A New Treatment for Actinic Keratoses

Posted by Mark Abramowicz, M.D.

The April 30th issue of The Medical Letter included an article on ingenol mebutate (Picato), a new gel treatment for actinic keratoses. Actinic (solar or senile) keratoses are scaly, flat-to-slightly-raised pink skin lesions caused by chronic exposure to ultraviolet light. They are especially common on the head and neck, sometimes occurring as solitary lesions or in small numbers, but when sun damage is severe the number of lesions may be so large as to virtually preclude individual removal. Left alone, a small percentage of actinic keratoses may progress to become squamous cell carcinoma.

The relationship of actinic keratoses to sun exposure is clear. They occur on areas of the skin exposed to the sun, more commonly in Australia than in England, more commonly in patients with greater exposure to the sun in childhood, more commonly in patients with a history of severe sunburn, and less commonly in patients who use sunscreens.

Actinic keratoses can be removed by surgical excision, cryotherapy with liquid nitrogen, or electrical desiccation, but they are often numerous, and some may be too small to be visible. Field treatment with a cream or gel is more effective, but all of these therapies (topical fluoruracil has been used the longest) cause local reactions that can be temporarily disfiguring. Picato, like all new drugs, is claimed to have some important advantages over older products, and is likely to cost more.

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