Imiquod Cream Just pescribed for multiple small skin cancers; No certainty if safe and effective for those with immune system disorders.

[Alliand]

In addition to vasculitis and GCA,and being trated with 12 mg methylpred per day and 15mg. Methotrexate once a week, I imagine I am immunosupressed. I also have a long history of squamous cell skin cancers on feet, and now with more. My dermatomatologist prescribed Imiqiuod, a topical skin cancer treatment applied to any spots 3 X week.

He knows about the other autoimmune problems, but afraid he is getting forgetful. When I read the package inserts at home , it states "it is not known if imiquod cream is safe and effective for people who do not have a normal immune systems " . I am concerned that the doctor is becoming a little forgetful ( he is using the cream himself and area very inflamed on his forehead.)

Have any of you been prescribed this topical skin cancer tx while on immunosuppressive drugs? What would you do in my place? I am tempted to try one spot. It is to be used for up to 16 weeks; am feeling a bit desperate to get rid of these many small cancers while treating the vasculitis issues. Anyone here who can help? I am holding off; will be seeing theumatologists in 3 .weeks. Any advice or experience with Imiquod while immunosuppressed. Thanks.

[Skipper]

Hi, I have had GPA for over 1l years and been on Azathioprine (immunosuppressant drug) which is likely to give you skin cancers. My dermatologist prescribes Efudix (fluorouracil) which would appear to act the same as your imiquod. I have had no side effects with regard to my immune system and have used it on about four different occasions. It does work but you have to be patient and it certainly doesn't look very nice for a few weeks. I am currently treating my lower lip which makes eating and drinking very difficult. My consultant is quite happy for me to use it. I have to use is once a day for four weeks. Why not try it on one spot for a week and see how it goes. If there are no cancer cells it doesn't react. Best of luck.

[Alliand in reply to Skipper]

I am glad that you haven't had a problem, and the Efudix is working for you in spite of your GPA and Azanthopine. I saw a new dermatologist last week who preferred the cautious route; "freezing" for actinic keratosis and surgical removal with biopsy when a skin cancer is apparent on sight. I have had so many over the last 12 years, I've gotten quite good at spotting them and getting care quickly.

My whole life, my skin, although in good condition on my face , (thankfully) has been hypersensitive since I was a child, and with a lot of allergic reactions to medications.On biopsy, I have had a granuloma annulae and a painless "hypersensitivity" reaction on my thigh which looked like I had been in a car accident; it slowly disappeared on its own. For me, at least, freeze and cut (very small) is more emotionally comfortable for me.

I know how the cream chemo looks; the dermatologist who prescribed the Imiquod was using it himself on his forehead and drew it to my attention.. I was going to do as you suggested and try it on one spot, but was lucky to get a 2nd opinion appt. the next day b/c someone cancelled.

I also had a lip squamous cell (interior) removed by a Mohs surgeon who did it under IV anesthesia; perfect result.

My vasculitis seems to be affecting the skin on my lower legs and arms aside from the cancers with many purple and red marks, another reason I did not want to add complications. Paying for years in the sun.

In general, skin aside, how do you feel on Azanthopine? Are you also on prednisone?

Have you had any Rituxamab infusions? Good luck and continued success.

I have been living with this for a year and a half , ; the worst part is the chronic fatigue; I think the methotrexate (just taking it for 5 weeks once a week) has helped with musculoskeletal pain, but not with fatigue.

I have been offered the Rituxamab infusions by my rheumatologist, and have been reluctant, but based on the responses of the folks on this blog, I may go for it. Thanks for responding.

[Skipper in reply to Alliand]

My lip has now cleared up from using the Efudix but last week had two suspect basal cell carcinomas cut out and sent for biopsy. Over a period of about five years I have had four ops with one skin graft and lots of freezing. Result of Azathioprine and sun in childhood.

I have just stopped Azathioprine after 11 years and except for skin problems have had no side affects. I am also on prednisolone, varying over the years, but now on 5mg and going to have my third Rituxamab this week. Felt so much better after the first two infusions and it certainly helped with the fatigue. Everyone I know that has had Rituxamab has benefited from it. I wish you all the best if you decide to go for it.

All good wishes to you.