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The lack of a clinical effect of cimetidine in the treatment of epidermodysplasia verruciformis

2004; Elsevier BV; Volume: 50; Issue: 6 Linguagem: Inglês

10.1016/j.jaad.2003.12.037

1097-6787

Walmar Roncalli Pereira de Oliveira, Cyro Festa Neto, Evandro A. Rivitti,

Genetic and rare skin diseases.

The lack of a clinical effect of cimetidine in the treatment of epidermodysplasia verruciformis We read with great interest the article by Micali et al 1 regarding the use of cimetidine to treat flat wart-like lesions caused by epidermodysplasia verruciformis (EV).The authors reported excellent improvement of the lesions in a 16-year-old boy after three months of treatment with cimetidine (40 mg/kg per day).Furthermore, the boy showed no signs of relapse at a 6-month follow-up.We have been treating 20 patients with EV for more than 9 years.The group includes 12 women and 8 men, ages 15 to 40.All patients have presented clinically with features typical of EV (flat wart-like lesions and pityriasis versicolor-like lesions) and more than 60% have developed malignancies after the third decade of life.Their diagnoses were confirmed by histopathological and electron microscopic exams. 2 Impairment of the cell-mediated immunity was manifested in most of the patients by the cutaneous anergy to a variety of common skin antigens and by the reduction of the lymphocyte transformation to phytohemaglutinin. 3 EV human papillomaviruses 25 and 14d were the most frequent human papillomavirus types detected in their lesions by nested polymerase chain reaction.Because there is some evidence that cimetidine may facilitate the development of a cell-mediated immune response, 4 and cimetidine efficacy has been reported in the treatment of recalcitrant warts, 5 we decided to treat 8 of our EV patients with cimetidine.Written consent was given by all patients after a thorough explanation of the purpose of the study, which was approved by the Institutional Review Board of University of Sa ˜o Paulo, Brazil.The patients were provided with 3 daily dosages of cimetidine, totaling 40 mg/kg per day, for a total of 6 months.All the patients treated were women (18-32 years of age) and none were receiving any medica-