Treatment of primary vulvar paget disease with 5% imiquimod cream.

INTRODUCTION: Our objective was to evaluate the efficacy of conservative treatment with imiquimod in Paget vulvar disease. MATERIALS AND METHODS: We describe a case series that includes 10 patients with histopathologic diagnosis of extramammary Paget disease of the vulva, who were treated with 5% imiquimod cream. Of these patients, 3 were treated for recurrent disease and 7 were treated for initial primary disease. The patients applied the cream every other day until the lesions were no longer clinically detected.They were previously instructed on how and where to apply the cream by making them use a mirror while following the physician's directions. RESULTS: Complete clinical and histologic remission of the disease was achieved in 9 patients. The remaining patient had partial histologic response and is still under treatment. The treatment was well tolerated despite moderate irritation. No recurrences were observed during a mean follow-up of 18 months. CONCLUSIONS: On the basis of the results, the authors consider that 5% imiquimod cream could be considered a safe and effective therapeutic option for the treatment of primary vulvar Paget disease. Further studies are needed to determine the real efficacy and safety of 5% imiquimod cream for the treatment of this infrequent disease.

Asma ocupacional por doble agente causal / Occupational asthma caused byt wo different agents

Se describe el caso de una trabajadora con asma ocupacional en el que se detecta un doble agente etiológico condicionado por la exposición mixta en distintas áreas de trabajo. Los isocianatos y resinas epoxi se han descrito como responsables de enfermedad profesional y se ha confirmado su relevancia en las pruebas de función pulmonar tanto de manera inmediata como tardía y en la prueba de provocación bronquial específica. Se destaca la necesidad de evaluar exhaustivamente la exposición a sustancias en el ambiente laboral y comprobar la mejoría clínica tras el cese permanente de la exposición a los agentes implicados

We describe a case of a worker with occupational asthma caused by two separate etiologic agents, resulting from mixed exposures in different work areas. Isocyanates and epoxy resins are established causes of occupational disease, and their role in this case was confirmed by immediate and delayed pulmonary function testing, together with a specific bronchial challenge. A thorough evaluation of exposure to harmful substances in the workplace is essential, together with continued clinical monitoring following cessation of exposure in order to verify clinical improvement