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Topical application of imiquimod (as a 5% cream) is widely used for treatment of external ano-genital warts and superficial basal cell carcinoma. It works by activating immune cells via the toll-like receptor, inducing local production of interferon alpha and enhancing natural killer and cytotoxic cell activity and is known to cause local erythema/oedema and rarely exacerbation of psoriasis. Taylor and colleagues describe an HIV-negative patient with penile warts and a past history of eczema in whom topical application of imiquimod cream was associated with widespread severe eczema at sites previously affected, in the absence of any local reaction. This case highlights the need for caution when using topical imiquimod, or other immune response modifiers, in patients with eczema. See p 227 (See figure below)
Rectal chlamydia can be caused by …