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Petrified ears associated with pseudopseudohypoparathyroidism

more frequently according to the frequency of application of the product. The uniform position of the lesions on the back in our patients, seems to indicate that the ability of the application zone to absorb the drug and its particular lymphatic distribution, could have a role in the onset of these symptoms. However this observation is not supported by the data of the literature where in one case the lesions appeared on the scrotum and in other cases the site was not mentioned. In conclusion it could be hypothesized that this phenomenon represents a local immune reaction which occurs following multiple frequent applications of imiquimod only in particular anatomical areas, as a response to the absorption of the active ingredient. This substance, activating the lymphocytes and macrophages with consequent secretion of cytokines, causes a principal inflammatory reaction at the site of the lesion that is followed by other secondary reactions, along the cutaneous lymphatics which drain the area being treated. By their inflammatory nature these reactions are completely benign, and spontaneously resolve upon suspension of treatment, with the resolution of the local inflammation. They do not appear to be correlated to the resolution of the primary lesion. Treating them would appear unnecessary.