Dramatic Clearance of HIV-Associated Bowenoid Papulosis Using Combined Oral Acitretin and Topical 5% Imiquimod

August 2014 | Volume 13 | Issue 8 | Editorials | 901 | Copyright © August 2014


Joel Hua-Liang Lim MRCP,a Kar-Seng Lim MRCP,b and Wei-Sheng Chong FRCPc

aDepartment of Internal Medicine, Tan Tock Seng Hospital, Singapore
bThe Dermatology Practice, Singapore
cNational Skin Center, Singapore

but can be painful and was left as final line treatment. As such, a novel combination of oral acitretin 25 mg daily and topical 5% imiquimod every alternate day was commenced. Resolution of BP lesions can take up to 18 months6 in patients with HIV.
Acitretin is a second-generation anti-psoriatic retinoid that induces keratinocyte differentiation and leads to the retardation of cellular turnover. It is via this mechanism that we postulate the combination regime was able to achieve good clinical results expediently. Review at 7 months post-treatment revealed sustained remission of disease.
In conclusion, we would like to underscore the association of HIV with BP and the need to treat it to prevent malignant transformation, which is potentiated in view of the former. We would also like to highlight the effectiveness of acitretin used with topical imiquimod in the treatment of HIV-associated BP.

Disclosure

The authors have not declared any relevant conflicts.

References

  1. Cardoso JC, Calonje E. Cutaneous manifestations of human papillomaviruses: a review. Acta Dermatovenerol Alp Panonica Adriat. 2011; 20(3):145-54.
  2. Von Krogh G, Horenblas S. Diagnosis and clinical presentation of premalignant lesions of the penis. Scand J Urol Nephrol. Suppl 2000; (205):201-14.
  3. JM Ricart, J Cordoba, M Hernandez, I Esplugues. Extensive genital bowenoid papulosis responding to imiquimod. J Eur Acad Dermatol Venereol. 2007; 21(1):113-5.
  4. Redondo P, Lloret P. Topical imiquimod for bowenoid papulosis in an HIVpositive woman. Acta Derm Venereol. 2002; 82(3):212-3.
  5. Van der Meiden W.I., Van,t Hof A.T. One–year experience with imiquimod cream in the treatment of large or widespread ano-genital warts in patients seen at the Erasmus MC STD clinic. Abstracts of the 12th Congress of the European Academy of Dermatology and Venerology, 15-18 October 2003, Barcelona, Spain. J Eur Acad Dermatol Venereol. 17; Nov 2003, 4158.
  6. James C. Godfrey, Mary C. Vaughan and Judith V. Williams. Successful treatment of bowenoid papulosis in a 9-Year-Old girl with vertically acquired human immunodeficiency virus. Pediatrics. 2003; 112;e73

AUTHOR CORRESPONDENCE

Joel Hua-Liang Lim MRCPjoellimhualiang@gmail.com
Close Menu