Imiquimod has been used in 4 patients, with varying success.
A 22-year-old man presented with SCC in situ in association with EV and was treated with imiquimod applied 5 times weekly for 3 months. This regimen resulted in significant improvement in the multiple facial SCC in situ, but the EV lesions of the extremities were not treated.10
A 52-year-old man was prescribed systemic interferon (6 million U, 2 times weekly for 8 months) and imiquimod (5 times weekly for 17 weeks) for treatment of Bowen disease and EV, with resulting resolution of both at follow-up of 17 weeks.11
In contrast, lesions of 2 HIV-positive brothers (11- and 12-years old) did not improve after treatment with imiquimod 3 times weekly for 2 months.12
Combination therapy with interferon alfa and imiquimod or systemic retinoids has been used.
A 19-year-old woman with a 12-year history of persistent EV lesions was treated with interferon alfa-2a, 3 million U, 3 times weekly, and acitretin, 50 mg/d for 6 months, with complete clinical resolution of disease. Lesions recurred after 3 months off treatment, and the patient was prescribed acitretin for an additional 3 months. Her face remained lesion-free at her 1-year follow-up, although EV lesions recurred on the hands.13
A 43-year-old woman with EV and a history of multiple oral and genital SCC was prescribed peginterferon alfa, 1 μg/kg/wk, and acitretin, 0.2 mg/kg/d, but relapsed clinically after peginterferon alfa-2b was discontinued. Six months after her acitretin dose was increased to 0.5 mg/kg/d, only a few EV lesions were visible.14
Oral retinoids (acitretin and etretinate) as monotherapy are helpful in decreasing overall lesion number, but recurrence is common after discontinuation of medication.15- 17
A 20-year-old immunocompetent man with EV achieved marked decrease in the size and number of lesions after 6 months of isotretinoin, 0.8 mg/kg/d, which was maintained with low-dose isotretinoin, 0.3 mg/kg/d.18
Treatment of 4 patients with congenital EV (ages 31-52 years) with etretinate, 1 mg/kg/d for 4 months, resulted in flattening and lightening of lesions. Complete clearing was never seen, and lesions returned after cessation of treatment.15
A 25-year-old woman with extensive EV lesions for 19 years was treated with oral acitretin, 0.5-1 mg/kg/d, for 6 months, which slightly improved the appearance of her lesions. After discontinuation of treatment, the lesions returned to their baseline state.16
A 14-year-old girl and her 18-year-old brother, who had EV and other medical morbidities, were treated with etretinate, 1 to 1.5 mg/kg/d. The lesions initially showed mild to moderate flattening but recurred after discontinuation of the medication.17
Oral cimetidine, a histamine 2 antagonist, has been used in the treatment of EV lesions and was unsuccessful in a case series of 8 female patients, most of whom had cutaneous anergy (ages 15-40 years).19
In HIV-positive patients, the effect of HAART on EV lesions has been reported in 5 cases.
A 45-year-old man presented with numerous EV lesions. With HAART therapy and increase in CD4 lymphocyte count from 100/μL to 500/μL, the lesions had cleared completely by his 3-year follow-up.6
A 38-year-old man with diffusely distributed lesions showed no benefit after starting HAART therapy, despite an increase in CD4 lymphocyte count and a decrease in viral load. He was also unsuccessfully treated with cyrotherapy, podophyllotoxin, and imiquimod.7
In a case series of 3 patients with untreated HIV and a CD4 lymphocyte count of less than 400/μL, only 1 patient showed decrease in lesion number after initiation of HAART therapy.8