Induction of vitiligo after imiquimod treatment of condylomata acuminata

Abstract

BackgroundCondylomata acuminata (genital warts) is the most common sexually transmitted disease, and imiquimod is the sole FDA-approved medication for combating this condition. Vitiligo associated with imiquimod treatment of condylomata acuminata is rare.Case presentationA 28-year-old male with condylomata acuminata of the penis presented to our clinic. After removing his condylomata acuminata, we advised him to use imiquimod 5% cream to prevent relapse. When he presented to our clinic again about 12 weeks later, he complained of vitiligo patches on his penis and scrotum. Physical examination showed vitiligo patches involving the glans penis, shaft of the penis, and scrotum, and remaining pigmented areas within the plaques of vitiligo.A skin biopsy of the dorsal surface of the penis showed a complete absence of melanocytes and melanin granules in the basal layer; the dermis was normal.ConclusionThis is the first report of a case of imiquimod-induced vitiligo diagnosed by histopathological examination. This adverse effect should be considered when dermatologists prescribe this medication.

Immune and molecular correlates in melanoma treated with immune checkpoint blockade

“…Imiquimod, a TLR-7 agonist, is used topically to treat human papilloma virus (HPV) and basal cell carcinoma but local depigmentation has been observed following treatment 50,51 . Monobenzone causes haptenization of melanocyte proteins, inducing an immune response against melanocytes that both causes vitiligo-like depigmentation and attack on melanoma cells 52 .…”

“…Imiquimod, a toll-like receptor 7 agonist, is used topically to treat human papillomavirus and basal cell carcinoma, but local depigmentation has been observed after treatment. 50,51 Monobenzone causes haptenization of melanocyte proteins, inducing an immune response against melanocytes that causes both vitiligo-like depigmentation and an attack on melanoma cells. 52 These observations suggest that prompting an immunologic attack on skin epitopes, through either checkpoint blockade or these other topically applied immune activators, prompts a dual attack on cancer cells and healthy melanocytes.…”

Imiquimod‐induced vitiligo‐like hypopigmentation after treatment for radiation keratosis

“…Several mechanisms have been proposed for the vitiligo‐like hypopigmentation that may occur after topical imiquimod 5% cream, but the mechanism is not yet clear. It may be that the medication activates the Langerhans cells in the lesions via antigen presentation, leading to the destruction and apoptosis of melanocytes . Imiquimod binds to Toll‐like receptor (TLR)‐7 and TLR‐8, increasing production of pro‐inflammatory cytokines such as interferon (IFN)‐α, tumour necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐8, IL‐10, and IL‐12.…”

Paget's Disease of the Vulva Treated with Imiquimod: Case Report and Systematic Review of the Literature

“…In randomized trials, the most common side effect of imiquimod is local erythema, which has been reported in up to 42% of patients [35] . Otherwise, it is well tolerated but occasionally can lead to more pronounced unwanted effects such as adenopathy [36] , severe eczema [37] , vitiligo [38] or meningitis [39] . In women with EPDV, imiquimod was generally well tolerated with mild-to-moderate local reactions in a majority of cases.…”