Predictors of Treatment Response in Actinic Keratosis Treated With Ingenol Mebutate 0.015% Gel

Specific dermoscopic features of actinic keratosis (AK), including the detection of a red pseudonetwork and facial location of the lesions, are strong predictors of a favorable response to treatment with ingenol mebutate (IngMeb) 0.015% gel, according to the results of a retrospective analysis conducted in Italy and published in the Journal of the European Academy of Dermatology and Venereology.

The investigators sought to determine whether certain dermoscopic characteristics of AK of the face and scalp areas might predict patients’ response to IngMeb therapy independently

Using a per-patient and per-lesion approach, they evaluated clinical and dermoscopic responses retrospectively 1 month after treatment with IngMeb 0.015%. Safety was assessed by local skin reaction composite score calculation.

To assess independent predictors of patient response, demographic, clinical, and dermoscopic factors were evaluated by univariate and multivariate logistic regression analysis. A total of 55 patients age ≥18 years with 245 AK lesions were enrolled in the study. IngMeb treatment was administered for 3 consecutive days on a selected area of skin on the face or scalp.

Per-patient response assessment identified 45.4% (25 of 55) of participants as poor/partial responders and 54.5% (30 of 55) of participants as complete responders, which correlated on a per-lesion approach to 26.9% (66 of 245) and 73.1% (179 of 245) of AK lesions, respectively.

Overall, dermoscopy reclassified 14 participants in the per-patient analysis and 48 AK lesions in the per-lesion analysis from complete to poor/partial responders.

Multivariate analysis demonstrated that AK lesions characterized dermoscopically by having a red pseudonetwork and located on the face were independently and significantly associated with a complete dermoscopic response to IngMeb therapy (P <.001), whereas the presence of microerosions was a negative predictor of treatment response.

The investigators concluded that the strength of the present study is its reliance on the large number of AK lesions included for analysis and the precise tracking of the lesions at specific time points through the use of clinical and dermoscopic examinations. The results of this study should help to improve the selection of patients with AK lesions who might benefit most from this treatment.

Reference

Pampena R, Benati E, Borsari S, et al. Tracking actinic keratosis of face and scalp treated with 0.015% ingenol mebutate to identify clinical and dermoscopic predictors of treatment response [published online January 22, 2018]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.14803