Picato - Ingenol Mebutate
This is a useful treatment for solar keratoses – also called as actinic keratoses – the scaly, crusty, pinkish areas that result from sun damage.
The cream is applied for 2 or 3 days to the affected area (depending on the body area involved)
The main side effects are an intense local reaction which is maximal on Day 4 or 5. This reaction includes local irritation, inflammation and itching. Ulceration and crusting may also develop. In the long term the treated skin may develop hyper- or hypopigmentation. Telangiectasias (vessel changes), allergic contact dermatitis and photosensitivity may also occur. Management of these effects is usually simple & most people seem to settle without any need for treatment. Cool, wet compresses and bland emollients or moisturiser can bring relief. If very inflamed, a topical steroid - 1% hydrocortisone or a more potent steroid will assist.
When Should I Use Picato?
Picato is probably best avoided in the hot summer months as use on already inflamed skin can be difficult. The treated skin can become extremely inflamed and itch and this can be worse in the heat. Using in the cooler months may lessen the risk of post-inflammatory hyperpigmentation.
It is important to remember that the greater the inflammatory response the better the therapeutic and cosmetic result.
Occasionally, the treatment may need to be continued for a lot longer duration.