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Picato Side Effects

Generic name: ingenol topical

Medically reviewed by Last updated on Apr 27, 2021.

Note: This document contains side effect information about ingenol topical. Some of the dosage forms listed on this page may not apply to the brand name Picato.

In Summary

Common side effects of Picato include: dermal ulcer, localized vesiculation, skin erosion, swelling of skin, and erythema of skin. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to ingenol topical: topical application gel/jelly

Side effects requiring immediate medical attention

Along with its needed effects, ingenol topical (the active ingredient contained in Picato) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking ingenol topical:

More common

  • Cracking of the skin
  • flushing, redness of the skin
  • pain and itching at the application site
  • redness, blistering, peeling, or loosening of the skin
  • skin ulcers
  • swelling of the skin
  • unusually warm skin

Less common

  • Burning, dry, or itching eyes
  • discharge or excessive tearing
  • eye pain
  • infection at the application site
  • redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
  • swelling around the eyes

Incidence not known

  • Burning, crusting, dryness, flaking of the skin
  • chills
  • cough
  • diarrhea
  • fast heartbeat
  • fever
  • hoarseness
  • irritations
  • itching, scaling, severe redness, or soreness of the skin
  • joint or muscle pain
  • painful blisters on the trunk of the body
  • persistent non-healing sore
  • pink growth
  • red irritated eyes
  • red skin lesions, often with a purple center
  • reddish patch or irritated area
  • redness, irritation, or itching of the eye, eyelid, or inner lining of the eyelid
  • shiny bump
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • tightness in the chest
  • trouble breathing or swallowing
  • unusual tiredness or weakness
  • white, yellow or waxy scar-like area

Side effects not requiring immediate medical attention

Some side effects of ingenol topical may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

For Healthcare Professionals

Applies to ingenol topical: topical gel


The most commonly reported side effects were local skin responses including erythema, flaking/scaling, crusting, swelling, vesiculation/postulation, and erosion.[Ref]


Frequency not reported: Hypersensitivity reactions[Ref]


Very common (10% or more): Application site erythema (up to 94%), application site exfoliation (up to 90%), application site scab (up to 80%), application site swelling (up to 79%), application site erosion/ulceration (up to 32%), application site vesicles (up to 20%), application site pain (including application site burning) (up to 15%)

Common (1% to 10%): Application site pruritus, application site irritation

Uncommon (0.1% to 1%): Application site discharge, application site paresthesia, application site ulcer, application site warmth[Ref]


Very common (10% or more): Flaking/scaling (85%), crusting (80%), vesiculation/postulation (56%)

Postmarketing reports: Allergic contact dermatitis, application site pigmentation changes, application site scarring, chemical conjunctivitis[Ref]


Very common (10% or more): Application site pustules (up to 43%)

Common (1% to 10%): Application site infection

Postmarketing reports: Herpes zoster[Ref]

Nervous system

Common (1% to 10%): Headache[Ref]


Common (1% to 10%): Eye lid edema, periorbital edema

Uncommon (0.1% to 1%): Eyelid pain

Frequency not reported: Chemical conjunctivitis, corneal burn, eyelid ptosis[Ref]


Very common (10% or more): Swelling (79%)[Ref]


1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. "Product Information. Picato (ingenol topical)." Leo Pharma Inc, Parsippany, NY.

3. Cerner Multum, Inc. "Australian Product Information." O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.