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Case Reports in Dermatological Medicine
Volume 2011, Article ID 412684, 3 pages
Case Report

Acantholytic Pityriasis Rubra Pilaris Associated with Imiquimod 3.75% Application

1Department of Dermatology, Cleveland Clinic, Cleveland, OH 44195, USA
2Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA

Received 19 July 2011; Accepted 25 August 2011

Academic Editors: E. Erkek, M. Hide, and G. E. Piérard

Copyright © 2011 Natasha Atanaskova Mesinkovska et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Imiquimod is an immunomodulator with both antitumor and antiviral properties. It is currently available in two cream formulations as Aldara (imiquimod 5%) and the newly approved Zyclara (imiquimod 3.75%). Imiquimod has been associated with localized erythema, crusting, and scaling at the site of application. However, more severe generalized skin eruptions including erythema multiforme, psoriasis, and hyperpigmentation have been described. The newly approved imiquimod 3.75% cream is a presumably safer alternative due to its lower concentration. This paper describes the development of generalized acantholytic pityriasis rubra pilaris after the treatment of an actinic keratosis on the forehead with imiquimod 3.75% cream.