Imiquimod Cream Prevents Cutaneous Dysplasia in Renal Transplant Recipients

NEW YORK SEP 05, 2005 (Reuters Health) - Treatment with the immune response modifier imiquimod reduces the number and severity of cutaneous dysplasia lesions in high-risk renal transplant recipients, investigators report. "It remains to be seen," they say, "whether imiquimod will be the agent used to arrest the ever-increasing burden of cutaneous neoplastic and infectious complications that result from long-term immunosuppression."

Immunosuppressed renal transplant recipients face a high risk of viral warts, actinic keratoses, carcinoma in situ, and squamous and basal cell carcinoma, the authors explain in the August Archives of Dermatology, and the lesions are often difficult to treat.

Dr. Charlotte M. Proby from the University of London, England, and colleagues investigated the safety and efficacy of 5% imiquimod cream in a placebo-controlled trial involving 21 immunosuppressed renal transplant recipients with confirmed invasive squamous cell carcinoma or carcinoma in situ and clinical evidence of dysplastic skin.

Seven of 14 patients receiving active treatment had a reduction in areas of dysplastic change, the authors report, compared with 1 of 6 patients taking placebo. (One patient was excluded late in the trial.)

Five of the treated patients and 1 placebo patient had reduced numbers of keratoses and reduced dysplasia on histological assessment, the report indicates.

No malignancy developed on imiquimod-treated skin during the active treatment phase, the researchers note, whereas 1 tumor developed on placebo-treated skin and 2 tumors developed on control skin of patients in the active treatment group.

"Our data suggest that 5% imiquimod cream is safe to use 3 times per week on up to 60 square centimeter areas of skin in renal transplant recipients and is generally well tolerated," the investigators write.

"The apparent benefit of imiquimod in this study requires confirmation with a larger study population treating more extensive areas of diseased skin, perhaps under occlusion or after pretreatment with keratolytics," the researchers say.

SOURCE:

• Arch Dermatol 2005;141:985-993.