An elderly man with a history of sun-damaged skin experiences a painful reaction when solar keratoses of the scalp are treated with ingenol mebutate gel. What is this reaction and how should a patient be managed in this situation?
A 76-year-old man presented to his GP for a tender scalp. He had a long history of chronic solar damage, with multiple squamous cell carcinomas having been excised in the past. Apart from multiple areas of skin grafts, he continued to have extensive field changes to the remaining scalp. Sheets of small actinic keratoses could be found, as well as areas of thicker scaly skin changes.
The GP decided to use a ‘field treatment’ to treat the entire scalp, as targeting individual lesions over the scalp was impractical. Ingenol mebutate 0.015% gel was prescribed, to be applied for three days to the scalp.