Ingenol mebutate

How it works

Derived from Euphorbia peplus sap, it induces rapid lesional cell death and a neutrophil-mediated inflammatory response that clears dysplastic keratinocytes.

Prescribing in practice

• Marketing authorisation was suspended and the product withdrawn after data suggested a possible increased risk of skin malignancy at treated sites, so it should no longer be prescribed; use an alternative field therapy.
• Where historically used, intense local skin reactions including erythema, flaking, crusting and vesiculation were expected over the short treatment course.
• Patients previously treated should have treated areas monitored for new or changing skin lesions.

Monitoring

Patients who received this agent should have the treated skin kept under surveillance for new or suspicious lesions; check current MHRA advice before any use.

Counselling the patient

• This treatment has been withdrawn over a possible skin cancer concern and is no longer used.
• If you used it in the past, report any new or changing skin spots to your clinician.
• Ask your clinician about alternative treatments for sun-damage skin patches.

Evidence & guidelines

Following an EMA/MHRA safety review, ingenol mebutate's authorisation was suspended and the product withdrawn due to concerns about increased skin cancer risk at application sites.