Induction of vitiligo after imiquimod treatment of condylomata acuminata

Abstract

Background: Condylomata acuminata (genital warts) is the most common sexually transmitted disease, and imiquimod is the sole FDA-approved medication for combating this condition. Vitiligo associated with imiquimod treatment of condylomata acuminata is rare.

Case presentation: A 28-year-old male with condylomata acuminata of the penis presented to our clinic. After removing his condylomata acuminata, we advised him to use imiquimod 5% cream to prevent relapse. When he presented to our clinic again about 12 weeks later, he complained of vitiligo patches on his penis and scrotum. Physical examination showed vitiligo patches involving the glans penis, shaft of the penis, and scrotum, and remaining pigmented areas within the plaques of vitiligo.A skin biopsy of the dorsal surface of the penis showed a complete absence of melanocytes and melanin granules in the basal layer; the dermis was normal.

Conclusion: This is the first report of a case of imiquimod-induced vitiligo diagnosed by histopathological examination. This adverse effect should be considered when dermatologists prescribe this medication.

Figure 1

Vitiligo patches involving the glans penis, shaft of the penis, and scrotum after the use of imiquimod 5%. a. Vitiligo on the patient’s penis,some remaining pigmented areas within the vitiligo. plaques . b. vitiligo on the patient’s scrotum.

Figure 2

Loss of melanocytes and melanin granules. a. Normal stratum corneum, stratum granulosum, and stratum spinosum, with loss of melanocytes and melanin granules in the basal layer. Dermis showing no abnormalities (H&E ×100). b. loss of melanocytes and melanin granules in the basal layer (H&E ×200).

Figure 3

Absence of melanin granules. a. Absence of melanin granules in epidermis. Normal dermis. (Masson-Fontana stain for melanin ×100). b. Absence of melanin granules in epidermal basal cell layer. (Masson-Fontana stain for melanin ×200).

Figure 4

Normal skin (control): normal of melanocytes and melanin granules. a. presence of melanocytes and melanin granules in epidermis. Normal dermis (Masson-Fontana stain for melanin ×100). b. presence of melanocytes and melanin granules in epidermal basal cell layer. (Masson-Fontana stain for melanin ×200).