A post for dermatologists: patients often come to you with various small skin growths, including HPV, pigment spots, and even various small skin tumors. You refer these people for removal, which is the right thing to do, but sometimes there's a more conservative way to get rid of these things, and perhaps everyone needs this method before removal.
I've already written about using interferon topically in sprays and ointments, but unfortunately, this effective protein penetrates the skin very poorly (some believe it doesn't penetrate at all). For those who have forgotten, interferons are signaling molecules that trigger a cascade of signals that cause infected or mutated cells to self-destruct to stop the spread of the threat. In other words, this activates the Th1 immune response (cellular immunity).
So, there's imiquimod cream —a topical immunomodulator that acts as an "inducer" of the body's own immune system. Its key feature is that it doesn't attack viruses or tumor cells directly, but rather stimulates the body to produce interferons, specifically interferon alpha [1]. Unfortunately, for some reason, doctors know little about it, or underestimate its effectiveness. The drug is available as a 5% cream (the most well-known brand is Aldara ) and is prescribed for the treatment of:
- Genital warts caused by HPV.
- Actinic keratosis (precancerous skin condition).
- Superficial basal cell carcinoma (a type of skin cancer).
From a pathophysiological perspective, I see great benefit from such a drug: for young patients, it can boost local immunity until complete recovery; for older patients, it can prepare the affected tissue for removal without the risk of relapse. Moreover, there are case reports of cures in the elderly, even without surgery:
“These reports present cases of malignant lentigo (melanoma in situ) on the cheek of a 92-year-old patient and on the scalp of a 90-year-old patient, demonstrating successful treatment with 5% imiquimod cream, offering a non-surgical alternative for large facial lesions. These reports demonstrate that modification of the immune response can lead to complete remission without the risks associated with surgery in older patients.” [2]
1. https://en.wikipedia.org/wiki/Imiquimod
2. https://karger.com/cde/article/17/1/568/936153/Nonsurgical-Treatment-of-Lentigo-Maligna-with
