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Ingenol mebutate gel appears to have a dual mechanism of action: (i) rapid lesion necrosis and (ii) specific neutrophil-mediated, antibody-dependent cellular cytotoxicity. Because of the rapid destruction of AKs lesions after application of ingenol mebutate gel, treatment is necessary for only 2 or 3 days. The subsequent immune-mediated response targets any residual dysplastic epidermal cells.
The mechanism of action involves two stages: initial disruption of cell plasma membranes and mitochondria leading to cell necrosis (chemoablation) followed by the induction of neutrophil-mediated antibody dependent cellular cytotoxicity that eliminates remaining tumor cells [38,40]. Ingenol mebutate is available in two gel formulations: 0. 015%, indicated for a three-day treatment course on the face or scalp; and 0.