Ingenol mebutate: a novel treatment for actinic keratosis

• Ingenol mebutate gel (Picato® gel, LEO Pharma, Ballerup, Denmark) is a novel topical self-applied treatment for nonhyperkeratotic, nonhypertrophic actinic keratoses in adults. • Picato gel (0.05%) is applied to trunk and extremity lesions for 2 consecutive days, and at lower strength (0.015%) applied to face and scalp lesions for 3 consecutive days. • The mechanism of action is rapid induction of cell necrosis followed by neutrophil-mediated antibody-dependent cellular cytotoxicity. • Ingenol mebutate is transported via P-glycoprotein, through the epidermis to the subcutis, with no detectable systemic absorption. • Efficacy is broadly similar to alternative field-directed topical treatments, but the treatment regime offers potentially greater effectiveness. • Local skin reactions (erythema, irritation, pruritus and pain) shortly follow completion of applications, reducing by week 2 and resolving by week 4. • There is no evidence of drug interactions, and the mode of treatment minimizes the probability.