What is Ingenol: Uses, Dosage, Side Effects and More

Ingenol is a topical medication that doctors prescribe to treat actinic keratoses, which are rough, scaly patches on your skin caused by sun damage. This gel-based treatment works by targeting abnormal skin cells that could potentially develop into skin cancer if left untreated.

The medication comes from a plant called Euphorbia peplus, commonly known as milkweed or petty spurge. Your dermatologist might recommend ingenol when you have multiple actinic keratoses in one area that need treatment.

What is Ingenol Used For?

Ingenol treats actinic keratoses, those rough, sandpaper-like patches that appear on sun-exposed areas of your skin. These patches are considered precancerous, meaning they have the potential to turn into squamous cell carcinoma if not addressed.

You'll typically see actinic keratoses on your face, scalp, ears, neck, forearms, or hands. These areas get the most sun exposure over the years. The patches might feel rough when you run your finger over them, and they can range in color from skin-toned to reddish-brown.

Your doctor specifically chooses ingenol when you have several actinic keratoses clustered together in one treatment area. This makes it more efficient than treating each patch individually with other methods like freezing or scraping.

How Does Ingenol Work?

Ingenol works through a dual-action process that targets abnormal skin cells while preserving healthy tissue. The medication triggers cell death in the damaged cells that form actinic keratoses, essentially causing them to break down and shed away.

At the same time, ingenol activates your immune system to recognize and attack any remaining abnormal cells in the treated area. This immune response helps ensure that the treatment is thorough and reduces the chance of the keratoses returning.

This is considered a moderately strong topical treatment. The effects happen relatively quickly compared to other topical medications, but this also means you might experience more noticeable skin reactions during the healing process.

How Should I Take Ingenol?

You apply ingenol directly to the affected skin area once daily for either 2 or 3 consecutive days, depending on where you're treating. For face and scalp treatment, you use it for 3 days. For body areas like arms or hands, you typically use it for 2 days.

Before applying the gel, wash your hands thoroughly and make sure the treatment area is clean and dry. Squeeze out enough gel to cover the entire treatment area with a thin layer, then gently rub it in until it disappears.

You don't need to take this medication with food or water since it's applied to your skin. However, you should avoid getting the gel near your eyes, mouth, or any open wounds. After application, wash your hands immediately to prevent accidentally spreading the medication to other areas.

Apply the gel at the same time each day, preferably in the evening. This helps minimize sun exposure to the treated area right after application.

How Long Should I Take Ingenol For?

The treatment course with ingenol is very short - just 2 to 3 days total. Unlike many other topical treatments that require weeks or months of use, ingenol works quickly and intensively over this brief period.

After you complete the 2 or 3-day treatment cycle, you stop using the medication entirely. Your skin will continue to react and heal over the following weeks, typically taking about 2 to 4 weeks to fully recover.

You won't need to repeat the treatment unless new actinic keratoses develop in the same area, which might happen months or years later. Your dermatologist will monitor your skin and determine if future treatments are necessary.

What Are the Side Effects of Ingenol?

Most people experience skin reactions in the treated area, which are actually signs that the medication is working effectively. These reactions are part of the normal healing process as your skin sheds the damaged cells.

The most common side effects you might notice include redness, swelling, and tenderness in the treated area. These symptoms typically start within a day or two of beginning treatment and can last for several weeks.

Here are the reactions you might experience, starting with the most common ones:

• Redness and inflammation that can be quite noticeable
• Swelling around the treated area
• Burning or stinging sensation during and after application
• Crusting or scabbing as the damaged skin heals
• Peeling or flaking of the skin
• Itching in the treatment area
• Temporary darkening or lightening of the skin

These reactions show that ingenol is targeting the abnormal cells effectively. While they can look alarming, they're generally not dangerous and will resolve as your skin heals.

Less common but more serious side effects can include severe allergic reactions, though these are rare. Signs of a serious reaction include widespread rash, difficulty breathing, or swelling of your face, lips, tongue, or throat.

Some people might experience headaches, eye irritation if the medication accidentally gets near the eyes, or flu-like symptoms during treatment. These effects are temporary and usually mild.

Who Should Not Take Ingenol?

You shouldn't use ingenol if you're allergic to any of its ingredients or if you've had severe reactions to similar topical medications in the past. People with certain skin conditions or compromised immune systems might also need to avoid this treatment.

Your doctor will carefully evaluate whether ingenol is right for you based on your medical history and current health status. They'll consider factors like your skin type, the severity of your actinic keratoses, and any other medications you're taking.

Specific situations where ingenol might not be appropriate include:

• Pregnancy or breastfeeding (safety hasn't been established)
• Active skin infections in the treatment area
• Open wounds or cuts where you need to apply the medication
• Severe eczema or psoriasis in the treatment area
• History of severe skin reactions to topical medications
• Current use of certain immunosuppressive medications

Your dermatologist will discuss these factors with you and help determine if ingenol is the best treatment option for your specific situation.

Ingenol Brand Names

Ingenol mebutate was previously available under the brand name Picato in many countries, including the United States and Europe. However, this medication was voluntarily withdrawn from the market by the manufacturer in 2020 due to safety concerns.

The withdrawal happened after studies suggested a potential increased risk of skin cancer at the treatment site in some patients. As a result, ingenol mebutate is no longer commercially available for treating actinic keratoses.

If you were previously prescribed Picato or ingenol mebutate, your doctor will recommend alternative treatments for your actinic keratoses. There are several other effective options available that can address your skin concerns safely.

Ingenol Alternatives

Since ingenol is no longer available, your dermatologist has several other effective treatments for actinic keratoses. These alternatives work differently but can achieve similar results in clearing abnormal skin cells.

Topical alternatives include imiquimod cream, which boosts your immune system to fight abnormal cells, and fluorouracil cream, which targets rapidly dividing cells. Both require longer treatment periods than ingenol but have well-established safety profiles.

Your treatment options now include:

• Imiquimod cream (applied 2-3 times per week for several weeks)
• Fluorouracil cream (used twice daily for 2-4 weeks)
• Diclofenac gel (applied twice daily for 2-3 months)
• Cryotherapy (freezing with liquid nitrogen)
• Curettage (scraping off the abnormal tissue)
• Photodynamic therapy (light-activated treatment)

Each option has different benefits and considerations. Your dermatologist will help you choose the best alternative based on your specific needs, skin type, and lifestyle factors.