July/August 2016
Volume 14 • Issue 4
Original contribution
Survey of Patient Satisfaction With Ingenol Mebutate Gel Treatment for Actinic Keratosis From a Community Dermatology Practice Dale Schaefer, MD Abstract Actinic keratosis (AK) is a condition that can present as a discrete lesion or as areas of confluent lesions. It is generally treated either with cryosurgery or, less frequently, with patient-applied topical medications or photodynamic therapy. Topical therapies can offer benefits over cryosurgery, especially in patients with significant actinic damage. The long durations of topical treatment required and the persistence of associated local skin reactions (LSRs) may deter some patients from adhering to topical therapies and thus affect clinical outcomes. This study describes patient satisfaction with ingenol mebutate treatment for AK in a community dermatology practice in Austin, Texas. Patients were invited to participate in a survey to evaluate their level of satisfaction with the treatment. The patients completed a questionnaire on ease of use, tolerability, appearance of their skin after treatment, and their likelihood of repeat use of ingenol mebutate for AK. Overall, 42 patients completed the questionnaire. The majority of patients had a ≥10-year history of AK, had received prior cryosurgery, and had used topical therapies, most commonly fluorouracil. After treatment with ingenol mebutate, more than 90% of patients reported a good or excellent treatment experience and an improved appearance of their skin. Patients cited the brief 2- to 3-day treatment regimen, high efficacy for clearance of AK, and the rapid resolution of LSRs as factors in their satisfaction with treatment. (SKINmed. 2016;14:259–265)
A
ctinic keratosis (AK) is a common skin disease and a frequent dermatologic diagnosis in patients 45 years and older.1 The average patient with AK usually has multiple lesions,2–4 any of which may progress to squamous cell carcinoma (SCC). The prevailing opinion is that all AKs should be evaluated for treatment to reduce the risk of progression to more invasive disease.5–7 Lesion-directed cryosurgery is the most commonly used method to treat localized AK.8,9 It becomes less practical for patients who have numerous lesions in a contiguous area of skin,10 and it is associated with posttreatment hypopigmentation11 and recurrence of treated lesions.12 Topical field treatment can treat areas of skin with large numbers of lesions, but adherence can be problematic because of the requirements for multiple applications and long durations of treatment.10,13 Further, the associated local skin reactions (LSRs) may cause physical discomfort and be unsightly. Ingenol mebutate gel, 0.05% and 0.015%, is a topical treatment for AK that requires a brief, 2- or 3-day application regi-
men, depending on the area of the body being treated.14 Phase 3 studies of ingenol mebutate used as monotherapy15,16 and used sequentially after cryosurgery17,18 have demonstrated sustained clearance of AKs, with a good tolerability profile. We have used ingenol mebutate treatment in a community dermatology practice in Austin, Texas. We report here the results of a survey we conducted to assess the level of satisfaction with ingenol mebutate, as well as the response to therapy, among our patients. Methods Dermatology patients who had received ingenol mebutate gel treatment for AK were invited to participate in the survey. The survey questionnaire was prospectively administered during a clinic visit for a dermatologic evaluation from January 2014 to January 2015. Eligible patients underwent a clinical evaluation before and after treatment and provided informed consent at their clinic visit. The questionnaire assessed the patients’ attitudes about their treatment experience.
From Austin Dermcare, Austin, TX Address for Correspondence: Dale Schaefer, MD, Austin Dermcare, 3807 Spicewood Springs Road, Suite 200, Austin, TX 78759 • E-mail: dschaefermd@gmail.com
SKINmed. 2016;14:259–265
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