Various treatment modalities are used in classical KS depending on the clinical presentation and extension of lesions. Surgical excision is a good therapeutic option in isolated lesions, and local radiation therapy can be used in the case of multiple lesions. Systemic treatments with vinblastine, bleomycin, doxorubicin, etoposide, or intralesional interferon alpha have been used, besides cryotherapy, laser or photodynamic therapy.[1
Topical imiquimod is a ligand of the Toll-like receptors 7 and 8 on dendritic cells, and it functions as an immune response modifier. Imiquimod also stimulates antiangiogenic cytokines, downregulates the expression of proangiogenic factors, upregulates the expression of endogenous inhibitors, and induces endothelial cell apoptosis.[4
] It has been used successfully in the treatment of infantile hemangiomas and pyogenic granulomas with its antiangiogenic activity.[5
In a prospective, open-label, single center, phase II clinical trial, imiquimod cream was applied under occlusion 3 times a week for 24 weeks in 17 immunocompetent Kaposi patients. Half of the patients showed a marked improvement and complete remission was achieved in 2 cases.[8
] Recently a 72-year-old man with multiple, small papules on the right foot was treated with 5% imiquimod cream on alternate days and complete healing was achieved at 10 weeks.[1
] In another case report, an 87-year-old man with widespread lesions on both legs was treated with 5% imiquimod cream with complete response. This patient experienced flu-like symptoms with every day applications, the symptoms disappeared by reducing the applications to every other day.[2
] Bernardini et al
] recently reported a case of localized KS that was treated successfully with imiquimod 5% cream, under occlusion overnight for at least 8 hours, 3 times a week for 3 months.