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Updated: Aug 17, 2025
Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
Case report: A rare case of imiquimod-induced atypical pemphigus vulgaris
Francesco Moro1,2, Davide Ciccone1, Luca Fania1
1Dermatology Clinic, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy.
Background:
Pemphigus vulgaris is an autoimmune intraepithelial bullous disease involving the skin and the mucous membranes. Imiquimod, a topical therapy for skin basal cell carcinoma, is an amine that induces the production of tumor necrosis factor alfa, interleukin-1 and other cytokines. Pemphigus induced by drugs has been frequently reported, mostly after systemic therapy.
Case Presentation:
We present the case of a 50-year-old man who developed skin, intraoral, and genital mucosae lesions 3 days after a treatment with Imiquimod for multiple superficial basal cell carcinoma of the trunk. Direct and indirect immunofluorescence results were compatible with the diagnosis of pemphigus vulgaris. Enzyme-linked immunosorbent assay was negative for desmoglein 1 and 3, but interestingly, by immunoblotting on keratinocyte extracts a band of 170 kDa was obtained by IgG. The patient, after interrupting Imiquimod application, started a treatment with prednisolone and in 4 weeks showed a complete remission.
Conclusion:
Topical Imiquimod therapy might induce atypical pemphigus vulgaris in some patients.
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