Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2025;15(2):5168 1

Effective Sequential and Rotational Therapy  
in a Patient With Xeroderma Pigmentosum
Jimena Carrero Martín1, Álvaro Núñez Domínguez1, Marta López Pando1,  

Raquel Santos-Juanes Galache1, Cristina Galache Osuna1, Jorge Santos-Juanes Jiménez1 

1 Dermatology Department. Central University Hospital of Asturias, Av Roma s/n. Oviedo, Asturias, Spain

Key words: Xeroderma Pigmentosum, Rotational Therapy

Citation: Carrero Martín J, Núñez Domínguez Á, López Pando M, Santos-Juanes Galache R, Galache Osuna C, Santos-Juanes Jiménez J. 
Effective Sequential and Rotational Therapy in a Patient With Xeroderma Pigmentosum. Dermatol Pract Concept. 2025;15(2):5168  
DOI: https://doi.org/10.5826/dpc.1502a5168

Accepted: February 5, 2025; Published: April 2025

Copyright: ©2025 Carrero Martín et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. 

Corresponding Author: Jimena Carrero Martín, C/Alfonso III El Magno, 16, 6K. 33001, Oviedo, Asturias. ORCID ID: 0000-0003-3423-
4326 x. E-mail: jimenacarrerom@gmail.com 

Case Presentation

The patient, an 11-year-old boy, was diagnosed with xero-

derma pigmentosum (XP) characterized by a mutation in 

intron 6 of the XPC gene (c.779+1G>A). He presented with 

four infiltrative squamous cell carcinomas, multiple hyper-

trophic actinic keratoses, and six basal cell carcinomas, 

five of which were excised within the previous year. The 

patient rigorously avoids sunlight and shields himself from 

artificial sources of ultraviolet radiation (Figure 1A-C).  

Treatment was initiated with 5% imiquimod cream, ap-

plied three times per week on a rotational basis to the fol-

lowing regions: 1) left side of the face; 2) right side of the 

face; 3) left side of the neck and upper back; 4) right side 

of the neck and upper back. Each area received treatment 

for 4–5 weeks until the onset of mild erythema. Notably, 

erythema and inflammation also manifested in untreated 

areas with actinic keratoses. Since starting this regimen two 

years ago, no new surgical intervention has been required 

(Figure 1D-F). 

Teaching Point

Although alternative therapies have been explored for this 

patient [1, 2], the tolerability of this particular regimen has 

improved compliance, facilitating extended intervals be-

tween clinical evaluations. 



2 Image Letter | Dermatol Pract Concept. 2025;15(2):5168

References

1. Rocha LKFL, Ferreira P, Gianotti MA, et al. Imiquimod chemo-

prophylaxis for field cancerization in xeroderma pigmentosum 

patients-A prospective study. Australas J Dermatol. 2023 Apr 13. 

DOI: 10.1111/ajd.14029. Epub ahead of print. PMID: 37052254.

Figure 1. (A-C) Before initiation with imiquimod, he presented squamous cell carcinomas, multiple hypertrophic actinic keratoses, and basal 

cell carcinomas. (D-F) Two years since starting imiquimod, no new surgical intervention has been required. 

2. Latour I, Hernández-Martín A, Ged C, Knöpfel N, Taïeb A, 

Torrelo A. Reversed actinic damage in two children with xero-

derma pigmentosum treated with topical imiquimod. J Eur Acad 

Dermatol Venereol. 2018 Jul;32(7):e282-e284. DOI: 10.1111/

jdv.14818. Epub 2018 Feb 23. PMID: 29377344.