{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:59:47Z","timestamp":1753891187980,"version":"3.41.2"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T00:00:00Z","timestamp":1669248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Topical Imiquimod therapy might induce atypical pemphigus vulgaris in some patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.1054544","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T06:53:47Z","timestamp":1669272827000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: A rare case of imiquimod-induced atypical pemphigus vulgaris"],"prefix":"10.3389","volume":"9","author":[{"given":"Francesco","family":"Moro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Ciccone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Fania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feliciana","family":"Mariotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adele","family":"Salemme","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siavash","family":"Rahimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabatino","family":"Pallotta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Di Zenzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5826\/dpc.1201a37","article-title":"Pemphigus vulgaris: present and future therapeutic strategies.","volume":"12","author":"Didona","year":"2022","journal-title":"Dermatol Pract Concept."},{"key":"B2","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s00281-015-0541-1","article-title":"Immune response in pemphigus and beyond: progresses and emerging concepts.","volume":"38","author":"Di Zenzo","year":"2016","journal-title":"Semin Immunopathol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1067\/mjd.2000.107808","article-title":"Immunomodulatory and pharmacological properties of imiquimod.","volume":"43","author":"Sauder","year":"2000","journal-title":"J Am Acad 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Schiavo","year":"2008","journal-title":"Int J Dermatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1001\/archderm.140.7.889","article-title":"Localized pemphigus foliaceus induced by topical imiquimod treatment.","volume":"140","author":"Lin","year":"2004","journal-title":"Arch Dermatol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/s0301-2115(02)00482-7","article-title":"Successful treatment of a high-grade intraepithelial neoplasia with imiquimod, with vulvar pemphigus as a side effect.","volume":"109","author":"Campagne","year":"2003","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1684\/ejd.2019.3517","article-title":"Imiquimod-induced widespread psoriasiform eruptions.","volume":"29","author":"Igari","year":"2019","journal-title":"Eur J Dermatol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1038\/jid.2013.65","article-title":"Anti-\u03b1-2-macroglobulin-like-1 autoantibodies are detected frequently and may be pathogenic in paraneoplastic pemphigus.","volume":"133","author":"Numata","year":"2013","journal-title":"J Invest Dermatol."},{"key":"B12","first-page":"245","article-title":"Treatment of recalcitrant pemphigus vulgaris with the tumor necrosis factor alpha antagonist etanercept.","volume":"74","author":"Berookhim","year":"2004","journal-title":"Cutis."}],"container-title":["Frontiers in 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