Enhanced Treatment for Stubborn Warts and Pediatric Molluscum

Treating Plantar Warts and Molluscum at Home

For stubborn plantar warts that hurt and do not response to treat- ment and molluscum in children where office procedures are difficult to tolerate, there is a need to enhance the out-of-office component of the care plan. Office treatment involves curettage plus cryosurgery for plantar warts and superficial, gentle curettage alone for molluscum. Home treatment is usually 5% imiquimod cream, 3 times weekly. To enhance home treatment, I give the patient the disposable curette used in the office, with instructions to repeat the procedure at home as needed. This empowers the patient or parent to assume more responsibility for the treatment and may cut down on frequent return office visits.

Wayne Fujita, MD
Aiea, HI

Rebooking a BCC Biopsy

Don’t be scared to rebook a basal cell carcinoma biopsy for a future visit when you may have a space or cancellation instead of doing it that day because you feel you must.

Ron Vender, MD
Hamilton, Ontario, Canada

Expensive Doctor’s Note

Periodically, I have a patient ask for 2+ days of sick leave for a skin condition that really does not require time off. Not only do I think it is ethically wrong to do this, I also do not want to waste any time supporting this behavior. Although I discourage the patient from taking time off and tell them that they should be fine if they use their medicine, I offer to write a doctor’s note but charge an exorbitant fee. In most cases, when they hear about the fee, they agree to simply use their medicine and return to work immediately. Of course, you need to be selective in this regard because there are patients who could clearly benefit from some time off while their disease is getting under control.

Benjamin Barankin, MD
North York, Ontario, Canada