ABSTRACT An actinic keratosis is a premalignant lesion of abnormal keratinocytes that develops on sun-exposed areas of the skin. Actinic keratoses are concerning because they can progress to squamous cell carcinoma in a minority of cases. The purpose of this column is to highlight some of the more commonly encountered drugs in dermatology. Ingenol mebutate (Picato) is a topical cream derived from the sap of the Euphorbia peplus plant and is approved by the Food and Drug Administration for use in the treatment of actinic keratoses. In this article, the role of ingenol mebutate as a dermatologic treatment for actinic keratoses will be discussed, and more specifically, this article will bring further understanding to the mechanism of action, administration, dosage, patient education points, adverse effects, and viable alternatives to this medication.