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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S10 JCAD journal of clinical and aesthetic dermatology November 2016 • Volume 9 • Number 11 porokeratosis of Mibelli, presternal keloids, and hydroxyurea-induced squamous dysplasia. 3 5–38 Author commentary. Although all potential clinical uses of an easily used topical therapy are important, effective treatment for molluscum contagiosum and keloids are highly clinically relevant. Data are very limited with IMG for these diagnoses; however, the case reports are encouraging and may offer a viable therapeutic suggestion for some cases. Summary This supplement provides a thorough review of the use of IMG for diagnoses other than AK, all of which are off-label uses. Treatment of superficial BCC has the greatest evidential support, and hopefully more studies will be forthcoming. The potential of IMG for treatment of SCC in- situ, AGV, VV, and actinic cheilitis are important considerations to keep in mind, especially in cases where other therapies may not have been effective or are not deemed to be viable. Importantly, controlled studies are needed to further assess optimal dosing and both short-term and long-term efficacy. However, this expectation is not practical for all of the potential cutaneous disorders and clinical scenarios that are likely to be encountered in clinical practice. Cautioning of the patient regarding anticipated LSRs is always important, and close follow-up suggested to assure an optimal therapeutic response regardless of the skin disorder that is being treated. References 1. Del Rosso, JQ, Kircik L, Goldenberg G, et al. Comprehensive management of actinic keratosis: practical integration of available therapies with with a review of a newer treatment approach. J Clin Aesthet Dermatol. 2014;7(9):S1–S12. 2. Picato gel (0.015%; 0.05%) [package insert]. Leo Pharma, Inc., Parsippany, New Jersey, 2009. 3. Ibrahim SF, Brown MD. Actinic keratosis: a comprehensive review. J Clin Aesthet Dermatol. 2009;2:43–48. 4. Ghuznavi N, Nocera NF, Guajardo AR, et al. Emerging medical treatments for actinic keratosis, squamous cell carcinoma and basal cell carcinoma. Clin Invest. 2012;2(9):909–921. 5. Ogbourne SM, Suhrbier A, Jones B, et al. Antitumor activity of 3- ingenyl angelate: plasma membrane and mitochondrial disruption and necrotic cell death. Cancer Res. 2004;64(8):2833–2839. 6. Rosen RH, Gupta AK, Tyring SK. Dual mechanism of action of ingenol mebutate gel for topical treatment of actinic keratoses: rapid lesion necrosis followed by lesion- specific immune response. J Am Acad Dermatol. 2012;66(3):486–493. 7. Kedei N, Lundberg DJ, Toth A, et al. Characterization of the interaction of ingenol 3-angelate with protein kinase C. Cancer Res. 2004;64:3243–3255. 8. Challacombe JM, Suhrbier A, Parsons PG, et al. Neutrophils are a k ey component of the antitumor efficacy of topical chemotherapy with ingenol-3-angelate. J Immunol. 2006;177:8123–8132. 9. Hampson P, Chahal H, Khanim F, et al. PEP005, a selective small- molecule activator of protein kinase C, has potent antileukemic activity mediated via the delta isoform of PKC. Blood. 2005;106(4):1362–1368. 10. Stahlhut M, Lord JM, Bertelsen M, at al. Ingenol mebutate initiates multiple specific cell death pathways in human cancer cells. J Am Acad Dermatol. 2012;66(4 Suppl 1):AB152. Abstract presented at the 70th Annual Meeting of the American Academy of Dermatology; March 16–20, 2012; San Diego, California. 11. Cozzi SJ, Ogbourne SM, James C. Ingenol mebutate field-directed treatment of UVB-damaged skin reduces lesion formation and removes mutant p53 patches. J Invest Dermatol. 2012;132(4): 1263–1271. 12. Lebwohl M, Shumack S, Stein Gold L, et al. Long-term follow-up study of ingenol mebutate gel for the treatment of actinic keratoses. JAMA Dermatol. 2013;149(6):666–670. 13. Eide M, Weinstock MA. Epidemiology of skin cancer. In: Rigel DS, Robinson JK, Ross M, et al, Eds. Cancer of the Skin, 2nd ed. Philadelphia: Elsevier-Saunders; 2011;44–55. 14. Elston DM. Malignant tumors of the epidermis. In: Elston DM, Ferringer T, Ko CJ, et al. Dermatopathology, 2nd ed. Philadelphia: Elsevier-Saunders; 2014;56–70. 15. Spencer JM. Basal cell carcinoma. In: Lebwohl MG, Heymann WR, Berth-Jones J, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed. Philadelphia: Saunders-Elsevier; 2010;78–82. 16. Wood Cobb C, Lawrence N. Bowen's disease and erythroplasia de Queyrat. In: Lebwohl MG, Heymann WR, Berth-Jones J, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed. Philadelphia: Saunders-Elsevier; 2010;105–106. 17. Waldorf H. Squamous cell carcinoma. In: Lebwohl MG, Heymann WR, Berth-Jones J, et al. Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed. Philadelphia: Saunders-Elsevier; 2010;702–706. 18. Williams V, Rosen T, Ceilley RI, et al. Topical treatment of skin cancer. In: Rigel DS, Robinson JK, Ross M, et al, Eds. Cancer of the Skin, 2nd ed. Philadelphia: Elsevier-Saunders; 2011;462–476. 19. Berman B, Viera M, Amini S, et al. Immune response modulators in the treatment of skin cancer. In: Rigel DS, Robinson JK, Ross M, et al, eds. Cancer of the Skin, 2nd ed. Philadelphia: Elsevier- Saunders; 2011;477–496. 20. Morton CA. Photodynamic therapy in skin cancer. In: Rigel DS,

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