Ingenol mebutate gel (Picato)

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Ingenol mebutate gel is used to treat thickened areas of skin caused by sun damage.

Wash your hands thoroughly after applying the gel.

Treated areas are likely to become swollen, red and sore. This will pass after a week or so, as the skin heals.

Type of medicineA topical treatment for sun-damaged skin
Used forTreating solar keratosis
Also calledPicato®
Available asGel

A solar keratosis is a small, thickened, scaly growth which develops on the skin. It is the most common skin condition resulting from sun-damaged skin. Solar keratoses are also known as actinic keratoses. Solar keratoses usually develop on areas of skin which have received a lot of sun exposure. They are usually harmless, but there is a small risk that they may eventually turn into skin cancer. In themselves, solar keratoses are not cancerous.

Topical treatments (meaning you apply them to the skin) are useful if you have a lot of small solar keratoses. Ingenol mebutate is one of the treatments that are available. It kills the abnormal skin cells and fresh normal skin grows back. The brand name for ingenol mebutate gel is Picato®. There are two strengths of gel: the lower strength (150 micrograms/gram) is used for keratoses on the face or scalp, and the higher strength (500 micrograms/gram) is used for keratoses on other areas of the body.

To make sure this is the right treatment for you, before you start using ingenol mebutate gel it is important that your doctor knows:

  • If you are pregnant or breast-feeding.
  • If you have ever had an allergic reaction to a skin preparation.
  • If you are taking or using any other medicines. This includes medicines you buy and herbal and homeopathic medicines.
  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about ingenol mebutate and a full list of the side-effects which you may experience from using it.
  • Use ingenol mebutate exactly as your doctor tells you to. Each tube is used for one application only, so open a new tube each time you use the gel. Find a convenient time in your day to apply it - do not use it straight after you have had a shower or bath, and do not use it less than two hours before you go to bed. Gently rub the gel on to the area to be treated and allow it to dry for about 15 minutes.
    • If you are using the 150 micrograms/gram strength on your face or scalp, apply the gel once a day for three days in a row.
    • If you are using the 500 micrograms/gram strength on your body or arms/legs, apply the gel once a day for two days in a row.
  • Once you have used the gel, wash your hands well (unless they are the treated area) and try to avoid touching the area for the next six hours. Do not wash the treated area during this six hours.
  • Only use ingenol mebutate on your skin - you must avoid it coming into contact with your eyes and mouth. If this does happen, wash the area with plenty of warm water straightaway.
  • As you use the gel, the area of skin you are treating is likely to become red and swollen. After a week it may blister and peel, but then it will begin to heal. Expect this reaction to happen, but if it becomes severe or if you are concerned about it, speak again with your doctor.
  • Try to keep any regular appointments with your doctor. This is so your doctor can check on your progress.
  • Some people find it helps to apply a moisturising cream to the skin around the damaged areas to help soften the skin.
  • When you have had a lot of sun exposure, your risk of developing skin cancer on some other part of your skin is increased. Check your skin regularly and tell a doctor if you notice any changes, such as new moles, small dark patches developing, or a change in an existing mole.
  • There is some general advice which will help prevent any further sun damage to your skin. Avoid being out in the sun between 11 am and 3 pm. Always use a broad-spectrum sunscreen with an SPF of 30 or higher, and which protects against both UVB and UVA light. Apply plenty of the sunscreen, and re-apply it regularly, particularly after swimming and if you are sweating a lot.

Local irritation including redness, itching, pain, swelling and peeling can all occur. These effects are normal and show that the gel is working. If the discomfort becomes severe or troublesome, or if you think the area may have become infected, you should contact your doctor for further advice. Also, up to 1 in 10 people using the gel have experienced headache as a side-effect of treatment. If this happens to you, ask your pharmacist to recommend a suitable painkiller.

If you experience any other symptoms which you think may be due to the gel, speak with your doctor or pharmacist.

  • Keep all medicines out of the reach and sight of children.
  • Store the gel in a refrigerator.
  • The tubes are for single use only - do not store opened tubes to use later.

This preparation is for use on the skin only. If someone swallows some of it, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

If you buy any medicines check with a pharmacist that they are safe to take with your other medicines.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking or using.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr John Cox
Document ID:
28811 (v1)
Last Checked:
Next Review:
The Information Standard - certified member

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