In case one, a 62-year-old woman with actinic keratoses on the forehead and nose was prescribed a 3-day course of ingenol mebutate 0.015%. On day two of treatment, she developed a painful erythematous pustular eruption on the forehead and nose associated with periorbital edema. The rash was not associated with pruritus or systemic symptoms such as fever or chills.
In case two, a 62-year-old man was prescribed ingenol mebutate 0.015% for actinic keratoses on the temples, cheeks, nose, and helices. On day three of treatment, he presented with brightly erythematous patches on the malar cheeks and nose with numerous overlying minute superficial pustules (Figures 1A and 1B). He denied pain, pruritus, or systemic symptoms.