Prof. Dr. Kamer Gündüz
Celal Bayar University Hospital
Department of Dermatology
imiquimod, Kaposi sarcoma, skin
J Dermatol Case Rep 2012 2, pp 52-53
Background: The classic Kaposi sarcoma is most common in the Mediterranean po-
pulation over 50 years of age and presents with reddish-brown papules and nodules
particularly on the lower limbs. Treatment depends on the clinical presentation and
extension of lesions. Imiquimod is as an immune response modifier with antiangio-
Main observations: We present a 74-year-old man with classic Kaposi sarcoma who
had multiple, small, violaceous papules and nodules on the trunk and extremities with
a history of 14 years. He complained particularly from plantar hyperkeratotic painful
nodules. Treatment with imiquimod 5% cream under occlusion resulted with almost
complete regression within 12 weeks. No local or systemic side effects were observed.
Conclusions: Topical imiquimod was a safe and effective therapy in our patient with
classic Kaposi sarcoma. (J Dermatol Case Rep. 2012; 6(2): 52-53)
Efficacy of 5% imiquimod cream in a patient with classic
Kamer Gündüz1, Ümran Günay1, Işıl Inanir1, Gülsüm Gençoğlan1, Peyker Temiz2
1. Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
2. Department of Pathology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
Kaposi’s sarcoma (KS) is a vascular neoplasm first descri-
bed in 1872 by Moritz Kaposi. Four variants have been de-
scribed: classic, endemic African, immunosuppression-as-
sociated, and human immunodeficiency virus (HIV) related.1,2,3
The classic variant is most common in the Mediterrane-
an population over 50 years of age. Clinically it presents
with reddish-brown papules and nodules particularly on the
lower limbs. Less frequently, the lesions may be located on
the upper arms, forearms, trunk, eyelids, and genital area.
The disease has a slow progression and benign course. Vi-
sceral or mucosal involvement is uncommon.1,2,3
We present a 74-year-old man with multiple, small, vio-
laceous papules and nodules on the trunk and extremities
with a history of 14 years. The histopathological examina-
tion of the lesions had given the diagnosis of Kaposi sarco-
ma (Fig. 1). Dermatological examination revealed appro-
ximately 10-15 violaceous papules and nodules with the
size of 0.5-1 cm scattered on the trunk and on the upper and
lower extremities. Oral mucosa was normal. Serology for
hepatitis B and C viruses and HIV were negative. No signs
of systemic involvement were found with the computerized
tomography of the chest and abdomen.
Figure 1. Fascicles of atypical spindled cells and slit-like
vascular channels (H&Ex100).
response modifier. Imiquimod also stimulates antiangioge- Download full-text
nic cytokines, downregulates the expression of proangioge-
nic factors, upregulates the expression of endogenous inhi-
bitors, and induces endothelial cell apoptosis.4It has been
used successfully in the treatment of infantile hemangiomas
and pyogenic granulomas with its antiangiogenic activity.5-7
In a prospective, open-label, single center, phase II clinical
trial, imiquimod cream was applied under occlusion 3 times
a week for 24 weeks in 17 immunocompetent Kaposi pa-
tients. Half of the patients showed a marked improvement
and complete remission was achieved in 2 cases.8Recently
a 72-year-old man with multiple, small papules on the right
foot was treated with 5% imiquimod cream on alternate days
and complete healing was achieved at 10 weeks.1In another
case report, an 87-year-old man with widespread lesions on
both legs was treated with 5% imiquimod cream with com-
plete response. This patient experienced flu-like symptoms
with every day applications, the symptoms disappeared by
reducing the applications to every other day.2Bernardini et
al9recently reported a case of localized KS that was treated
successfully with imiquimod 5% cream, under occlusion over-
night for at least 8 hours, 3 times a week for 3 months.
Topical imiquimod was a safe and effective therapy in our
patient with classic Kaposi sarcoma.
The patient was complaining particularly from the plantar
hyperkeratotic painful nodules (Fig. 2). He rejected surgical
intervention or radiotherapy. Therefore, occlusive treatment
with imiquimod 5% cream was started. In the first week we
applied thrice a week, no irritation was seen. Then we con-
tinued with everyday application. Rapid remission occurred
within a month and almost complete regression was seen in
the third month of treatment (Fig. 3). No local or systemic si-
de effects of imiquimod occurred within the treatment period.
No recurrences were seen in the 6-month follow-up period.
Various treatment modalities are used in classical KS de-
pending on the clinical presentation and extension of le-
sions. Surgical excision is a good therapeutic option in iso-
lated lesions, and local radiation therapy can be used in the
case of multiple lesions. Systemic treatments with vinbla-
stine, bleomycin, doxorubicin, etoposide, or intralesional
interferon alpha have been used, besides cryotherapy, laser
or photodynamic therapy.1,2
Topical imiquimod is a ligand of the Toll-like receptors
7 and 8 on dendritic cells, and it functions as an immune
Efficacy of 5% imiquimod cream in a patient with classic Kaposi sarcoma, Gündüz et al.
J Dermatol Case Rep 2012 2, pp 52-53
Figure 2. Hyperkeratotic nodules on the sole.
Figure 3. Almost complete remission with topical 5% imiqu-
imod at the end of 12 weeks.
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