Nanette B. Silverberg, MD: Uncovering Molluscum Epidemiology

Among the luxuries of established drugs in a disease space is the opportunity to reassess the field’s understanding of the disease itself.

In the second segment of an interview with HCPLive prior to the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this week, Nanette Silverberg, MD, chief of pediatric dermatology at Mount Sinai Health System, discussed the influx of epidemiological data following the US Food and Drug Administration (FDA) approvals of the first 2 drugs indicated to treat molluscum contagiosum: cantharidin formulation 0.7% w/v (YCANTHE) and topical berdazimer gel 10.3% (Zelsuvmi), each in the last year.

“One of the things that happens when a company releases a product in a space that has been otherwise empty, they improve the feng shui of the room, right?” Silverberg said. “You're putting in more and more furniture in the room, essentially, and new information comes out, and you look at things more critically.”

Silverberg explained to HCPLive that the advent of new treatments led to her reviewing her own prior clinical trial data—particularly as to what standard has been set for molluscum lesions.

“And I looked at it differently—I looked at it on a bell curve: what's the average, what's one standard deviation, what's two standard deviation?” Silverberg explained. “And what's interesting is in the outpatient pediatric practice that we had an average around 10 lesions per patients, but one standard deviation was 15 lesions— and that is actually the cutoff on CMS for billing of higher-level code in the destruction of multiple warts or molluscum. And it goes to show that billing and the world at large can overlap.”
Silverberg is interested in using more opportune data to now understand the drivers and exacerbators of molluscum—what clinical or demographic characteristics, or even comorbidities, increase the risk of a child presenting with 50-plus lesions? Even the average age of onset is now more clearly understood in practice-related data.

Silberberg additionally noted her interest in uncovering the potential interplay between eczema and molluscum—whether one is driving another.

“I literally have seen households where there's like 10 kids in the household, and everybody gets molluscum, but one kid has like 100,” Silverberg said. “And we just don't know why some kids are like that, but there are certain kids where there's something about their atopic dermatitis and their skin barrier that they just have rapid spread. And it's usually atopic dermatitis, but there may be other immunodeficiencies.”