Journal of Clinical and Aesthetic Dermatology

AUG 2017

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

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35 JCAD journAl oF clinicAl And Aesthetic derMAtology August 2017 • Volume 10 • number 8 o r i G i n A L r e s e A r c h Lsr following application of the 0.05% ingenol mebutate gel formulation are considered too i ntense for use of this dose on the face. Gaide and cattin 16 reported the case of a 72-year-old woman who inadvertently applied ingenol mebutate gel 0.05% to her cheeks instead of her chest. Very shortly thereafter, she experienced pronounced erythema of the skin over the cheekbones, superficial erosions, and conjunctivitis. thirty days later, in addition to clearance of the Ak, there was excellent cosmesis and smooth skin, with a rejuvenated look, and clearance of numerous solar lentigines. the authors who observed these results suggested a potential role for ingenol mebutate for skin rejuvenation. 16 one relevant difference between chest skin and facial skin is the reduced number of pilosebaceous units: 30 times fewer units for the chest versus the face. 17 Pilosebaceous units are the progenitors of new epithelium after skin damage, including damage from topical agents used for field treatment of Ak. 1 7 Areas of skin that contain many pilosebaceous units tend to re-epithelialize more rapidly than areas with fewer units. 17 Another difference is the fact that the epidermis and dermis are thinner on the chest, and this also may impede healing after topical Ak treatment. Finally, chest skin has a more variable distribution of subcutaneous fat compared with facial skin, which can result in an increased risk of scarring and pigmentary changes. 9,10 Photoaging of the chest, as at other anatomic sites, is caused by a combination of damage from UV radiation and the intrinsic aging process. 18,19 Photodamaged chest skin is characterized by laxity, lines and wrinkles, hyperpigmentation, erythema, tactile roughness, atrophy, and telangiectasias. 10 erythema and hyperpigmentation are more common on the superior décolletage, which is subject to more intense, cumulative UV exposure, whereas lines, wrinkles, and laxity folds develop more frequently on the inferior décolletage. topical ingenol mebutate may provide a beneficial effect on photodamaged skin. erlendsson et al 20 studied the preventive effect of ingenol mebutate 0.015% against progressive cutaneous photodamage from UV exposure over 20 weeks in hairless mice. the investigators assessed keratosis grade, epidermal hypertrophy, dysplasia, and dermal actinic damage. monthly topical application of ingenol mebutate resulted in a significantly lower composite UV-damage score as compared with UV radiation alone, and it prevented progression of cutaneous photodamage in this murine model. An effect on photoaging in humans was reported by braun and Gerber, 21 who observed a clearing of mottled pigmentation and a reduction in tactile roughness six weeks after treating Ak on the scalp of an 82-year-old man with ingenol mebutate 0.015% once daily for three consecutive days. the authors commented that ingenol mebutate "may exert a noteworthy cosmetic effect on signs of skin aging" and proposed its use as a novel therapeutic option for photoaged skin. in our study, we observed a significant reduction from baseline on Day 59 in all six assessed signs of photoaging. in addition, patients' assessment of the skin manifestations of photoaging and patient satisfaction with treatment improved across all of these parameters from Day 10 to Day 59. tsQm scores Figure 5. treatment satisfaction Questionnaire for medication (tsQm) scores for 4 domains Figure 6. time course of local skin responses (Lsr) LSR Score (mean, SEM)

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