[Bullous reaction after application of a single dose ingenol mebutate].

Picato (ingenol mebutate) was recently marketed for local treatment of actinic keratosis (AK). Compared to alternative creams and gels, Picato is a quick and efficient treatment, which is applied for only two to three days. A patient developed a bullous reaction to the gel after a single application. Picato 150 microg/g was applied in the evening to AK in the patient's forehead. The patient experienced a headache during the night, and the next morning big, thin-walled bullae had developed in the treated area.