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

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S8 JCAD journal of clinical and aesthetic dermatology November 2016 • Volume 9 • Number 11 days for a 2.5cm nodular BCC involving the right temple with application encompassing an additional 2.5cm of perilesional normal skin. 28 LSR developed with marked burning sensation and erythema/flaking/ subsequent desquamation. At Day 37, visible inflammation was long resolved and the site was cleared clinically. Patient satisfaction was high as he wanted to avoid surgery or any prolonged therapy (Figures 2A, 2B, and 2C). Author commentary. Data are too limited to make specific suggestions on use of IMG for BCC other than superficial BCC. However, in selected cases where patients (especially elderly) may not be good candidates for surgical treatment and/or physical modalities, IMG used for at least three consecutive days may be reasonable coupled with close follow-up. Selection of concentration may be made based on anatomic location with 0.015% suggested for the face, and 0.05% recommended for other sites. Repeated courses of treatment may be warranted. Ingenol mebutate use in SCC in-situ/actinic cheilitis. There are limited data on the use of IMG for treatment of SCC in- situ (Bowen's disease). Histologically, SCC in-situ is characterized by full-thickness epidermal atypia with loss of maturation, intraepidermal atypical keratinocytes in a buckshot or nested pattern, and intrafollicular involvement in some cases. 14 • Case series. Three cases of biopsy-proven SCC in-situ treated with IMG have been reported: § An 80-year-old woman with large left pretibial lesion refractory to PDT and topical imiquimod; treated with IMG 0.05% once daily applied on two consecutive days. Clinical and histologic clearance with postinflammatory hyperpigmentation was noted at nine weeks. 29 (Figure 3) § A 73-year-old woman with a 2.5cm lesion on the right thigh present for one year treated with IMG 0.05% once daily applied on two consecutive days. Postinflammatory hyperpigmentation was noted at four weeks with histologic clearance confirmed by post-treatment biopsy. § An 87-year-old woman with a 2.0cm lesion on the left preauricular cheek treated with IMG 0.015% once daily applied on three consecutive days. At four weeks post-treatment, clinical resolution was observed and histologic clearance was confirmed by post-treatment biopsy. • Study. In a Phase 1/2 study, 16 patients who failed or refused conventional therapy were treated with direct application of the liquid Euphorbia peplus sap to SCC in-situ lesions at various sites once daily for three consecutive days. 27 Many of the NMSC lesions treated in this study were refractory to other therapies, were F i g u r e 4 . P r e - a n d p o s t - t r e a t m e n t i m a g e s o f s e l e c t e d c a s e s w i t h a n o g e n i t a l w a r t s ( A G W ) : ( a ) A p a t i e n t w i t h m u l t i p l e G W s a t p e n i s s h a f t . ( b ) A p a t i e n t s h o w e d c o m p l e t e c l e a r a n c e a t D a y 1 4 a f t e r o n e t i m e t r e a t m e n t w i t h i n g e n o l m e b u t a t e ( I M ) 5 0 0 µ g / g . ( c ) A p a t i e n t w i t h p l a n e , p l a q u e - l i k e p e r i a n a l G W s . ( d ) A p a t i e n t s h o w e d c o m p l e t e c l e a r a n c e a t D a y 1 4 a f t e r o n e t i m e t r e a t m e n t w i t h I M 5 0 0 µ g / g . ( e ) A p a t i e n t w i t h m u l t i p l e s m a l l p e r i a n a l G W s . ( f ) A p a t i e n t s h o w e d c o m p l e t e c l e a r a n c e a t D a y 5 a f t e r o n e t i m e t r e a t m e n t w i t h I M 1 5 0 µ g / g . ( g ) A p a t i e n t w i t h m u l t i p l e s o l i t a r y G W s a t m o n s p u b i s . ( h ) A p a t i e n t w i t h p e r s i s t e n t c l e a r a n c e s i n c e 2 4 0 d a y s a f t e r o n e t i m e t r e a t m e n t w i t h I M 1 5 0 µ g / g . R e p r i n t e d w i t h p e r m i s s i o n f r o m : S c h o p f R E . C o n d y l o m a a c c u m i n a t a : n o v e l t r e a t m e n t b y t o p i c a l i n g e n o l m e b u t a t e ( a b s t r a c t 6 0 3 ) . J I n v e s t i g D e r m a t o l . 2 0 1 4 ; 1 3 4 : S 1 0 5 .

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