Detection of human papillomavirus and response to topical 5% imiquimod in a case of stucco keratosis

Stucco keratosis is a skin disorder with papular warty lesions that usually appear on the lower limbs in elderly people. The aetiology, pathogenesis a nd treatment is still a matter of debate. We report a 75-year-old non-immun osuppressed man with extensive lesions all over his body, which had not res ponded to curettage or electrodesiccation. To determine the possible role o f human papillomavirus (HPV) in stucco keratosis, we used nested polymerase chain reaction (PCR) to identify HPV DNA in the lesions. To include a broa d range of both cutaneous and mucosal HPV types, PCR was performed with two sets of degenerate primers. Using this approach we detected HPV types 9, 1 6, 23b, DL322 and a variant of HPV type 37 in multiple stucco keratoses. Im iquimod (5% cream), a new compound that modifies the immune response by sti mulating production of cytokines, applied overnight, three times a week for 5 weeks, resulted in resolution of all treated lesions.