The Medical Letter on Drugs and Therapeutics
Ingenol Mebutate (Picato) for Actinic Keratoses
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The FDA has approved ingenol mebutate (Picato – Leo) for topical treatment of actinic keratoses (AKs). The new drug is derived from the sap of the Euphorbia peplus plant, a traditional folk remedy for warts and other skin lesions.

ACTINIC KERATOSES — Abnormal keratinocyte proliferation, typically caused by long-term UV exposure, can cause red, scaly actinic keratosis lesions, which are a marker for possible "field cancerization" of the skin, indicating an increased risk for squamous cell carcinoma (SCC).1,2

Field therapy with topical fluorouracil (5-FU) or imiquimod is highly effective and treats subclinical AKs, but both of these agents require weeks to months of administration and can cause disfiguring erythema, blisters and ulceration over a period of several months. Other treatments include diclofenac gel, which is relatively well tolerated but only ... more      

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