Picato (ingenol mebutate) gel?

Hey Folks,

Just finished my 3 nights of acid facial peel w/ blowtorch option. Yeah, it hurts and you look like hell - I still do. And I woke up with soreness and burning at 3 a.m. all 3 nights so far. But if it reduces or eliminates the AKs on my face, it'll be worth it. Assuming I ever heal (joking). As to the question of alcohol + Picato... I conducted my own study and found that one stiff drink per night during the application process did not affect the pain level at all.  So presumably it did nothing to the efficacy. Seriously, it's doubtful the mebutate is affected by blood alcohol, if I read the clinical pharmacology correctly. Having said that, the mechanism by which this drug attacks and kills the AKs is unknown. So I'm volunteering to be the guinea pig here. If my Derm says I'm healed, but no better, I'll report back. If I'm healed and AKs are reduced/eliminated, I'll let you know that, too.

I'm having all the same symptoms already reported here, though not so painful that I'd never do this stuff again. Is anyone except me feeling dry lower eyelids and chapped upper lip? I'm thinking the vehicle this stuff uses migrates some distance in the skin. Also, there needs to be further discussion with professionals regarding using one tube over 3 days vs. using all of one tube in one day. I see the logistical goal in confining the treatment area. But one of the components in Picato is citric acid, which can hydrolyze easily upon exposure to the atmosphere. Might be very possible for the pH of the citric acid left in the tube to change over time and affect some of the properties. If so, not sure how much effect it might have. But that should be discussed, as well as exposure to moisture and air on other components. Surely the tiny tube size would mitigate some of those effects (?).

BTW, I was face-to-face with clients Mon. & Tues. (today), having begun the Tx on Sat. night. They never said anything & probably figured I'd gotten sunburned. I think we are often too hard on ourselves when it comes to appearance. I doubt they spent ther rest of their day wondering, "what happened to him?" My advice: don't sweat the temporary appearance issues.

Good luck to all of you!

Landon

At the end of July, I used Picato on my nose and top of cheeks. My experiences are described in an earlier post. This week, I used a second tube of the gel on my forehead. It has been a totally different experience (thank goodness). My skin is red, feels tight, there's some blistering--- BUT, no agonizing pain, no difficulty sleeping. I'm going to save the third vial until after my dermatologist appt in October, just in case there are any areas he recommends I use it on--- otherwise, will apply to my chin and lower cheeks.

This is my first post to this website. When I searched online for information about Picato I found portions of this discussion, which were helpful to me.

This is my fourth day after starting to apply Picato to my face and ears. The dermotologist / physician assistant (PA) prescribed it to repair skin with sun damage. The PA gave me a promotion card to get a discount on this product. I called the phone number on the card and was approved for one three-tube application of the .015 gel for $25, a substantial discount.

The first thing I noticed is how small the tubes of Picato are, they are tiny. A brochure says each tube covers an area 2 inches by 2 inches, which is small. The PA told me to apply it to a larger area, and I did. I think the company needs to clarify if they really want one tube applied only to a 2 x 2 inch area, or if it can be spread further. I wonder if my applying it to a larger area reduces its effectiveness. The tube also has a long neck, which makes it impossible to get out all of the gel. The tubes of gel should be about twice as big for practical use.

I followed the suggestion in this postings to apply it in the morning (thinking there was less chance of getting it in my eyes than if I applied it at night and rolled on a pillow). My experience was similar to others noted in this discussion. After about four hours I began to feel and look as if I had a bad sunburn, and that continued to be the main effect of the medicine. Over time some spots appeared to be a darker red, and I assumed that those were sun-damaged areas. On the second day I felt as if my ears were swollen somewhat. The ointment does seem to affect my eyes somewhat, making them water, and irritate my nasal passage.

I am in my fourth day and the redness and stinging have decreased. I have considerable flaking of skin,  but little blistering. I will be interested to see how it turns out after a week or two. The experience was not pleasant, but not as bad as I expected, and will be worth it if it helps my skin. Good luck to other users, and thanks for posting helpful information here.

Here's another forum for Picato users:

http://www.topicalinfo.org/forum/topic.asp?TOPIC_ID=1132

I tried Picato on my face after many rounds of both Carac and Effudex, Blue light over the past ten+ years.  The reaction was immediate and severe.  I think you have to be extremely careful that you do not over apply this thin clear liquid, especially to your face.  The areas blistered within 24 hours and throbbed during sleep.  The best part of the miserable two days was how quickly the application phase is over unlike the other creams.  If you can endure that then you are on to the healing phase.  I could not go out for 4 days it was so raw and erupted.  After that I could apply mild make-up to cover the spots.   The true test of its benefit will be to see if the effects last longer than the other treatments as I seem to get the AKs in the same places over and over again.

I am about to try the formula meant for the body to spots on my hands and arms tomorrow.  I will be very careful to use a minimal amount of the gel.  We'll see how that goes.

There is a coupon from the manufacturer which allows two refills of each prescription for a $25 co-pay.  It is worth taking advantage of this now.

My dermatologist is very anxious to hear how this new treatment works as it is so appealing to have something you apply for two days instead of weeks like the creams.....

Good luck!

On Aug 09, 2012 3:07 PM VickiB wrote:

Good morning! It's Vicki B here and way back when (end of March?) I started this conversation with questions about experience with Picato. I've been following along on this message board and a couple others and yesterday I started with the first application to my face. (We had an opportunity to go to the first week of the London games and I didn't want to do it before that! Also, I waited until my derm got a free 3 tube sample for me as we have no RX coverage so the cost was really high, out of pocket).

My experience so far, 24 hours in. I am getting every speck out of each tube, including cutting the top off the tube because I am covering my whole face. 3 hours after first application yesterday morning I could feel what was similar to a sunburn and by mid afternoon it was completely distracting and I would say pretty uncomfortable. By yesterday evening- 12 hours later- I had a large blister on my chin and my entire face was very red and uncomfortable. I had showered in the AM one hour prior to first application and I did not wash it off before bed. I kept my hands off my face during the day and I also stepped up hand washing throughout the day. I avoided letting our new kitten near my face (she licks) and I did not touch her during the day as a precaution to not transfer any to her. I stayed up and busy until around 11 pm. Mild headache all afternoon and evening.

Meds for day: 2 ibuprophen around 1pm, 2 tylenol around 4pm, 600mg IB and .5 xanax at bedtime. I had confirmed that mixing tylenol and IB are okay and that they work differently on pain receptors so it can be of some help. I slept well for 4 hours, woke and repeated IB and .5 more xanax and slept through until 8am, no problem. When I woke up, face was less inflamed than when I went to bed.

I am using a clean pillowcase each night and I am not washing with soap or applying aquafor at this point. Showered this morning, washed hair taking no particular precautions about keeping shampoo off face but basically just thoroughly rinsed face with water. I did not dry my face with regular bath towel. I have been using and HIGHLY recommend using, Viva paper towels to blot face dry- they are very soft and, of course, disposable. 

I made ice packs in freezer bags with some isopropol alcohol added to them- it keeps the ice slushy and moldable. Double bag it- I suspect the last thing you want on your face during this is rubbing alcohol.

So- that's it for the first 24 hours. More information than you want to know, right? But I'm finding the details of others helpful so maybe this will help someone else.

Oh- previous hx: White Irish skin, a couple of severe sunburns over 60 years but not constant sun exposure. 4 previous Mohs surgeries on my face which I documented at amarkonmywall.wordpress.com "" target="_blank" rel="nofollow">http://amarkonmywall.wordpress.com " target="_blank" rel="nofollow">amarkonmywall.wordpress.com (search Mohs on that page), including photos. Four other BCCs on back, legs, all since turning 50. Many AKs burned in past. I am taking photos of Picato treatment every 12 hours and will share if people want.

As I finish up this report on Day 1, my face is heating up uncomfortably so I'm about to take first IB, 600mg for the day two hours after this morning's (2nd day) application. Let's see if I can get a couple bushels of tomatoes canned before things get too hot. :-) Good luck everyone.

Oh, yes! Regarding alcohol consumption: my personal experience is that more than a drink causes me to flush on the best of days (being a woman of a certain age) and I'm thinking the addition of hot flashes to this is probably not the best thing. That being said, I had a gin and soda yesterday afternoon. ;-)

Hi, Vicky. I'm Karen in Chandler, Az. I am 66 as of Sunday and got my first Picato yesterday. I'm also fair skinned (English/Welsh), have been sun worshipping in the desert for desert for 42 years. I have AKs all over me, of course, had one Moh's surgery smack dab in the middle of my face (right cheek) in 2005 that hadn't quite turned to Squamos. Since then I've been pretty good about going to the derm two or three times a year and getting the nitrogen stuff. On Monday though derm said it was time I did a treatment like Picato. My younger brother did Efudex several years years ago, went through it all, and still does it occasionally VOLUNTARILY! He's more brave than I am! And his skin looks so good, clear and healthy. He was never the fool I've been though about the sun. I am interested in your post especially, because we're close in age and skin type. My dad died of melanoma when he was just my age and never got in the sun, but my skin has more of a redhead tone to it than his did. My mom was auburn haired and a little ruddy. I'm brunette, but still have her skin. Anyway, I haven't gone through all the posts. So don't know how you faired by the end of your treatment. When I was with the derm, I was all fired up about doing it, was planning to start this morning, since she thinks I'll be okay by Christmas. After reading the posts, I'm not so sure about that, and might wait till January so I can hibernate. Any advice will be appreciated, and I would like to see your pictures if you wouldn't mind sending them. I think this forum is great! Will give me someone to whine to when I'm miserable! ?

Just wanted to report my experience so others can have a reference to compare. 

I am a 58yo male who has had numerous AKs in the past that were treated with liquid nitrogen spray.  I have also had a course of photodynamic therapy.  Over the past 2 years, multiple rough areas reappeared on my forehead, nose, and ear lobe, and a few very distinct ugly red areas appeared on my cheek.  All areas were considered AKs.

I made an appointment to see my dermatologist and was expecting to receive the nitrogen therapy.  Instead, he mentioned that a new topical gel was available and recommended I try it--any areas that were not successfully treated he said he could zap with the spray on follow-up.  I obtained Picato Gel and like others on this board was amazed at how small the tubes were.  I applied the contents of tube number 1 to my entire forehead, bridge of my nose, spots on right cheek, spot on left ear, and a little on my lip.  Needless to say, that was a major feat to do given the tube size.  Application 1 was fairly well tolerated with minor exceptions: I did get a headache and noticed difficulty swallowing (I think I must have swallowed a bit that I put on my lip).  Word of caution--if you apply the gel to your lip, I would recommend that you be very careful not to have your lip come in contact with the other lip until the gel has sufficiently dried.  Alternatively, you may want to put a paper towel over your lips to prevent contact (just my advice).  I did not experience much pain or burning but did have skin tightness.  I did, however, pre-medicate with acetaminophen about an hour prior to application.  I assume the more abraded skin you have, the worse the pain is likely to be (again, just my opinion).

After reading some of the posts in this forum, I had some apprehension about application number 2.  I followed the same routine and had similar results with the exception of more burning and swollen eyelids.  The pain was tolerable.

Same routine for application 3.  Again, burning was noticeable, mild pain, swollen eyelids.  I was glad all of the applications were done and experienced fewer side effects than expected.  YMMV.

Face continued to be tight over the next several days.  I started to peel around day 5.  I was extremely careful not to facilitate the peeling.  I also did not shave during the entire time period as I did not want to aggravate the cheek areas.  The peeling continued until around day 9 at which time I was able to shave very comfortably.

Given the rough areas on my forehead and red burning skin on my cheek prior to Picato, I was very pleased with the results.  I used all of the gel from each tube and applied gel around the same time each day.  I took acetaminophen but did not need any other medication or ice.  Again, your experience may differ.  The results were very acceptable and, in contrast to nitrogen which leaves a white mark on treated areas, there were no after effects.  I would estimate that ~85% or more of areas were successfully treated.  I think almost all areas would have been eliminated if the tube was a bit larger as I might have missed some spots during application. 

Given my history, I assume that even with use of sunscreen some rough and red areas may return.  If so, I would gladly go for another course.  I have a follow-up visit scheduled with my dermatologist to review results.  

 

Similar to picatogel user I am posting to inform about my use of the gel.

 

I am 49 yr old mail and have suspected AKs all over my face.  I used it on cheeks, nose, tops of ears, temples and forehead.  I thought there was enough gel in the tubes for my application.  Cost was $25 with discount card, $75 without.

 

First application was on my face for 8 hours.  Started with tightening of the skin, followed by burning sensation and a headache.  Pain was minimal.  At the end of the day it felt like a severe sunburn.  

 

Second day the gel was on for 10 hours.  Severe itching and less burning then the day before.  Crazy headache required advil.

 

Third day the gel was on for 8 hours.  Worse itching then 2nd day, less burning and no headache.

 

Flaking of skin occurred by the end of the third day.  I shaved throughout the process without any issues.  If you have shaved with a sunburned face, you are familiar with the feeling.

 

It is now the 5th day since I started and the skin flaking is still occurring, it has gotten worse each day.  I do not notice any change in the size/color of the AKs so time may tell.  The feeling of a sunburned face went away today.

On Dec 12, 2012 2:39 PM dp492012 wrote:

Similar to picatogel user I am posting to inform about my use of the gel.

 

I am 49 yr old mail and have suspected AKs all over my face.  I used it on cheeks, nose, tops of ears, temples and forehead.  I thought there was enough gel in the tubes for my application.  Cost was $25 with discount card, $75 without.

 

First application was on my face for 8 hours.  Started with tightening of the skin, followed by burning sensation and a headache.  Pain was minimal.  At the end of the day it felt like a severe sunburn.  

 

Second day the gel was on for 10 hours.  Severe itching and less burning then the day before.  Crazy headache required advil.

 

Third day the gel was on for 8 hours.  Worse itching then 2nd day, less burning and no headache.

 

Flaking of skin occurred by the end of the third day.  I shaved throughout the process without any issues.  If you have shaved with a sunburned face, you are familiar with the feeling.

 

It is now the 5th day since I started and the skin flaking is still occurring, it has gotten worse each day.  I do not notice any change in the size/color of the AKs so time may tell.  The feeling of a sunburned face went away today.

My experience was pretty similar.  I left the gel on for 8 hours each time.

Give it 8-10 days and you will likely see some changes in the appearance of the AKs.  Do not facilitate the flaking or peeling.  Just let it flake/peel.  You can wash the skin and/or apply lotion but I would not pull on any skin that does not want to flake off on its own. 

 

 

Hi - I am a 46-year old female with suspected AK's on my nose and cheeks. I followed the manufacturer's/doctor's directions and applied the gel to these areas for the last 3 nights. I have'nt really had any severe reactions to the medication yet - just some burning, redness, and flaking of the skin, but no blisters, swelling, itching or anything like that. It is now day 4 and I have some minor irritation. I have been drinking lots of water, taking Ibuprofen, and during the day I apply a lot of moisturizer. I'm just wondering if this medication is really going to work for me (?). Did anybody else achieve good results without getting severe reactions? I'm just curious and hoping these AK's will disappear after the course of treatment. Thanks for any replies. I really appreciate it. Mary