Clinical Medicine Insights: Dermatology

Actinic keratoses (AK) are frequent, sun-induced lesions. Ingenol mebutate (IE) is a newly launched treatment for AK which major advantages is a short term application (3 days for a 0.015% concentration for face and scalp and 2 days for 0.05% for other body sites). IE is a macrocyclic diterpene ester extracted from the sap of the plant Euphorbia peplus. Its mechanism of action associates induction of rapid cell death and recrutement of neutrophils via PKCδ activation. Placebo controlled studies reported a rate of complete clearance on the face and scalp of 42% with IE and 3.7% with placebo and of 34.1% versus 4.7% for trunk an extremities. Partial clearance (at least 75% improvement) was seen in 63.9% of patients, versus 7.4% with placebo for face and scalp and 49.1%, versus 6.9% for trunk and extremities. Local skin reactions, sometimes severe, can be observed as early as day 1, peak at day 4 and resume within 2 weeks. Long term studies have shown that about half the patients who have responded are still in remission after 12 months. A number of studies are on their way to look at comparative, combination or repeated strategies to optimize the management of AK.