Picato® gel (Ingenol Mebutate)

Written by Dr Jill Tomlinson on .

Picato® gel (Ingenol Mebutate) is a topical medication that is used to treat sunspots (also called "actinic keratoses" or "solar keratoses"). It differs from other topical creams such as Aldara® (imiquimod) and Efudix® (fluorouracil) because it only requires daily application for two or three days to achieve its effect, rather than for 3-8 weeks. 

About Picato®

Picato® is available only with a doctor's prescription and comes in two different strengths (0.05% and 0.015%), the choice of which is made by your doctor based on the area of the body that is being treated. You can expect a reduction in sunspots of around 80-85% in the areas treated after the course of treatment. Treatment on the face or scalp is generally for three days, whereas treatment on the limbs or trunk is for two days. The medication costs around $140 to purchase at a pharmacy or chemist and is not listed on the Pharmaceutical Benefits Scheme.

Picato® is a medication that is developed and produced in Australia. In 1997 Australian scientists isolated a group of compounds from the Euphorbia peplus plant. The active ingredient in Picato® is ingenol mebutate, which is produced in Australia. Queensland and New South Wales are the only places in the world where the plant is grown for commercial use. 

How does it work?

Picato® works by killing rapidly growing cells. It is a cytotoxic medication. 

Can Picato® be used to treat skin cancers?

At this time Picato® is licensed only for the treatment of sunspots, not skin cancers. Clinical trials are underway investigating the treatment of early skin cancers with Picato®, but at this time Dr Jill Tomlinson does not recommend the use of Picato® gel for the treatment of skin cancers. 


Picato® should be kept in the fridge, out of the reach of children. Once the treatment course has finished please discard any left over gel. 

Apply Picato® only to the areas advised by your doctor. 

When treating the face or scalp apply Picato® gel 0.015% once a day for three consecutive days. 

When treating the trunk or limbs apply Picato® gel 0.05% once a day for two consecutive days.

Apply Picato® gel with a fingertip and spread evenly over the treatment area, allowing 15 minutes for it to dry. The application should cover a  5cm x 5cm area and the visible sunspot or sunspots. After application wash your hands with soap and water immediately (unless you are treating your hands, in which case only wash the fingertip that was used for applying the gel.

Apply only to dry skin, so do not apply immediately before or immediately after taking a shower. Avoid touching or washing the treated area for six hours after application. Do not apply Picato® gel less than two hours before you go to bed. Do not cover the treated area with bandaids, bandages or other dressings. Do not get Picato® gel in your eyes. If you do get gel in your eyes, wash your eyes with large volumes of water and seek medical attention. 

During treament, protect yourself from sunlight and ultra violet radiation through the use of hats, clothing and sun-avoidance behaviour. Do not use sunscreen on the area of treatment during treatment. After treatment has ended you can (and should) use sunscreen on the treated area whenever it is exposed to the sun. 

Side effects of Picato® gel

It is expected that you will have a skin reaction during treatment with Picato® gel. These reactions include skin redness, skin flaking, blister formation, swelling, pain, itching and skin irritation. You may also experience a headache. 

Skin reactions are temporary. They start within one day of treatment and can continue worsening for one week after the application of Picato® gel stops. Healing of the skin is usually complete at around two weeks after treatment. If you have ongoing problems or concerns please contact your doctor. 

More severe side effects can include skin ulceration and weeping, and swelling of the eyelids. If you think the treatment site has become secondarily infected (which is associated with more severe pain, redness and discharge) please contact your doctor so that you can be reviewed and your doctor can provide advice on further treatment. 

 How do I know if Picato® gel is right for me?

Please see your doctor to discuss if Picato® gel is right for you. Picato® gel is only available with a doctor's prescription, so you will need to see a doctor to access this treatment. 

What are the alternatives?

Alternative options for the treatment of sunspots include Aldara® cream (imiquimod), Efudix® cream (fluorouracil), Solaraze® gel (diclofenac) and cryotherapy. Information written by Dr Jill Tomlinson about these treatments is available in the weblinks provided; further information is available at the NPS MedicineWise website. To discuss the pros and cons of each treatment, and which one is best for you, please arrange an appointment by calling (03) 9427 9596.