Imiquimod-Induced Effluvium After Intravaginal Application for Treatment of Cervical Intraepithelial Neoplasia

The document reports two cases of telogen effluvium, a form of temporary hair loss, following intravaginal application of imiquimod (IMQ) for the treatment of cervical intraepithelial neoplasia (CIN). The first patient, a 31-year-old woman, experienced sudden hair loss after using a cumulative dose of 71.875 mg of IMQ, which resolved almost completely within 7 months after stopping the treatment. The second patient, a 32-year-old woman, had hair loss after using a cumulative dose of 250 mg of IMQ, which returned to normal within 2 months after cessation of IMQ. Both patients had severe systemic symptoms preceding hair loss. Trichogram and clinical examination supported the diagnosis of telogen effluvium. The document suggests that IMQ therapy can cause reversible diffuse telogen effluvium, especially in patients with severe systemic adverse reactions. This side effect should be recognized as IMQ use expands, including intravaginal applications, to provide proper patient counseling and avoid unnecessary diagnostic procedures.