Similar articles

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.

[1]Barry, R.B., Hughes, B.R., Cook, L.J., 2008. Involution of infantile haemangiomas after imiquimod 5% cream. Clin. Exp. Dermatol., 33(4):446-449.

[2]Brouty-Boyé, D., Zetter, B.R., 1980. Inhibition of cell motility by interferon. Science, 208(4443):516-518.

[3]Bruckner, A.L., Frieden, I.J., 2006. Infantile Hemangiomas. J. Am. Acad. Dermatol., 55(4):671-682.

[4]Duda, D.G., Sunamura, M., Lozonschi, L., Kodama, T., Egawa, S., Matsumoto, G., Shimamura, H., Shibuya, K., Takeda, K., Matsuno, S., 2000. Direct in vitro evidence and in vivo analysis of the antiangiogenesis effects of interleukin 12. Cancer Res., 60(4):1111-1116.

[5]Guo, Z., Li, G., Xu, Q., Gao, Y., Li, P., Zhang, X., Duan, Y., Guo, X., Zheng, B., 2009. Clinical observations on the treatment of infantile hemangiomas with topical imiquimod 5% cream. J. Nanjing Med. Univ., 23(3):177-182.

[6]Hazen, P.G., Carney, J.F., Engstrom, C.W., Turgeon, K.L., Reep, M.D., Tanphaichitr, A., 2005. Proliferating haemangioma of infancy: successful treatment with topical 5% imiquimod cream. Pediatr. Dermatol., 22(3):254-256.

[7]Ho, N.T., Lansang, P., Pope, E., 2007. Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study. J. Am. Acad. Dermatol., 56(1):63-68.

[8]Li, V.W., Li, W.W., Talcott, K.E., Zhai, A.W., 2005. Imiquimod as an antiangiogenic agent. J. Drugs Dermatol., 4(6):708-717.

[9]Martinez, M.I., Sanchez-Carpintero, I., North, P.E., Mihm, M.C.Jr., 2002. Infantile haemangioma: clinical resolution with 5% imiquimod cream. Arch. Dermatol., 138(7):881-884.

[10]McCuaig, C.C., Dubois, J., Powell, J., Belleville, C., David, M., Rousseau, E., Gendron, R., Jafarian, F., Auger, I., 2009. A phase II, open-label study of the efficacy and safety of imiquimod in the treatment of superficial and mixed infantile hemangioma. Pediatr. Dermatol., 26(2):203-212.

[11]Musumeci, M.L., Schlecht, K., Perrotta, R., Schwartz, R.A., Micali, G., 2008. Management of cutaneous hemangiomas in pediatric patients. Cutis, 81(4):315-322.

[12]Sanchez-Carpintero, I., Martínez, M.I., Mihm, M.C.Jr., 2006. Clinical and histopathologic observations of the action of imiquimod in an epithelioid hemangioendothelioma and Paget’s mammary disease. J. Am. Acad. Dermatol., 55(1):75-79.

[13]Sidbury, R., Neuschler, N., Neuschler, E., Sun, P., Wang, X., Miller, R., Tomai, M., Puscasiu, E., Gugneja, S., Paller, A.S., 2003. Topically applied imiquimod inhibits vascular tumor growth in vivo. J. Invest. Dermatol., 121(5):1205-1209.

[14]Sidky, Y.A., Borden, E.C., 1987. Inhibition of angiogenesis by interferons: effects on tumor- and lymphocyte-induced vascular responses. Cancer Res., 47(19):5155-5161.

[15]Stanley, M.A., 2002. Imiquimod and the imidazoquinolones: mechanism of action and therapeutic potential. Clin. Exp. Dermatol., 27(7):571-577.

[16]Sun, Z.J., Zhao, Y.F., Zhang, W.F., 2007. Immune response: a possible role in the pathophysiology of hemangioma. Med. Hypotheses, 68(2):353-355.

[17]van Seters, M., van Beurden, M., ten Kate, F.J., Beckmann, I., Ewing, P.C., Eijkemans, M.J., Kagie, M.J., Meijer, C.J., Aaronson, N.K., Kleinjan, A., et al., 2008. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N. Engl. J. Med., 358(14):1465-1473.

[18]Wang, C., Quevedo, M.E., Lannutti, B.J., Gordon, K.B., Guo, D., Sun, W., Paller, A.S., 1999. In vivo gene therapy with interleukin-12 inhibits primary vascular tumor growth and induces apoptosis in a mouse model. J. Invest. Dermatol., 112(5):775-781.

[19]Wang, J.Y., Liu, L.F., Mao, X.H., 2012. Treatment of lymphangioma circumscriptum with topical imiquimod 5% cream. Dermatol. Surg., in press.

[20]Welsh, O., Olazarán, Z., Gómez, M., Salas, J., Berman, B., 2004. Treatment of infantile haemangiomas with short-term application of imiquimod 5% cream. J. Am. Acad. Dermatol., 51(4):639-642.