THERAPEUTIC
PEARL
Treatment of molluscum contagiosum with ingenol mebutate Saba Javed, BS,a and Stephen K. Tyring, MD, PhDb Houston, Texas
THERAPEUTIC CHALLENGE Molluscum contagiosum (MC) is a common and benign contagious viral skin condition of childhood that accounts for approximately 1% of all diagnoses of skin disorders and up to 10% of skin disorder diagnoses in the pediatric population \10 years of age in the United States. However, the current treatment options involve some degree of pain and discomfort and cause irritation to the patient—with accompanying distress to the parents of small children. Therefore, the need exists for a safe, painless, effective, and rapid treatment option.
SOLUTION We used ingenol mebutate to treat a 4-year-old female with MC lesions on her arms and abdomen. The patient was originally treated with imiquimod 1% for 1 month, with minor improvement in some areas and the appearance of new lesions in other areas. The patient was given samples of ingenol mebutate 0.015% cream, applied to the top of the lesion once daily for 3 days. The patient returned to the clinic after 3 days with the minor complaints of redness and irritation of the skin but improvement of the lesions. The patient continued treatment once daily for another 3 days, which led to resolution of the lesions. There were no signs of recurrence at 1 month of follow-up. Ingenol mebutate has recently been approved for the treatment of actinic keratosis by inducing cell death and also has the potential for treatment of nonmelanoma skin cancer. The mechanism of action has not been fully discerned, but it is hypothesized to have a dual mechanism of action: (1) rapid lesion necrosis and (2) specific neutrophil-mediated, antibody-dependent cellular cytotoxicity.1 Ingenol mebutate has not been reported to have been used as a treatment for MC; herein, we report the successful use of this agent against MC in a young child. REFERENCE 1. Rosen RH, Gupta AK, Tyring SK. Dual mechanism of action of ingenol mebutate gel for topical treatment of actinic keratoses: rapid lesion necrosis followed by lesion-specific immune response. J Am Acad Dermatol 2012;66:486-93.
From The University of Texas Medical School at Houstona and the Center for Clinical Studies,b Houston. Funding sources: None. Dr. Tyring is an investigator and speaker for Leo Pharma. Reprint requests: Saba Javed, Center for Clinical Studies, 451 N Texas Ave, Webster, TX 77598. E-mail: [email protected].
J Am Acad Dermatol 2014;70:e105. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.11.046
e105
PEARL
Treatment of molluscum contagiosum with ingenol mebutate Saba Javed, BS,a and Stephen K. Tyring, MD, PhDb Houston, Texas
THERAPEUTIC CHALLENGE Molluscum contagiosum (MC) is a common and benign contagious viral skin condition of childhood that accounts for approximately 1% of all diagnoses of skin disorders and up to 10% of skin disorder diagnoses in the pediatric population \10 years of age in the United States. However, the current treatment options involve some degree of pain and discomfort and cause irritation to the patient—with accompanying distress to the parents of small children. Therefore, the need exists for a safe, painless, effective, and rapid treatment option.
SOLUTION We used ingenol mebutate to treat a 4-year-old female with MC lesions on her arms and abdomen. The patient was originally treated with imiquimod 1% for 1 month, with minor improvement in some areas and the appearance of new lesions in other areas. The patient was given samples of ingenol mebutate 0.015% cream, applied to the top of the lesion once daily for 3 days. The patient returned to the clinic after 3 days with the minor complaints of redness and irritation of the skin but improvement of the lesions. The patient continued treatment once daily for another 3 days, which led to resolution of the lesions. There were no signs of recurrence at 1 month of follow-up. Ingenol mebutate has recently been approved for the treatment of actinic keratosis by inducing cell death and also has the potential for treatment of nonmelanoma skin cancer. The mechanism of action has not been fully discerned, but it is hypothesized to have a dual mechanism of action: (1) rapid lesion necrosis and (2) specific neutrophil-mediated, antibody-dependent cellular cytotoxicity.1 Ingenol mebutate has not been reported to have been used as a treatment for MC; herein, we report the successful use of this agent against MC in a young child. REFERENCE 1. Rosen RH, Gupta AK, Tyring SK. Dual mechanism of action of ingenol mebutate gel for topical treatment of actinic keratoses: rapid lesion necrosis followed by lesion-specific immune response. J Am Acad Dermatol 2012;66:486-93.
From The University of Texas Medical School at Houstona and the Center for Clinical Studies,b Houston. Funding sources: None. Dr. Tyring is an investigator and speaker for Leo Pharma. Reprint requests: Saba Javed, Center for Clinical Studies, 451 N Texas Ave, Webster, TX 77598. E-mail: [email protected].
J Am Acad Dermatol 2014;70:e105. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.11.046
e105
