Are there any ways to treat EMPD without surgery?

Surgery is not always possible, or desired, for extramammary Paget’s disease (EMPD) treatment and when its not some patients have been prescribed topical treatments (such as Imiquimod, also known as Aldara, Bascellex or Zyclara).

Imiquimod is a topical cream that acts as an immune response modifier and is generally used to treat genital warts, superficial basal cell carcinoma (sBCC) and actinic keratosis (AK). The product was approved by the U.S. Food and Drug Administration in 1997 under the brand Aldara (produced by 3M) but later became available worldwide under other names including Zyclara or Bascellex.

As an immune response modifier, Imiquimod attempts to activate the immune system to fight abnormal cell growth. Imiquimod has been used by some doctors – in an off-label manner – in the treatment of extramammary Paget’s disease (EMPD). The length of use of Imiquimod in EMPD treatment can vary from weeks to many months.

Side-effects of Imiquimod differ widely between EMPD patients. Some EMPD patients that have used Imiquimod mention that it causes redness, swelling, itching, burning, sores, blisters, tenderness and can be very painful. Others note a change in skin color that may or may not go away as well as flu-like symptoms, headache, drowsiness, weight-loss, and fatigue.

The success of Imiquimod treatment varies significantly by patient. Early EMPD research studies on Imiquimod used only women in their studies. More recent Imiquimod articles have included more EMPD patients in their research and additional insights have been found.

Some physicians are apprehensive to prescribe Imiquimod for EMPD treatment due to its off-label use and lack of thorough research with EMPD patients. Other doctors are concerned about the possibility of masking any future EMPD symptoms or causing EMPD to separate into multiple fragments, making future surgical margin unreliable.

Imiquimod is also used when surgery is not an option either due to the location of the EMPD or the ability of the patient to tolerate what can often be complex surgery. While Imiquimod may appear visually to help some EMPD patients, it is important to note that only a biopsy, with associated proper pathology, can determine the presence of extramammary Paget’s disease (EMPD) in a patient.

Some doctors have prescribed Imiquimod (also known as Aldara, Zyclara, or Bascellex) in combination with other topicals or instead of Imiquimod. These other topicals include: Efudix (also called Fluorouracil, Fluoroplex, Adrucil, Carac, and Tolak); Calcipotriene (also called Calcitrene, Dovonex, and Sorilux) and Tretinoin (a derivative of  Vitamin A often sold as Retin-A Micro, Refissa, Retin-A Micro Pump, Tretin-X, Atralin, Avita, Renova, Retin-A, and TRETIN-X Cream Kit).

Periodically, EMPD patients report Efudix giving them burns, sores, blisters, and severe pain. The overall use of topicals with EMPD is small and thus there is limited evidence of effectiveness.

In a study in 2020, Rapamycin (also know as Sirolimus) was also found to be useful in treating EMPD. Rapamycin is a topical cream. Rapamycin is a macrolide compound that is traditionally used to coat coronary stents. Rapamycin is an immunosuppressant that has been isolated from soil samples taken from Easter Island in 1964.

Other non-surgical treatments have been tried with varied results. More information on therapeutics used with EMPD can be found here.

Treatments for extramammary Paget’s disease (EMPD) often differ but frequently include one or more of the following: Mohs surgery, wide local excision (WLE) surgery, topical creams, carbon dioxide (CO2) laser, photodynamic therapy (PDT), cavitational ultrasonic surgical aspiration (CUSA), radiation therapy, skin grafts, and chemotherapy.

The content presented on this website, encompassing both textual material and visual media, serves educational and informational purposes aimed at aiding individuals affected by extramammary Paget’s disease (EMPD) and their families in comprehending the complexities associated with EMPD. It is imperative to note that the website is not designed to serve as a replacement for professional medical advice, diagnosis, or treatment. Furthermore, the website does not advocate for or endorse any specific treatments, tests, physicians, procedures, or products. Should you suspect that you are experiencing symptoms of EMPD, we strongly advise you to seek guidance from your healthcare provider.