No abstract

eConsults was feasible and well received by PCPs, which improves access to dermatology care with a potential to reduce wait times for traditional consultation.

Treatment of moderate to severe psoriasis often requires systemic therapy, including biologics. Partial response to biologics and relapses are commonly managed with dose escalation. Secukinumab is a relatively new biologic that is currently used to treat moderate to severe psoriasis. There has been no literature published on dose escalation of secukinumab. This article describes the off-label use of a higher dose of secukinumab (450 mg every 4 weeks) instead of the standard dosing (300 mg every 4 weeks) in 2 patients with moderate to severe psoriasis. The first case involves a male patient with a high body mass index (BMI) (≥30 kg/m) and severe psoriasis who was started on secukinumab at 450 mg following a partial response to treatment with the standard 300-mg dose. His psoriasis significantly improved with the higher dose of secukinumab. The second case discusses a female patient with treatment-resistant psoriasis and a BMI of 31.6 kg/m who initially achieved a complete remission with standard dosing of secukinumab. Later, her psoriasis relapsed and she was dose-escalated to secukinumab 450 mg in an attempt to recapture response, but this dose escalation was unsuccessful. In both cases, there were no adverse events observed with a higher dose of secukinumab. These cases demonstrate that dose escalation of secukinumab (450 mg rather than on-label 300 mg every 4 weeks) may be considered in selected patients with incomplete clearance, particularly for those with a high BMI. However, secukinumab dose escalation may not be as beneficial in patients with loss of efficacy.

Molluscum contagiosum (MC) is a common childhood mucocutaneous viral infection characterized by small, discrete, domeshaped, umbilicated papule(s) [1]. It is caused by the MC virus, in the Poxviridae Molluscipox genus. The epidermis is commonly inoculated at sites of impaired skin barrier function from direct minor trauma, such as from scratching or shaving [2]. The disease predominantly affects immunocompetent children, but can be more extensive in the setting of immunosuppression. In adults, it is often sexually transmitted and immunocompromised individuals are more susceptible, most notably in the setting of human immunodeficiency virus infection. Reported prevalence of the disease varies widely across the literature. It is estimated that MC virus affects approximately 4.6% of children in the United States and its incidence has been rising since the 1960s [1].In immunocompetent children, MC is benign and self-resolves within a few months to years without active treatment. At times, the lesions can be widespread, distressing to the patient-particularly when present on the face-and may be associated with a molluscum dermatitis, potentially exacerbating underlying atopic dermatitis. Following an inflammatory host immune response to virally infected lesions, patients can also develop an id reaction-like eruption of erythematous, pruritic papules on the extensors. Such symptomatic scenarios often warrant active treatment despite the benign and self-limiting nature of the poxvirus infection. When deciding on a treatment plan, patient preference along with the risks and benefits of each treatment option must be considered [1]. Treatment of MC is usually well tolerated and can effectively alleviate symptoms, limit spread, clear the infection, improve cosmetic appearance, reduce patient distress, prevent secondary bacterial infections, and help control underlying atopic dermatitis [3].There are many different treatment options for MC, including Keywords: Cantharidin; Canthacur; Molluscum Contagiosum; Chemical Burn; Adverse Effect Le molluscum contagiosum (MC) est une infection virale généralement bénigne et spontanément résolutive affectant la peau. L'application de cantharidine dans un cabinet de médecin est une option thérapeutique sécuritaire, efficace et couramment utilisée pour traiter le MC. Toutefois, son mauvais usage peut entraîner des effets indésirables rares, mais importants. Cette étude de cas décrit l'incident malheureux d'un enfant ayant développé une brûlure chimique sévère en réponse à un mauvais usage de Canthacur-PS, qui contient de la cantharidine 1 %, de la podophylline et de l'acide salicylique, pour le traitement du MC. En outre, elle met en évidence l'importance pour les médecins de bien connaître cette infection au poxvirus, les indications de traitement du MC chez les enfants immunocompétents, et les options de traitement disponibles, incluant l'administration sécuritaire et les complications possibles de la cantharidine. Chez les enfants, la cantharidine peut facilement être appliquée aux lé...