[Efficacy of topical imiquimod 5% in a patient with chronic radiodermatitis on the hands].

Chronic radiodermatitis is defined as a chronic inflammation of the skin associated with exposure to ionizing radiation. It usually presents in individuals who, because of their profession, have been repeatedly exposed to low doses of radiation over a long period of time without appropriate protection. Several treatments have been described, including topical 5-fluorouracil, dermabrasion, ablative laser, photodynamic therapy, and surgery. In 2006 Sachse et al. described the use of imiquimod in a 60-year-old patient with chronic thoracic radiodermatitis. We report the case of a 69-year-old male radiologist referred to our clinic for assessment of skin lesions that had appeared 2 years earlier on the dorsum of the fingers of both hands. The patient had performed fluoroscopy in clinical practice for 25 years without wearing gloves or using other recommended protective measures. Physical examination revealed skin atrophy, poikiloderma, loss of skin adnexa, ulcerations, and hyperkeratotic lesions on the dorsum of several fingers of both hands with nail involvement (Fig. 1). Several of the lesions were biopsied. Histologic findings in the specimen taken from the third finger of the left hand were compatible with actinic keratosis, and the changes observed in the specimen taken from the third finger of the right hand were conclusive for squamous cell carcinoma. After informing the patient of the treatment options, a 4-week cycle of imiquimod cream, 5% was prescribed to reduce the number of lesions, with application 3 times a week. Tolerance was good and the number of lesions had decreased significantly by the end of the cycle (Fig. 2). Because the lesion on the third finger of his left hand persisted, the patient was referred to the traumatology department, where the distal phalanx of the affected finger was amputated. Imiquimod (Aldara) is an immune response modulator belonging to the family of imidazoquinolines. Topical imiquimod stimulates the innate and acquired immune