous vascular disorders, including 19 infantile hemangiomas (IHs) (12 superficial/7 mixed type), 5 nevus flammeus (NF), and 1 pyogenic granuloma (PG). Imiquimod 5% cream was applied every other day for 4 to 16 weeks (average 9.6 weeks). Results: Of the 19 IHs treated, an overall efficacy of 52.6% was achieved, with a clinical resolution rate of 15.8%, excellent rate of 26.3%, and moderate rate of 10.5%. The superficial type responded the best at 66.7%, while the mixed type showed only 28.6% effectiveness, which was predominantly from their superficial parts. No obvious response was noted in the 5 patients with NF. Side effects were observed in 78.9% of the patients, mostly mild to moderate local irritations and occasionally severe reactions such as thick crusting and ulceration. Systemic side events were observed in 4 IH patients including fever and digestive tract reactions. No recurrence was observed during the follow-up examination. Conclusions: Topical imiquimod could be an alternative option for the treatment of uncomplicated superficial IHs with satisfactory tolerability.

Japanese clinical practice guidelines for vascular anomalies 2017

“…In the reports related to the CQ: Drug type: The drugs were classified into imiquimod, timolol, propranolol, corticosteroid, and others Drug concentration and dosage form: Imiquimod was used as a 5% cream, timolol as 0.5% ophthalmic solution or gel, propranolol as 1% ointment, and corticosteroid were often used as ointments of agents ranked as relatively strong such as clobetasol propionate, halobetasol propionate, and betamethasone dipropionate Methods for topical application: Frequent administration methods were once a day every other day for imiquimod, 2 times a day every day at 1–2 drops each time for timolol, 2 times a day every day for propranolol, and 2 times a day every day for corticosteroid. Methods for efficacy evaluation: Comparison of gross findings and photographs were adopted in all papers.…”

Imiquimod in dermatology: an overview

“…Anecdotal case reports also showed resolution of several other vascular tumors such as pyogenic granuloma, epithelioid hemangioendothelioma, angiolymphoid hyperplasia with eosinophilia, and lymphangioma circumscriptum with imiquimod treatment.…”

“…Since an initial report showing imiquimod's potential in accelerating infantile hemangioma (IH) regression, more evidence have emerged on the efficacy of imiquimod in the treatment of several cutaneous vascular tumors or disorders including Kaposi's sarcoma (KS), pyogenic granuloma, among others . Imiquimod‐induced regression of vascular tumors is probably mediated by its immunomodulatory and anti‐angiogenic effects…”

Retiform hemangioendothelioma treated with conservative therapy: report of a case and review of the literature

“…The antitumorigenic effect of corticosteroids is mediated by vasoconstriction, hormonal influences, and inhibition of angiogenesis . Recently, it was reported that topical imiquimod treatment affects human infantile hemangioma, including ulcerated ones and mouse hemangioendothelioma . Some reports suggested that imiquimod inhibits the growth of hemangioendothelioma through induction of TIMP1 expression, which is a known inhibitor of angiogenesis and cell motility …”

“…Pulsed dye laser, local corticosteroid injection, or external application of imiquimod cream has been administered in the management of some vascular tumors, including hemangiomas of infancy. [27][28][29][30] The pulsed dye laser produces an antitumorigenic effect by inducing destruction of the vascular wall, which results from the generation of thermal energy as the laser light is absorbed into hemoglobin within the lumina. The antitumorigenic effect of corticosteroids is mediated by vasoconstriction, hormonal influences, and inhibition of angiogenesis.…”