Topical imiquimod cream 5% for resistant perianal warts in a renal transplant patient

Abstract

Renal transplant recipients represent a patient subgroup for whom the effective treatment of genital warts poses a significant problem in genitourinary medicine. This case demonstrates the safe and effective treatment of resistant perianal warts in a male renal transplant recipient using imiquimod.

Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients

“…Imiquimod has previously been evaluated in uncontrolled studies or case series for the treatment of AK and other diseases in OTR with good success. 14,[16][17][18][19][20] In contrast to these studies, this is a vehicle-controlled, randomized study that evaluated imiquimod in a variety of transplant patients with AK and explored a substantial margin of safety by requiring two full sachets of drug to be applied to 100 cm 2 3· ⁄week for 16 weeks. A similar vehicle-controlled, randomized study by Brown evaluated renal transplant patients with a similar dosing schedule but applied only a single sachet.…”

“…Compared to immunocompetent patients, the local skin reaction profile seemed to be similar in intensity but slightly protracted in our graft recipients. 15,17,20 With respect to efficacy, imiquimod patients experienced significant reduction in AK lesion counts, with most patients experiencing clearance of at least 75% of AKs in the treatment area. Conversely, vehicle treated patients showed a considerable progression of disease.…”

Efforts to Counteract Locally the Effects of Systemic Immunosupression: A Review on the Use of Imiquimod, a Topical Immunostimulator in Organ Transplant Recipients

“…Multiple palmoplantar warts in a 17-year-old cardiac transplant recipient and another patient receiving immunosuppressive therapy for autoimmune hepatitis were successfully treated with a combination of C02 laser vaporization .followed by topical 5% imiquimod cream under occlusion, with no recurrences at 9-12 months (55). Application of imiquimod three times weekly for 16 weeks to perianal warts in a renal transplant recipient induced clinical clearance without recurrence over 11 months (48). Complete resolution of recalcitrant warts on the lips of a lung transplant patient was also reported after treatment with 10 weeks ofthree times weekly topical imiquimod (15).…”

Safety and Efficacy of 5% Imiquimod Cream for the Treatment of Skin Dysplasia in High-Risk Renal Transplant Recipients

“…In another study 6 of superficial BCCs, imiquimod treatment resulted in signs of erosion after 3 to 5 days in 5 of 6 immunocompetent patients. The delayed response in our immunosuppressed patients has previously been observed in RTR-treated perianal warts 27 and may reflect a failure to recruit the effector cells needed to stimulate the cutaneous immune system of immunosuppressed individuals (see the following subsection).…”