2020 dermMentors™ Resident of Distinction Award™ at the Coastal Dermatology Symposium

The dermMentors™ Resident of Distinction Award™ recognizes top residents in dermatology. DermMentors.org and the dermMentors™ Resident of Distinction Award™ are sponsored by Beiersdorf Inc and administered by DermEd, Inc. The 2020 dermMentors™ Residents of Distinction™ presented new scientific research during the general sessions of the virtual 16th Annual Coastal Dermatology Symposium on October 16, 2020.

Overall Grand Prize
Topical Cantharidin Revisited: A Phase 2 Study Investigating a Commercially Viable Formulation of Cantharidin (VP-102) for the Treatment of Molluscum Contagiosum

Anthony K. Guzman, MD; Jessica L. Garelik, DO; Steven R. Cohen, MD, MPH, Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York 
Disclosures: None. 

Background 
Molluscum contagiosum (MC) is a common cutaneous infection caused by a DNA poxvirus, predominantly affecting children. There is a paucity of high-quality evidence on which to make clinical decisions in treating MC.¹ Cantharidin, a topical vesicant historically derived from a blister beetle, is a commonly used treatment for this condition. However, despite the prevalence of its use, cantharidin is not approved by the US Food and Drug Administration, is not standardized in formulation or treatment regimen, and is not always manufactured in accordance with good manufacturing practice (GMP), leading to a lack of commercial availability.^2,3

Objective 
To determine the efficacy and safety of VP-102, a novel, standardized, commercially viable cantharidin formulation produced under GMP for the treatment of MC.

Methods 
We conducted a 12-week, open-label pilot trial at a single outpatient dermatology clinic. Patients aged 2 to 17 years (N=30) with a clinical diagnosis of MC and fewer than 50 lesions were included. Patients were treated with a single-use vial containing a standardized 0.7% w/v cantharidin solution, produced under GMP (VP-102), applied with the wooden end of a cotton swab approximately every 21 days for up to 4 treatments or until complete lesion clearance. Patients were instructed to wash treatment off all lesions at either 6 hours (cohort 1: 14/30, 46.7%) or 24 hours (cohort 2: 16/30, 53.3%), or earlier if notable blistering occurred. Lesion counts and adverse events, including local skin reactions, were documented at each visit. Quality of life also was measured using the Children’s Dermatology Quality of Life Index at baseline and at the end of study (EOS). The primary end point was the percentage of patients achieving total clearance by EOS on day 84. 

Results 
The mean patient age was 5.8 years (range, 2–12 years). A total of 26 patients (86.7%) experienced at least 1 expected local skin reaction, such as blistering or erythema. No serious or unexpected treatment-related adverse events were encountered. A total of 25 patients pooled from both cohorts completed the study. Eleven patients (44.0%) achieved total lesion clearance by EOS. The mean (standard deviation) lesion count was significantly reduced from 23.0 (15.6) at baseline to 6.8 (11.7) at EOS (P<.0001). The mean (standard deviation) Children’s Dermatology Quality of Life Index score was markedly improved from 3.9 (5.6) at baseline to 0.38 (1.3) at EOS (P=.01).

Conclusions 
VP-102 was well tolerated with either a 6- or 24-hour exposure and was associated with a significantly reduced lesion count, improved quality of life, and complete clearance of MC lesions in nearly half of the patients.

References

1. van der Wouden JC, van der Sande R, Kruithof EJ, et al. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017;5:CD004767.
2. Coloe J, Morrell DS. Cantharidin use among pediatric dermatologists in the treatment of molluscum contagiosum. Pediatr Dermatol. 2009;26:405-408.
3. Pompei DT, Rezzadeh KS, Viola KV, et al. Cantharidin therapy: practice patterns and attitudes of health care providers. J Am Acad Dermatol. 2013;68:1045-1046.

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