title: Ingenol mebutate gel for actinic keratosis.
abstract: BACKGROUND
  Actinic keratosis is a common precursor to sun-related squamous-cell carcinoma. Treating actinic keratoses and the surrounding skin area (i.e., field therapy) can eradicate clinical and subclinical actinic keratoses. Topical field therapy currently requires weeks or months of treatment. We investigated the efficacy and safety of a new topical field therapy for actinic keratosis, ingenol mebutate gel (0.015% for face and scalp and 0.05% for trunk and extremities).
  
  
  METHODS
  In four multicenter, randomized, double-blind studies, we randomly assigned patients with actinic keratoses on the face or scalp or on the trunk or extremities to receive ingenol mebutate or placebo (vehicle), self-applied to a 25-cm(2) contiguous field once daily for 3 consecutive days for lesions on the face or scalp or for 2 consecutive days for the trunk or extremities. Complete clearance (primary outcome) was assessed at 57 days, and local reactions were quantitatively measured.
  
  
  RESULTS
  In a pooled analysis of the two trials involving the face and scalp, the rate of complete clearance was higher with ingenol mebutate than with placebo (42.2% vs. 3.7%, P<0.001). Local reactions peaked at day 4, with a mean maximum composite score of 9.1 on the local-skin-response scale (which ranges from 0 to 4 for six types of reaction, yielding a composite score of 0 to 24, with higher numbers indicating more severe reactions), rapidly decreased by day 8, and continued to decrease, approaching baseline scores by day 29. In a pooled analysis of the two trials involving the trunk and extremities, the rate of complete clearance was also higher with ingenol mebutate than with placebo (34.1% vs. 4.7%, P<0.001). Local skin reactions peaked between days 3 and 8 and declined rapidly, approaching baseline by day 29, with a mean maximum score of 6.8. Adverse events were generally mild to moderate in intensity and resolved without sequelae.
  
  
  CONCLUSIONS
  Ingenol mebutate gel applied topically for 2 to 3 days is effective for field treatment of actinic keratoses. (Funded by LEO Pharma; ClinicalTrials.gov numbers, NCT00742391, NCT00916006, NCT00915551, and NCT00942604.).
authors.affiliation: Department of Dermatology, Mount Sinai School of Medicine, New York, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
authors.forename: Neil
authors.initials: N
authors.lastname: Swanson
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Anderson
authors.forename: Anita
authors.initials: A
authors.lastname: Melgaard
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xu
authors.forename: Brian
authors.initials: B
authors.lastname: Berman
mesh_terms: D000368:Aged; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004224:Diterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D005121:Extremities / Q000473:pathology; D005148:Facial Dermatoses / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012536:Scalp Dermatoses / Q000188:drug therapy / Q000473:pathology; D012867:Skin / Q000473:pathology; D013909:Thorax / Q000473:pathology; D016896:Treatment Outcome
chemical_list: C486592:3-ingenyl angelate; D003879:Dermatologic Agents; D004224:Diterpenes