der Linden M, et al. - Authors evaluated the basic traits of the immune infiltrate in vulvar Paget disease (VPD) and the influence of imiquimod. In VPD, the epithelium has less immune cells, but a dense stromal immune infiltrate. Following imiquimod therapy, the intraepithelial CD8+/Foxp3+ ratio and number of CD56+ increased, while a decrease in the numbers of CD14+ cells was seen which might indicate a treatment-induced type 1 immune response. They noted a difference of the microenvironment in VPD from the healthy vulvar skin and vulvar HSIL.