Journal of Clinical and Aesthetic Dermatology

Ingenol Mebutate Topical Gel 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/754617

Contents of this Issue

Navigation

Page 6 of 11

S7 JCAD journal of clinical and aesthetic dermatology November 2016 • Volume 9 • Number 11 § The most common LSRs occurring in 75 and 50 percent of subjects were erythema and scaling/ flaking/dryness, respectively. LSRs including erosion/ulceration, vesiculation, exudation, and scarring may occur with IMG for superficial BCC, especially with use of IMG 0.05%. • Study. A retrospective chart review was completed that identified six patients from a community private dermatology practice with seven superficial BCCs treated with IMG. 26 Three male patients and three female patients were affected; age range was 47 to 75 years. Five of six lesions were <1.5cm with one lesion measuring 3.5cm. Affected sites included the back (n=3), chest (n=2), and shoulder (n=2). Efficacy was determined by clinical assessment in all patients at follow-up visits at Weeks 2 and 4, and at three-month intervals thereafter (longest follow-up 14 months); three patients underwent post-treatment biopsy at three months. 26 § IMG 0.05% was used to treat all lesions with application encompassing a 0.5cm margin of perilesional normal skin. The 3.5cm lesion was treated for two days; all other lesions were treated for seven days. Four lesions were occluded with an adhesive bandage and three lesions were not. § LSR, primarily erythema, flaking, and/or crusting, occurred in all patients on the first two days, peaked at Day 2 to Day 7, and resolved usually within 14 days. Symptoms associated with LSRs were usually mild and included itching and/or burning. § All patients remained clinically clear at follow-up with the longest follow-up at 14 weeks. Three patients underwent post-treatment biopsy at three months, which showed no residual tumor. Author commentary. Available data supports that IMG, especially the 0.05% concentration, is effective in many cases of superficial BCC. Occlusion, especially with an aluminum disk, may increase efficacy and may also augment the potential for dyspigmentation and scarring. The optimal regimen is unclear. The author suggests three consecutive daily applications on the trunk and extremities. Experience is limited on the head and neck. In some cases, a single application or application on two consecutive days may be reasonable in carefully selected cases. Patients should be informed about anticipated LSRs and potential for scarring and dyspigmentation. Ingenol mebutate use in basal cell carcinoma. Data on treatment of BCC, other than superficial BCC, are limited with IMG. § Study. Twenty-eight patients who failed or refused conventional therapy were treated with direct application of the liquid Euphorbia peplus sap to BCC lesions at various sites (histologic type not defined) once daily for three consecutive days. 27 Complete clinical response at one month was 82 percent; 18 of 20 patients undergoing post- treatment biopsy were negative. Fifty-seven percent of patients remained clear at last follow-up (mean 15 months; range 21–31 months among all NMSC patients). It is important to note that among all of the NMSCs in this study (BCC, SCC, SCC in-situ), 43 percent had failed prior treatment, 30 percent were >2cm in size, and 35 percent were located on the head and neck region. § Case report. A 66-year-old man with multiple major medical problems was treated with IMG 0.015% once daily applied on three consecutive F i g u r e 3 . A ) B o w e n ' s d i s e a s e l e s i o n o n t h e l e f t p r e t i b i a l a r e a a n d B ) h i s t o p a t h o l o g i c a l v i e w b e f o r e t r e a t m e n t . C ) P o s t i n f l a m m a t o r y h y p e r p i g m e n t a t i o n o n t h e l e f t p r e t i b i a l a r e a a n d D ) h i s t o p a t h o l o g i c a l v i e w n i n e w e e k s a f t e r i n g e n o l m e b u t a t e t r e a t m e n t . Re p r i n te d w i t h p e r m i s s i o n f ro m : S a l l e ra s Re d o n n e t M , Q u i n t a n a Co d i n a M . In g e n o l m e b u t a te g e l fo r t h e t re a t m e n t o f B owe n's d i s e a s e : a c a s e re p o rt o f 3 p a t i e n t s. D e r m a t o l T h e r. 2 0 1 6 ; 2 9 ( 4 ) : 2 3 6 – 2 3 9 .

Articles in this issue

Archives of this issue

view archives of Journal of Clinical and Aesthetic Dermatology - Ingenol Mebutate Topical Gel 2016