Management of actinic cheilitis using ingenol mebutate gel: A report of seven cases

Abstract

Actinic cheilitis (AC) can precede the development of squamous cell carcinoma of the lip, a location with high risk of invasiveness and metastasis. We communicate the good results that we obtained when treating seven patients suffering from AC with ingenol mebutate (IM) 0,015% concentration gel on three consecutive days. Three patients achieved complete clearance and four significant improvement. IM is a topical field treatment approved for actinic keratosis. To our knowledge, reported experience in the management of AC with IM is very limited. Local skin responses grade 3 were the main adverse event observed and they resolved in all patients without specific therapy within 1 to 2 weeks. IM is characterized by its rapid clinical effect, its favorable safety profile and its dosing period of only 3 days, shorter than with other field therapies. All these facts make it an attractive new therapy for AC, with need for further study.

Dermoscopy and reflectance confocal microscopy for monitoring the treatment of actinic cheilitis with ingenol mebutate gel: Report of three cases

“…Thus, local skin reactions (LSR) can range from mild inflammation to severe vesiculation, pustules, and erosions (Longo et al, ). It has been described as a possible therapeutic option for AC in few case reports (Barrado Solís et al, ; Flórez et al, ; Tzika et al, ). In our cases of AC, three once‐daily applications of 150 μg/g IngMeb gel on three consecutive days were able to completely clear the disease in all the cases without any different adverse reaction beyond those already known in case of treatment of actinic keratoses.…”

“…Local skin response (LSR) score include erythema, flaking or scaling, crusting, swelling, vesciculation, pustulation, and erosion or ulceration (Rosen, Marmur, Anderson, Welburn, & Katsamas, 2014). Few case series examined the effectiveness of IngMeb for the treatment of AC using clinical and dermoscopy examination (Barrado Solís et al, 2015;Fl orez, Batalla, & De La Torre, 2017;Tzika, Masouy e, M€ uhlstädt, & Laffitte, 2016). Dermoscopy and reflectance confocal microscopy (RCM) are currently the most used noninvasive imaging techniques that help clinicians not only to achieve high diagnostic accuracy for skin cancer diagnosis but also to monitor treatments over time (Fargnoli, Kostaki, & Piccioni, 2012;Longo et al, 2012;Maher et al, 2016).…”

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

“…17 Treatment options for AC include topical therapy or surgical interventions, although due to a lack of comparative studies, there is little consensus regarding optimal treatment. [18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series. [18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series.…”

“…Newer treatment options include ingenol mebutate, methyl 5-aminolevulinate (MAL)-or 5-aminolevulinic acid (ALA)-PDT, erbium: yttrium-aluminium (Er:YAG) ablative fractional laser (AFL)-assisted MAL-PDT or erbium laser resurfacing ( Table 2). [18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series. 18,19 MAL-PDT or ALA-PDT have been shown to be effective, non-invasive and largely well-tolerated treatment options, with an excellent cosmetic outcome and sustained clinical response in most patients; however, these data were from small retrospective or noncontrolled studies.…”

“…[18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series. 18,19 MAL-PDT or ALA-PDT have been shown to be effective, non-invasive and largely well-tolerated treatment options, with an excellent cosmetic outcome and sustained clinical response in most patients; however, these data were from small retrospective or noncontrolled studies. [20][21][22]25 Daylight PDT (dPDT) may also be a useful, less painful treatment option (Prof. Basset-Seguin personal communcation).…”