History
- Patient with warts, being treated with imiquimod
- Presents with painful vulvar ulcers
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Imiquimod-induced vulvar ulceration
Diagnosis
Imiquimod-induced vulvar ulceration
Lesson
Imiquimod commonly causes erythema and oedema, but ulceration is less common. Ulcers may be small, but can be large enough to cause considerable pain and even urinary retention. Patients are often mistakenly presumed to have herpes.
Ulceration does not imply over-treatment. We have seen at least one case of ulceration following only 2 applications of imiquimod. It is probably due to an exaggerated immune response.
Management requires discontinuation of treatment, and some clinicians recommend topical steroids. Severe local imiquimod reactions are not allergic in nature, and treatment can be resumed, but cautiously.