Erosive Pustular Dermatosis of the Scalp Following Treatment With Topical Imiquimod for Actinic Keratosis

Erosive Pustular Dermatosis: A Manifestation of Immunosenescence A Report of 8 Cases

“…That the driving force of the disease is the exaggerated immune response is evidenced by a recent report of concomitant elevation of serum matrix metalloproteinase-3 in patients with EPD [34] and multiple cases that have been successfully treated with immunosuppressive therapies [2,35,36,37]. Amplification of the immune reaction can also be triggered by topical treatments used in dermatology including imiquimod, 5-fluorouracil, and ingenol mebutate, which have been reported to cause EPD in chronically sun-damaged patients [8,38,39]. …”

“…When eventual healing does occur, there is typically residual scarring alopecia in affected areas of the scalp, or scarring with post-inflammatory hyperpigmentation on the legs [1,5]. Triggering factors include various forms of damage to cutaneous integrity including physical and topical therapy, surgery, malignancy, and trauma [5,6,7,8,9,10,11]. Acute pustulosis of the scalp is a newer variant of the disease that has been recently described [12].…”

Squamous Cell Carcinoma as an Important Differential Diagnosis of Erosive Pustular Dermatosis of the Scalp

“…The clinical differential diagnosis includes squamous cell carcinoma, perifolliculitis abscedens et suffodiens, folliculitis decalvans, dermatitis artefacta, pyogenic granuloma, IgA pemphigus, Tinea, pustular psoriasis and cicatricial pemphigoid [7][8][9].…”

Acute Renal Failure Caused by Imiquimod 5% Cream in a Renal Transplant Patient: Review of the Literature on Side Effects of Imiquimod

“…The most common of those weird systemic side effects are influenza-like symptoms and headache. A review of the literature revealed lots of unusual adverse reactions related to the topical use of this drug, which are summarized in table 1[10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57]. …”

“…It is known that this drug produces an induction of cytokine expression in the application area. Moreover, it could induce a systemic increase in the immune response, which is particularly amplified in patients treated with immunosuppressive drugs [12,44]. With respect to psoriasis there is evidence of the ability of the innate immune system to drive psoriasis through the TLR-7 agonists of imiquimod [14].…”