Disturbances in Wound Healing After Treatment with Imiquimod and Diclofenac in Elderly Men

Four men, aged 68-90 years, experienced disturbances in wound healing after treatment with imiquimod (Aldara or Zyclara) and/or diclofenac (Solaraze) for extensive actinic keratoses on their scalps. The 90-year-old man developed erosive disturbances with hypertrophic granulation after using diclofenac 3% gel, which did not heal despite various treatments. The 68-year-old man had putrid erosion under imiquimod 5% cream treatment, resulting in the loss of vellus hair and requiring keratolytic treatment. The 69-year-old man showed ulcerating inflammation after using imiquimod 3.75% cream, which initially reduced in size with treatment but eventually required split-thickness skin grafting. The 78-year-old man, treated with both diclofenac 3% gel and imiquimod 5% cream, developed non-healing erosion that partially improved with local treatment but also necessitated split-skin grafting. The authors suggest that the destruction of small vellus hair follicles, which are important for reepithelization, may contribute to the observed wound healing disturbances.