Imiquimod treatment of exuberant granulation tissue in a nonhealing diabetic ulcer

A 62-year-old white woman presented with a 1-year history of a recalcitrant diabetic foot ulcer on the plantar aspect of her left foot. She had recently seen an orthopedic surgeon who recommended amputation. The dermatology service was consulted after the patient refused to undergo surgery. The ulcer first developed during cast placement for Charcot arthropathy. After failing to respond to treatment with numerous topical debriding and antibacterial agents (concomitantly with wet-to-dry dressings), the patient underwent her first surgical debridement approximately 7 months before she presented to our clinic. She subsequently underwent 2 additional surgical debridements of the ulcer, at 3 and then 2 months, before she was seen in the dermatology department. Histopathologic review of all excised tissue failed to show evidence of malignancy. Two of the debridements were performed with the patient under general anesthesia. Of note, the use of chemical cauterizing agents, such as silver nitrate, was not attempted in the outpatient setting in this case.