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Picato gel (Ingenol Mebutate)

Picato gel (Ingenol Mebutate) is a Queensland invention, with the very first trials conducted in Brisbane. Picato is derived from a common plant known a Milkweed and is now used to treat actinic keratosis (sunspots) and precancerous lesions all over the world.

Important Facts on Picato (Ingenol Mebutate)

  • Picato gel is the first topical therapy to effectively treat actinic keratosis (AKs) in just two or three days.
  • Use in Australia has been approved by the Therapeutic Goods Administration (TGA) for the topical treatment of solar keratosis in adults.
  • It is available in two different dosage strengths depending on the specific areas of the body requiring treatment
  • Patients can expect up to 80-85% reduction in AKs following treatment
  • Picato gel is only available with a doctor’s prescription.

How does Picato work?

picato weedThe active ingredient, Ingenol mebutate,belongs to a class of medications called cytotoxic agents. The gel works by killing rapidly growing cells such as the abnormal cells associated with sun spots. 

What types of skin cancers or skin lesions can be treated with this gel?

sun-damage treatmentsPicato is currently licensed for use in treating only actinic keratosesor sunspots.

Is Picato a form of natural skin cancer remedy?

natural skin cancer remediesPicato gel is one of only a few pharmaceuticals to have been developed and produced in Australia. The initial work on Picato began in 1997 following the discovery by Australian scientists of a group of compounds isolated from the Euphorbia peplus plant.


The active ingredient in Picato gel, ingenol mebutate,is produced in Australia with both Queensland and New South Wales being the only places in the world where the plant is produced for commercial use.


How do I store Picato?

picato for sunspotsPicato should be stored tightly sealed in a refrigerator and out of reach of children. Do not freeze the gel. Safely dispose of any medication that is outdated or no longer needed.

How do I usePicato gel?

For treatment of the face or scalp Picato gel 0.015% shouldbe used once daily for 3 consecutive days.


For treatment of the trunk or extremities Picato gel 0.05% should be used once daily for 2 consecutive days.


  • The total area of application should be 25cm2(e.g. 5cm x 5cm), and cover the visible sun spot(s).
  • The gel from the tube should be squeezed onto a fingertip and spread evenly over the entire treatment area, allowing it to dry for 15 minutes.
  • Wash your hands with soap and water immediately after application.  If treating the hands, only the fingertip that is used for applying the gel should be washed.
  • Gel should not be applied immediately before or after taking a shower as the skin needs to be very dry before application
  • Do not apply less than 2 hours before bedtime
  • If treatment is on the face it is important to avoid getting the gel in the eyes, should this happen, wash the eyes with large volumes of water and call your doctor
  • The tube is for single use only and should be discarded after use.


If you have missed the second or third application of Picato gel within 3 days of the last application, apply the second or third tube when you remember. If it has been more than 3 days since the last application, do not apply the remaining tube(s) and contact your doctor for advice.


Following application:

  • Avoid touching or washing the treated area for 6 hours
  • Avoid activities that may cause sweating
  • Do not cover the treated area with bandages or dressings
  • Protect the treated skin areas from sunlight and ultra violet radiation
  • Sunscreen may only be used following completion of treatment and once the skin has completely healed

How much does Picato cost?

One treatment of Picato costsapproximately $140.00 AUD

What are the potential side effects of Picato gel?

picato reactionsThe most common side effects are expected to occur and indicate that the treatment is working.


Such effects can include:

  • Skin reddening
  • Skin flaking, scaling or vesicle formation
  • Mild swelling
  • Pain, itching and mild irritation


Other effects may include:

  • Headache
  • Nasopharyngitis


The skin reactions are transient and usually occur within one day of commencing treatment and peak in intensity up to one week following completion of treatment. Healing should be complete within about 15 days. If the effects continue for longer you should contactyour my Skin Cancer Doctor.


Contact your doctor should you notice the following side effects:

  • Ulcers forming
  • Pustules
  • Skin weeping
  • Swelling of the eyelids
  • If you think the application site has become infected.

Can this gel be used to treat other forms of skin cancer?

brisbane sunspot treatmentAt this moment, it is NOT indicated to treat other forms of skin cancers such as Basal Cell Cancers and IECs, however Phase 2 Trials are in progress. My Skin Cancer Doctors do not endorse treatment of these cancers until TGA approval is granted.


What other options do I have for treating sunspots?

pdt sun-spots cureActinic keratosis (or sunspots) are very common precancerous lesions. They are also referred to as solar keratosis. Sunspots ought to be treated due to the potential of cancer arising within these lesions.  Even though Picato gel has been shown to be an excellent method of clearing sunspots, your doctor or dermatologist will discuss other options with you.


The ideal treatment will depend on tolerated downtime, the severity of your sunspots, any pre-existing skin condition and costs.


Alternatives to Picato gel include the following:


 Efudix: This cream is applied twice a day to sunspots for up to 3 weeks, you will be red and spotty for up to 4-5 weeks, and you must limit your exercise and UV exposure during this time. Complete healing of the treated area may not be evident for 1 to 2 months following completion of Efudix therapy.This is a time tested and cost effective (prescription cost of $60 AUD)method of treating sunspots

More on Efudix Treatment for sunspots


 The active ingredient of Efudix is 5-Fluorouracil which is a form of chemotherapy drug.  Abnormal (pre-cancerous or cancer) cells will selectively absorb Efudix allowing the drug to kill the abnormal cells.  The treatment will produce a skin reaction that typically develops over the first week of treatment with redness and slight scaling.  Over the second week the reaction intensifies with increasing redness and crusting with resolution of the reaction occurring several weeks following cessation of treatment. A stronger reaction will be observed in those who have a greater number of abnormal cells in the skin. It is important not to stop the treatment because of the reaction. Efudix is highly effective in treating AKs, particularly when large areas of skin are affected.  Repeated treatments may be required and this is perfectly safe.


Aldara (Imiquimod): This cream is used to treat a variety of skin conditions including warts, sunspots, skin cancers such as superficial basal cell carcinomas and even intra-epidermal carcinomas. Application time will vary according to clearance and side effects. Aldara has a very high clearance rate for solar keratosis, however this treatment is hampered by a long treatment course.

 More on Aldara for the treatment of sunspots


Aldara works by stimulating the immune system causing the release a number of chemicals called cytokines that are necessary to fight viruses and destroy cancer cells. Aldara treatment usually requires application of the cream 2 times a week for 6 weeks to a defined area of skin that should be no larger than 5cm x 5cm.


Common side effects of Aldara include:

  • Redness and inflammation
  • Drying, flaking and scaling
  • Scabbing and crusting


Less Common effects:

  • Itching and burning
  • Skin colour changes (may be permanent)
  • Skin swelling, blisters and ulcers
  • Flu-like symptoms such as headache, fever, muscle pain, nausea and fatigue


PDT: Is also known as photodynamic therapy. This is a once off treatment applied in rooms. Treatment is over within hours, and your skin starts to heal by day 3. Downtime following PDT is only 5-7 days at most.


TGA is currently reviewing recommendations of home use of PDT- known as daylight PDT. Studies are promising.


The advantage of PDT is its ability to treat large areas of skin at one time making it asuitable treatment for patients with large “fields” of affected skin.  Usually only one treatment is required for AKs with costs ranging from $1500 – $2500 AUD depending on the area treated. Although generally well tolerated, common side effects may include slight burning or stingingduring treatment and mild swelling and redness similar to sunburn afterward.  Peeling and redness subside after about week. Overall PDT results are usually very good with excellent cosmetic outcomes.

More on PDT for sun damage


Cryotherapy: This is also called liquid nitrogen or freezing. This is an excellent method to treat individual sunspots, however if sun-damage is extensive, field cryotherapy cannot be used, and topical creams come into play.

More on Cryotherapy for Sunspots


Fraxel 1927 laser: This is the most promising and exciting method of treating AKs. Recent studies have shown that one treatment can clear up to 85% of sunspots. Downtime is only 5-7 days. The other benefit of using a laser is that it also clears up skin pigmentation, fine wrinkles and age spots. The only downside of laser is the cost. Patients require 1-2 treatments, each treatment cost $990, and is supervised by a Dermatologist.

More on Fraxel 1927 for sunspots