DermInsider - VGR Session 3

Recognize the clinical features of common pediatric dermatology conditions 

Identify common comorbidities and complications of pediatric dermatology conditions 

What's the Diagnosis? Pediatric Dermatology Edition

DermInsider - A Virtual Grand Rounds Series - Session 3: What's the Diagnosis? Pediatric Dermatology Edition

Discuss treatment options for psoriasis, atopic dermatitis, acne, rare diseases, infestations, hair and nail conditions with patients

Describe the differences and comparative advantages of therapeutic options for a variety of pediatric dermatologic conditions

Discuss sunscreens, skin care of babies, and management of conditions in skin of color with my patients

Recognize, diagnose, and manage patients with staph, strep, hemangiomas, and vascular lesions 


2023 Virtual Grand Rounds Session 7: May 24, 2023 - Pediatrics 360: Best Practices and Innovations - Your Questions Answered

Pediatric Dermatology

WEDNESDAY, Jan. 28, 2026 (HealthDay News) -- The clinical presentation of measles in <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">pediatric</a> patients is variable, with atypical presentations more frequent in partially vaccinated or immunocompromised patients, according to research published in the January issue of SKIN.Kallie Crowl, from the Des Moines University College of Osteopathic Medicine in Iowa, and colleagues conducted a retrospective synthesis of 10 pediatric case reports and series to characterize the range of clinical presentations of pediatric measles in the context of vaccination status, immune history, and access to care.The researchers found that 80 percent of the cases reviewed exhibited the classic cephalocaudal rash progression, while some showed atypical patterns, including sparing of extremities or back-to-front distribution. In partially vaccinated or immunocompromised patients, atypical presentations were more frequent. There were inconsistent reports of Koplik spots. Due to overlap with other pediatric conditions and low clinical suspicion, diagnostic delays were common, especially among older children and adolescents."This review underscores a concerning erosion in the clinical recognition of measles, particularly in pediatric populations," the authors write. "Declining provider familiarity, atypical presentations, and misplaced diagnostic assumptions have contributed to delayed and often inaccurate diagnoses, even when patients exhibit classic features."<a target="_blank" rel="noopener noreferrer" href="https://skin.dermsquared.com/skin/article/view/3566">Abstract/Full Text</a>

Due to overlap with other pediatric conditions and low clinical suspicion, diagnostic delays are common

Study Characterizes the Variable Clinical Presentations of Measles in Pediatric Patients

FRIDAY, Nov. 7, 2025 (HealthDay News) -- The likelihood of outgrowing food allergy (FA) is reduced in association with the onset of <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">eczema</a> at 4 to 6 months, greater severity, and longer duration, according to a study presented at the annual meeting of the American College of Allergy, Asthma &amp; Immunology, held from Nov. 6 to 10 in Orlando, Florida.Nicole Koulov, from the University of Texas in Houston, and colleagues examined the effects of eczema onset timing, duration, and severity on subsequent development of oral tolerance in <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">children</a> aged 0 to 12 years with a history of outgrown immunoglobulin E-mediated FA.The researchers found that models estimated a significant nonlinear association between eczema duration and FA duration among 855 pediatric patients with eczema, with the predicted probability of outgrowing an allergy decreasing at lower durations, increasing with durations between eight and 10 years, then decreasing again. The odds of outgrowing an FA were lower in association with greater eczema severity. Children whose eczema began at 4 to 6 months of age had significantly lower odds of resolution compared with those with onset at 0 to 3 months; no significant difference was seen for later-onset groups."These findings show that eczema is more than just a coexisting condition -- it may directly influence whether children overcome food allergies," coauthor Amal Assa'ad, M.D., of the Cincinnati Children's Hospital Medical Center, said in a statement. "Our data suggest that the timing and management of eczema could be an important factor in helping children develop tolerance."<a target="_blank" rel="noopener noreferrer" href="https://acaai.org/news/study-finds-link-between-eczema-patterns-and-childrens-ability-to-outgrow-food-allergies/">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://25eventannual.com/acaai25/">More Information</a>

Onset of eczema between 4 and 6 months, greater severity, and longer duration linked to lower likelihood of outgrowing allergies

ACAAI: Eczema Onset, Severity Can Affect Child's Ability to Outgrow Food Allergy

THURSDAY, Nov. 6, 2025 (HealthDay News) -- For <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">children</a> with <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">atopic dermatitis</a> (AD), COVID-19 mRNA vaccination is associated with a reduced incidence of multiple infections and allergic complications, according to a study presented at the annual meeting of the American College of Allergy, Asthma &amp; Immunology, held from Nov. 6 to 10 in Orlando, Florida.Tristan Nguyen, from the University of Texas Medical Branch in Katy, and colleagues conducted a retrospective cohort study using data from TriNetX to compare vaccinated and unvaccinated pediatric patients with AD (17 years and younger). A total of 5,758 patients were included per cohort after 1:1 matching.The researchers observed an association for <a href="/conditions/covid-19" target="_blank" rel="noopener noreferrer">COVID-19</a> vaccination with a reduced incidence of multiple infections, including otitis media, pneumonia, bronchitis, bronchiolitis, non-COVID-viral infections, sinusitis, upper respiratory infection, impetigo, molluscum contagiosum, and skin infections (risk ratios, 0.623, 0.604, 0.488, 0.480, 0.547, 0.549, 0.647, 0.492, 0.597, and 0.559, respectively). There were also reduced risks seen for allergic complications, including asthma, allergic rhinitis, contact dermatitis, and other allergy-related conditions such as anaphylactic food reactions (risk ratios, 0.696, 0.561, 0.537, and 0.703, respectively). For otitis media, bronchiolitis, viral infections, upper respiratory infections, and allergic rhinitis, the hazard analysis showed significantly delayed time-to-event onset. There were no significant differences seen in psychiatric or growth-related outcomes."Our study suggests that COVID-19 vaccination not only protects against coronavirus but may also have broader health benefits for children with atopic dermatitis," principal author Zhibo Yang, M.D., Ph.D., also from the University of Texas Medical Branch, said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://acaai.org/news/covid-19-vaccination-linked-to-reduced-infections-in-children-with-eczema/">Press Release</a><a target="_blank" rel="noopener noreferrer" href="https://25eventannual.com/acaai25/">More Information</a>

Reduced risks seen for multiple infections and for allergic complications, including asthma, allergic rhinitis, contact dermatitis

ACAAI: COVID-19 Vaccination Reduces Risk for Multiple Infections in Children With Atopic Dermatitis

WEDNESDAY, Oct. 29, 2025 (HealthDay News) -- For <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">pediatric patients</a> with <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">atopic dermatitis</a>, juvenile arthritis, and inflammatory bowel disease, Janus kinase inhibitor (JAKi) therapy exposure is not associated with differences in height compared with control treatment, according to a study published online Oct. 29 in JAMA Dermatology.Hannah L. Cole, from Harvard Medical School in Boston, and colleagues examined the association between height and JAKi use in pediatric patients focusing on atopic dermatitis, juvenile idiopathic arthritis, and inflammatory bowel disease, for which JAKi therapies are commonly prescribed. Patients receiving treatment at 17 years or younger were included and matched with controls with any of these diagnoses who were receiving a corresponding comparator treatment not known to stunt growth at 17 years or younger and with no history of treatment with any of nine JAKis. Cohorts were propensity score-matched.The analyses included 1,042 individuals. The researchers found no significant differences in height (mean difference, –0.94 cm; 95 percent confidence interval, –2.14 to 0.25 cm; P = 0.12). In secondary analyses in each disease cohort, no significant differences were found. The proportions of patients with height less than two standard deviations below the mean were similar for all cohorts."These findings may inform shared decision-making about JAKi use in the pediatric population," the authors write. "Future studies should evaluate whether these findings generalize to younger populations, the effects of JAKi therapy on growth velocity, and the role of potential mediating factors, such as IGF-1 signaling."<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2840442">Abstract/Full Text</a>

No significant differences in height seen for JAKi exposure in atopic dermatitis, juvenile arthritis, and inflammatory bowel disease

JAKi Treatment Not Linked to Height Differences in Pediatric Patients

WEDNESDAY, Oct. 15, 2025 (HealthDay News) -- <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">Child</a> <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">atopic dermatitis</a> (AD) is associated with higher maternal depression scores, according to a study published online Oct. 5 in the Journal of the American Academy of Dermatology.Hannah Eunhae Kang, from the University of California, San Francisco, and colleagues examined the relationship between child AD activity and severity with maternal depression across childhood. The analysis included 12,124 mother-child dyads participating in the Avon Longitudinal Study of Parents and Children.The researchers found that mothers of children with active AD had higher Edinburgh Postnatal Depression Scale (EPDS) scores, with an average increase of 0.33 points when adjusting for child sex, maternal age at delivery, maternal race and ethnicity, measures of socioeconomic status, maternal history of AD, and maternal history of prenatal and postnatal depression. Severe AD was associated with a 0.68-point increase in EPDS scores, yielding a 45 percent increase in the odds of clinically relevant symptoms. There was a dose-response relationship between maternal depression and AD severity throughout childhood, with the largest effect sizes at ages 3 to 7 years among mothers of children with severe AD from lower socioeconomic backgrounds.“Early and ongoing mental health support for mothers of children with AD may include regular mental health screenings for mothers, particularly those managing severe cases and those from lower socioeconomic backgrounds,” the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(25)02968-8/fulltext">Abstract/Full Text</a>

Association stronger among mothers from lower socioeconomic backgrounds managing severe child AD in early childhood

Child’s Atopic Dermatitis Linked to Maternal Depression Scores

THURSDAY, Oct. 9, 2025 (HealthDay News) -- The U.S. Food and Drug Administration has approved the supplemental new drug application for Zoryve (roflumilast) cream 0.05 percent for the topical treatment of mild-to-moderate <a href="/conditions/atopic-dermatitis" target="_blank" rel="noopener noreferrer">atopic dermatitis</a> in <a href="/conditions/pediatric-dermatology" target="_blank" rel="noopener noreferrer">children</a> 2 to 5 years of age.The once-daily cream can be used anywhere on the body and for any duration. This approval offers an alternative to steroids.The approval is based on clinical trials that showed Zoryve cream rapidly improved the severity and extent of eczema signs and symptoms, with approximately 40 percent of children achieving a 75 percent improvement from baseline on the Eczema Area and Severity Index. Additionally, more than one-third of participants (35 percent) achieved clinically meaningful improvement in itch intensity in four weeks."Young children are particularly vulnerable to the bothersome symptoms of atopic dermatitis, because their immune system and skin barrier are less developed than those of older children and adults," Korey Capozza, founder and executive director at Global Parents of Eczema Research, said in a statement. "This condition doesn't just affect the child's skin -- it can affect the whole family by causing sleep disruption, emotional distress, and social isolation."Approval of Zoryve was granted to Arcutis Biotherapeutics.<a target="_blank" rel="noopener noreferrer" href="https://www.globenewswire.com/news-release/2025/10/06/3161656/0/en/FDA-Approves-Arcutis-ZORYVE-roflumilast-Cream-0-05-for-the-Treatment-of-Atopic-Dermatitis-in-Children-Ages-2-to-5.html">More Information</a>

The once-daily cream can be used anywhere on the body and offers an alternative to steroids in children ages 2 to 5 years

FDA Approves Zoryve for Atopic Dermatitis in Young Children

FRIDAY, Feb. 28, 2025 -- Few parents say their teen has asked about nonsurgical cosmetic procedures, according to the results of a C.S. Mott Children's Hospital National Poll on Children's Health released on Feb. 17.The survey included a national sample of 989 parents of children aged 13 to 17 years, with responses collected in August 2024.According to the results of the survey, very few parents say their teens have asked about nonsurgical cosmetic procedures (7 and 1 percent for girls and boys, respectively). Half of parents (51 percent) say teens should be allowed to get nonsurgical cosmetic procedures only for valid reasons, while just under one-third of parents (31 percent) think teens should be prohibited from them under any circumstances and 18 percent believe teens should be allowed to get them for any reason as long as they have parental approval. Parents also differ in what they believe are valid reasons for nonsurgical cosmetic surgery. The most parental support was seen for thinking the procedure may improve the teen's mental health (37 percent say valid; 38 percent say not valid). There was slightly less support seen for the teen wanting to look good for a special occasion (33 percent valid; 54 percent not valid), the teen being self-conscious about their appearance (33 percent valid; 50 percent not valid), or the teen being bullied due to their appearance (30 percent valid; 47 percent not valid)."When considering cosmetic procedures, it's important for parents and teens to be well informed so they can have realistic expectations about what the procedure will actually achieve and if it's worth the risk," Susan Woolford, M.D., a codirector of the Mott Poll, said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://mottpoll.org/reports/teens-too-young-non-surgical-cosmetic-procedures">More Information</a>

However, less than half of parents support procedures even for mental health or bullying concerns

One in Six Parents Support Teens Getting Nonsurgical Cosmetic Procedures

WEDNESDAY, Feb. 26, 2025 -- Children with obesity have increased rates of dermatologic conditions, according to a study published online Feb. 10 in Pediatric Dermatology.Samantha Epstein and Sonal D. Shah, M.D., from the Case Western Reserve University School of Medicine in Cleveland, conducted a retrospective cohort study involving children younger than 18 years with and without obesity and various dermatologic conditions and comorbidities.The researchers observed an association between childhood obesity and increased rates of all dermatologic conditions and the associated comorbidities evaluated. The most commonly associated dermatologic condition was acanthosis nigricans (risk ratio, 62.16), while the least common was acne vulgaris (risk ratio, 2.50). The incidence of dermatologic conditions trended upward, with a greater increase seen in children with obesity compared with those without obesity. Notably, from 2016 to 2023, the incidence of hidradenitis suppurativa increased by 17.18 percent. Comorbidities seen in higher proportions among children with obesity included type 2 diabetes mellitus, hypertension, hyperlipidemia, asthma, obstructive sleep apnea (OSA), attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder. Compared with children without obesity with one of these comorbidities, children with obesity with hypertension, ADHD, depression, or OSA had an increased risk for every skin condition apart from rosacea."While obese children are at increased risks for various skin conditions, children with obesity and additional comorbidities, such as diabetes, hypertension, ADHD, depression, OSA, or polycystic ovary syndrome, carry an even greater risk of certain dermatologic conditions," the authors write. "This supports the complex interplay between obesity and dermatologic health, particularly the proinflammatory effects of obesity."<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/pde.15887">Abstract/Full Text</a>

Children with obesity and specific comorbidities, including HTN and T2D, have increased risk for almost every skin condition

Children With Obesity Have Increased Rates of Dermatologic Conditions

THURSDAY, Jan. 23, 2025 (HealthDay News) -- On a global scale, childhood maltreatment is associated with a higher risk for developing some immune-mediated inflammatory disorders (IMIDs), according to a study published online Nov. 30 in Heliyon.Liam Snook, from the University of Birmingham in the United Kingdom, and colleagues investigated the association between childhood maltreatment and IMIDs. The analysis included 256,130 exposed patients and 712,478 matched, unexposed patients identified from a U.K. primary care database (Jan. 1, 1995, to Jan. 31, 2021).The researchers found that individuals exposed to childhood maltreatment had a significantly increased risk for developing rheumatoid arthritis (adjusted hazard ratio [aHR], 1.39) and psoriasis (aHR, 1.16). However, there was no statistically significant association with the risk for developing inflammatory bowel disease, multiple sclerosis, or systemic lupus erythematosus. Exposed individuals had a lower risk for celiac disease (aHR, 0.74) versus the unexposed group."Childhood maltreatment is estimated to affect one in three children globally; therefore, an increased risk of developing rheumatoid arthritis and psoriasis represents a substantial contribution to the burden of IMIDs," the authors write. "Implementation of broad public health approaches to prevent and detect childhood maltreatment and its negative downstream consequences, such as IMID development, is essential."<a target="_blank" rel="noopener noreferrer" href="https://www.cell.com/heliyon/fulltext/S2405-8440(24)16524-3">Abstract/Full Text</a>

Significantly higher risk seen for rheumatoid arthritis and psoriasis

Childhood Maltreatment May Up Risk for Immune-Mediated Inflammatory Disorders

MONDAY, Sept. 9, 2024 (HealthDay News) -- In young children, skin care product (SCP) use is associated with urinary phthalate/replacement metabolites, according to a study published online Sept. 4 in Environmental Health Perspectives.Michael S. Bloom, Ph.D., from George Mason University in Fairfax, Virginia, and colleagues examined the associations between SCP use and children's urinary phthalate/replacement metabolite concentrations. Children aged 4 to 8 years provided spot urines from 2017 to 2019, and mothers were queried about children's SCP use in the previous 24 hours (906 children). Liquid chromatography-tandem mass spectrometry was used to determine the concentrations of 16 urinary phthalate/replacement metabolites (630 children). Children's use of different SCPs was estimated as individual predictors of urinary phthalate/replacement metabolites.The researchers observed associations for lotion use with a 1.17-fold increase in monobenzyl phthalate, and for oils, they found associations with 2.86-, 1.43-, and 1.40-fold increases in monoethyl phthalate, monobutyl phthalate (MBP), and low molecular weight phthalates, respectively. Associations were seen for use of two-in-one haircare products with 0.84- and 0.78-fold lesser mono(3-carboxypropyl) phthalate and MBP, respectively. Some of these associations were modified by a child's race/ethnic identity. Four distinct SCP-use exposure scenarios were identified with self-organizing maps that predicted 1.09-, 1.31-, 1.13-, and 1.04-fold increases in monocarboxy isononyl phthalate, mono-2-ethyl-5-hydroxyhexyl terephthalate, monoethylhexyl phthalate, and diethylhexyl phthalate, respectively."The results can inform policies to address the use of endocrine-disrupting chemicals in skin care products that may be used on children and to help advise parents' decisions about using products to limit their children's exposure to potential developmental toxicants," Bloom said in a statement.<a target="_blank" rel="noopener noreferrer" href="https://ehp.niehs.nih.gov/doi/10.1289/EHP13937">Abstract/Full Text</a>

SCP use associated with urinary phthalate/replacement metabolites among young children

Skin Care Product Use by Children Tied to Phthalates/Replacement Metabolites

TUESDAY, Aug. 27, 2024 (HealthDay News) -- Early childhood obesity may increase the risk for pediatric immune-mediated skin diseases, according to a study published online Aug. 21 in the Journal of Investigative Dermatology.Seong Rae Kim, M.D., from the Seoul National University College of Medicine in South Korea, and colleagues examined associations between body mass index or body mass index changes and the development of three main immune-mediated skin diseases: alopecia areata, atopic dermatitis (AD), and psoriasis in a longitudinal cohort of roughly 2.16 million Korean children (2009 to 2020).The researchers found that children with obesity had a significantly higher risk for pediatric immune-mediated skin diseases than those with normal weight. A higher risk for AD was seen with an increase in body mass index, while a decrease in body mass index correlated with a reduced risk for AD. Transitioning from normal weight to overweight was associated with higher AD risk compared with maintaining a normal weight (adjusted hazard ratio, 1.15). However, those with a decrease in body mass index (overweight to normal weight) had lower AD risk (adjusted hazard ratio, 0.87) versus children who maintained overweight."Implementing purposeful interventions, including nutritional strategies, to decrease body weight may aid in reducing the risk of developing immune-mediated skin diseases in children," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(24)00257-4/fulltext">Abstract/Full Text</a>

Weight gain may increase atopic dermatitis risk, while weight loss may lower the risk

Childhood Obesity Tied to Pediatric Immune-Mediated Skin Diseases

TUESDAY, May 28, 2024 (HealthDay News) -- Parental electronic cigarette use is associated with increased odds of pediatric atopic dermatitis (AD), according to a research letter published online May 22 in JAMA Dermatology.Gun Min Youn, from the Stanford University School of Medicine in California, and colleagues conducted a retrospective cross-sectional analysis of the 2014 to 2018 National Health Interview Survey to examine the association between parental e-cigarette use and pediatric AD. Pediatric AD was ascertained by asking whether the child had eczema or any kind of skin allergy in the past 12 months.The researchers found that 13.1 percent of 48,637,111 weighted individuals (mean age, 8.4 years) indicated a history of AD. The prevalence of parental e-cigarette use was 14.4 and 18.0 percent in the non-AD and AD populations, respectively. Children with parental e-cigarette use had higher odds of AD after adjustment for asthma, allergic rhinitis, respiratory allergies, parental smoking history, and sociodemographic factors (adjusted odds ratio, 1.24). A similar trend was seen in a subgroup analysis of nonsmoking and smoking cohorts (adjusted odds ratios, 1.37 and 1.19, respectively), which persisted, regardless of parent sex."The data from this study can support only the conclusion that household e-cigarette use may be associated with past-year AD," the authors write.One author disclosed receiving consultation fees from Corvus Therapeutics.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2819260">Abstract/Full Text (subscription or payment may be required)</a>

Increased odds of atopic dermatitis seen for children with parental e-cigarette use, regardless of parent sex

Parental E-Cigarette Use Linked to Increase in Pediatric Atopic Dermatitis

TUESDAY, May 21, 2024 (HealthDay News) -- In pediatric patients, acrochordons may be a marker for metabolic disease, according to a study published online April 29 in Pediatric Dermatology.Rachel K. Greene, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a single-center retrospective cohort study of outpatient dermatology patients between Jan. 1, 2000, and Jan. 1, 2021, to examine the association between acrochordons, obesity, and metabolic syndrome. Children diagnosed with acrochordons were identified.The 55 patients younger than 18 years (mean age of diagnosis, 10.1 years) with acrochordon diagnosis were mainly Caucasian and female (76 and 64 percent, respectively). Mean body mass index was 27.3 kg/m2; 49.5 and 20 percent of participants were categorized as overweight and obese, respectively. The researchers found that acrochordon mainly appeared in the axilla. Three patients in the cohort (5.5 percent) met the criteria for metabolic syndrome. Compared with a sample from the National Health and Nutrition Examination Survey, the prevalence rates of obesity (42 versus 21 percent), type 2 diabetes mellitus (4.8 versus 0.6 percent), hyperlipidemia (8.1 versus 0 percent), and hypertension (1.6 versus 0 percent) were higher in the study cohort."While skin tags are largely benign and idiopathic, their presence may indicate underlying metabolic abnormalities in both adults and children, especially in the setting of obesity," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/pde.15639">Abstract/Full Text</a>

Prevalence of obesity, type 2 diabetes, hyperlipidemia, hypertension greater in children with acrochordons versus NHANES

Acrochordons May Be Marker for Metabolic Disease in Children

TUESDAY, April 30, 2024 (HealthDay News) -- Health care professionals should consider stigmatization and bullying in assessing the social and mental health of children and adolescents with chronic skin diseases, according to a study published online April 24 in JAMA Dermatology.Amy S. Paller, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. The analysis included 1,671 children.The researchers found that stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Only 27.0 percent of children with chronic acne, atopic dermatitis, alopecia areata, and vitiligo had T scores &lt;40 (minimal or no stigma) and 43.8 percent had at least moderate stigma (T score ≥45) versus children with a range of chronic diseases. There was a strong correlation between stigma scores and reduced QOL, depression, anxiety, and poor peer relationships. More than one-fourth of parents (29.4 percent) were aware of bullying of their child, which was strongly associated with stigma. More stigma was reported by girls than boys.&nbsp;"The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2817886">Abstract/Full Text (subscription or payment may be required)</a>

Stigma correlates with depression and differs based on level of severity and visibility

Stigma Affects Quality of Life in Children With Chronic Skin Conditions

WEDNESDAY, April 17, 2024 -- Once-weekly pulsed dye laser (PDL) treatment for port-wine birthmark (PWB) in infancy is associated with near-total or total clearance of PWB, with no reports of adverse events, according to a study published online April 17 in JAMA Dermatology.Shirin Bajaj, M.D., from the Laser &amp; Skin Surgery Center of New York in New York City, and colleagues describe the outcomes of once-weekly PDL treatments for PWB in infants in a case series involving 10 patients younger than 6 months with PWB who received once-weekly PDL between Jan. 1, 2022, and Dec. 31, 2023. Two months after the initiation of treatment, before-and-after treatment photographs were independently assessed and graded.The researchers found that after two months, seven of the patients had experienced near-total clearance (76 to 95 percent) or total clearance (96 to 100 percent) of their PWB with once-weekly PDL treatments. The remaining patients also experienced marked improvement (51 to 75 percent) and went on to achieve near-total clearance with additional treatments. To achieve near-total or total clearance in all patients, the median duration of treatment was two months and median number of treatments was eight. There were no adverse events reported."These outcomes are compelling and warrant attention and further investigation into the possibility that this novel and decreased treatment interval of one week, made possible by the absence of posttreatment-related purpura, is associated with potential improvement in outcomes and shorter overall treatment duration," the authors write.

Seven of 10 infants had near-total or total clearance after two months with once-weekly treatments

Once-Weekly Pulsed Dye Laser Beneficial for Port-Wine Birthmarks

TUESDAY, March 12, 2024 (HealthDay News) -- Pediatric atopic dermatitis (AD) is associated with greater odds of reported difficulties in learning and memory, but this association is driven by children with neurodevelopmental comorbidities, according to a study published online March 6 in JAMA Dermatology.Emily Z. Ma, from the University of Maryland School of Medicine in Baltimore, and colleagues examined the association between AD and symptoms of cognitive impairment (difficulty in learning or memory) among a weighted sample of 69.7 million U.S. children.The researchers found that compared with children without AD, children with AD were more likely to experience difficulties with learning (10.8 versus 5.9 percent) and difficulties with memory (11.1 versus 5.8 percent). When adjusting for sociodemographic factors, asthma, food allergies, and seasonal allergies or hay fever, AD was associated with increased odds of difficulties with learning (adjusted odds ratio [aOR], 1.77) and memory (aOR, 1.69). AD was associated with two to three times higher odds of memory difficulties among children with any neurodevelopmental disorder (aOR, 2.26), including attention-deficit/hyperactivity disorder (aOR, 2.90) or learning disabilities (aOR, 2.04). Among children without neurodevelopmental conditions, AD was not associated with learning or memory difficulties."These findings may improve the risk stratification of children with AD for cognitive impairments and suggest that evaluation for cognitive difficulties should be prioritized among children with AD and neurodevelopmental disorders," the authors write.One author disclosed ties to Pfizer, Sun Pharma, and Janssen.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2815633">Abstract/Full Text (subscription or payment may be required)</a>

However, finding limited to children with neurodevelopmental comorbidities, like ADHD or learning disabilities

Atopic Dermatitis in Children Tied to Learning, Memory Difficulties

FRIDAY, Jan. 19, 2024 (HealthDay News) -- Prenatal opioid exposure (POE) is associated with an increased risk for infection, eczema and dermatitis, and asthma in offspring, but it is not linked to allergies or anaphylaxis, according to a study published online Jan. 17 in JAMA Network Open.Erin Kelty, Ph.D., from the University of Western Australia in Crawley, and colleagues compared the risk for hospitalization and emergency department presentation for immune-related conditions in children with and without POE using linked administrative health records for all 401,462 children born between Jan. 1, 2003, and Dec. 31, 2018 (1,656 with POE).The researchers found that compared with nonexposed neonates, those with POE were more likely to be born preterm, have low birth weight for gestational age, and be coexposed to cigarette smoke. The risks for perinatal infection (adjusted odds ratio [aOR], 1.62) as well as eczema and dermatitis (aOR, 11.91) were increased in association with POE versus nonexposure. Both conditions were also increased in association with neonatal abstinence syndrome (aORs, 2.91 and 31.11, respectively). An increased risk for childhood asthma was also seen in association with POE (adjusted hazard ratio, 1.44) but allergies and anaphylaxis were not. For children with POE from opioids used to treat opioid use disorder but not pain, the risk for childhood eczema and dermatitis was increased. In contrast, POE from opioids used for pain but not to treat opioid use disorder was associated with increased infection risk."The findings suggest that POE may modify the developing immune system, changing how the immune system responds to subsequent conditions," the authors write.Two authors disclosed ties to Mundipharma; one author has a related patent pending.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814019">Abstract/Full Text</a>

Prenatal opioid exposure linked to increased risk for infection, eczema and dermatitis, and asthma in offspring

Study IDs Risks to Offspring Associated With Prenatal Opioid Exposure

WEDNESDAY, July 12, 2023 (HealthDay News) -- Confirmatory laboratory testing is only used in one in five cases of suspected tinea capitis (TC), according to a research letter published in the July issue of the Journal of the American Academy of Dermatology.Jeremy A.W. Gold, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues calculated TC incidence and described testing and treatment practices for 3.9 million commercially insured U.S. children identified from the Merative MarketScan Commercial Database (July 1, 2016, to Dec. 31, 2020).The researchers found that the one-year TC incidence was 16.3 per 10,000 person-years, with incidence highest among 5-year-olds (31.6 per 10,000 person-years), boys (20.9), and Southern residents (22.5). Pediatricians made the most diagnoses (54.6 percent), followed by dermatologists (11.7 percent) and family practitioners (10.4 percent). Clinicians infrequently used confirmatory testing (21.9 percent). When used, the most common tests were fungal culture (17.8 percent) and direct microscopy (9.7 percent). Testing was significantly more common for diagnoses by dermatologists (51.0 percent) versus pediatricians (16.4 percent) or family practitioners (11.0 percent). Three-quarters of patients were prescribed an antifungal (61.2 percent an oral antifungal and 14.7 percent a topical antifungal therapy)."Most patients diagnosed with TC received no confirmatory laboratory testing, which is concerning because visual inspection alone of suspected cutaneous fungal infections can lead to diagnostic errors and unnecessary antifungal use," the authors write.

Testing significantly less likely when diagnosis made by pediatrician, family practice clinicians

Confirmatory Testing Underused for Tinea Capitis Diagnosis

Pfizer Inc. plans to ask the U.S. Food and Drug Administration as soon as Tuesday to authorize its COVID-19 vaccine for emergency use in children aged 6 months to 4 years old.




 If approved, the two-shot regimen would become the first approved for use in children this young; older children are already eligible for the vaccine. In December, Pfizer suffered a setback when it
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 announced
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 that two doses of the vaccine, which are one-tenth the amount of an adult dose, did not produce a sufficient immune response in children aged 2 to 4 years. The company has already started testing a third dose in this age group.




 "At this time, we have not filed a submission and we're continuing to collect and analyze data from both two and three doses in our younger age cohort," Pfizer spokeswoman Jerica Pitts told
 
 The Washington Post
 
 on Monday. "As part of our ongoing commitment, we will share new updates as they become available."




 But federal regulators have been eager to review the Pfizer data in hopes of authorizing shots for young children as early as the end of February, multiple people familiar with the discussions told
 
 The Post
 
 . If Pfizer waits for data on three doses in these youngest Americans, the data would not be submitted until late March and the vaccine might not be authorized for that age group until weeks later, the newspaper said.




 "We know that two doses isn't enough, and we get that," one of the people familiar with the situation told
 
 The Post
 
 . "The idea is, let's go ahead and start the review of two doses. If the data holds up in the submission, you could start kids on their primary baseline months earlier than if you don't do anything until the third-dose data comes in."




 Last Friday, Pfizer briefed federal health officials on updated trial data on the shots, an administration official who spoke on the condition of anonymity, told the newspaper. The session included a "robust conversation" that three doses were likely to be much more powerful than just two shots, the administration official said. "But to get to three, you have to get two shots first," the official told
 
 The Post
 
 . Expert advisory panels to both the FDA and the U.S. Centers for Disease Control and Prevention are expected to meet on the two-dose application sometime in February.




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 Article
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If approved, the two-shot regimen would become the first approved for use in children this young

Pfizer Will Ask FDA to Approve Its COVID-19 Vaccine for Children Under 5 Years

Telemedicine has a beneficial effect on nonattendance among pediatric dermatology patients, according to a research letter published online Jan. 15 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Abigail Cline, M.D., Ph.D., from New York Medical College in Valhalla, and colleagues examined the impact of telemedicine on no-show rates in pediatric dermatology from three safety net clinics in New York City. A retrospective chart review was performed to examine all no-show and completed dermatology visits from Aug. 1, 2019, to Feb. 1, 2020 (all in-person visits) and Aug. 1, 2020, to Feb. 1, 2021 (in-person and virtual visits).




 The researchers found that during the first period (2019 to 2020) when all appointments were scheduled in person, the pediatric dermatology no-show rates were 47, 47, and 45 percent at the three sites. During the period from 2020 to 2021, the corresponding telemedicine no-show rates in pediatric dermatology were 26, 37, and 36 percent. Telemedicine was associated with a substantially reduced nonattendance rate in pediatric dermatology patients compared with the year earlier. However, the use of telemedicine had largely the converse effect in patients aged 65 years and older. During 2019 to 2020, the no-show rates in the elderly were 31, 29, and 35 percent compared with the telemedicine no-show rates of 31, 31, and 51 percent in 2020 to 2021.




 "Telehealth has the potential to expand access or further disenfranchisement; a considered approach is necessary to address the unique needs of disparate demographics," the authors write.




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Telemedicine linked to substantially reduced nonattendance rates in pediatric patients, but not in patients aged 65 years and older

Does Telemedicine Help to Cut Nonattendance for Dermatology Patients?

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Adelaide Hebert, MD, chief of pediatric dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston, to discuss the intricacies and challenges of pediatric clinical research.

This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers, and reflects their own views and opinionsIn this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Adelaide Hebert, MD, chief of pediatric dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston, to discuss the intricacies and challenges of pediatric clinical research.&nbsp;They begin by noting that past limitations left clinicians with few FDA-approved treatment options for younger patients, often relying on off-label therapies without robust pediatric data. However, legislative changes and incentives, such as patent extensions for drugs studied in pediatric populations, have encouraged pharmaceutical companies to invest in pediatric trials, enabling dermatologists to gain access to more targeted therapies for children.&nbsp;Despite this progress, enrolling young children in clinical trials remains challenging, partly due to concerns from parents about potential risks. Dr Hebert shares her approach to easing these concerns, often by conducting trials with adult and adolescent populations first so parents have a better understanding of a therapy's safety profile.&nbsp;Drs Hebert and Del Rosso then address the logistical aspects of pediatric trials, from initial phone screenings to addressing parents’ concerns about risk-benefit profiles, placebo arms, and the long-term safety of therapies. Dr Hebert underscores the need to accommodate the unique schedules and needs of young patients, such as adjusting appointments to fit around school hours.&nbsp;She also shares tips for administering injections to children, including using ice packs, straightforward explanations, and comforting strategies to make the experience as positive as possible.&nbsp;Throughout the conversation, Dr Hebert emphasizes the trust placed in dermatologists by parents and highlights the importance of respectful, compassionate communication, which ultimately strengthens the therapeutic alliance.&nbsp;Tune in to the full episode to learn more about pediatric clinical trials, hear insights on patient and parent communication, and get valuable guidance for dermatologists aiming to expand their expertise in pediatric patient care.

Derms and Conditions Podcast

Pediatric Dermatology Research: Doing the Right Things in the Right Way

In Episode 10 of&nbsp;Cutaneous Miscellaneous, our host Nicholas Brownstone, MD, speaks with Lisa Swanson, MD, a pediatric dermatologist practicing in Boise, Idaho.

In Episode 10 of&nbsp;Cutaneous Miscellaneous, our host Nicholas Brownstone, MD, speaks with Lisa Swanson, MD, a pediatric dermatologist practicing in Boise, Idaho.The episode begins with board review prep on pediatric dermatology. Dr. Swanson provides tips for learning pediatric dermatology for the board exam, including&nbsp;genodermatoses. She&nbsp;offers high-yield board review pearls on the differential diagnosis of a congenital, vascular-appearing nodule or plaque.&nbsp;Dr. Brownstone and Dr. Swanson then discuss how to become a better pediatric dermatologist in residency. Dr. Swanson advises on how to perform an efficient pediatric skin biopsy, tips on conducting a pediatric genital skin exam, counseling pearls, and how to handle the psychosocial aspects of skin disease in children.&nbsp;Learn how to improve your pediatric dermatology skills and how to increase your chances of matching into a Pediatric Dermatology Fellowship!

Cutaneous Miscellaneous Podcast

Pediatric Dermatology: How to Match into a Fellowship and Improve Your Skills

In Episode 20 of&nbsp;Derms and Conditions, host James Q. Del Rosso, DO speaks with Lisa Swanson, MD and has given her the moniker, "The Adele of Dermatology". Dr Swanson spends the episode discussing many high yield and practical tips when treating pediatric dermatology patients.

In Episode 20 of Derms and Conditions, host James Q. Del Rosso, DO speaks with Lisa Swanson, MD and has given her the moniker, "The Adele of Dermatology". Dr Swanson spends the episode discussing many high yield and practical tips when treating pediatric dermatology patients. She first discusses her favorite treatment for warts, including how to treat warts of both the hands and face. Next, Dr. Del Rosso asks Dr. Swanson how she counsels parents about changing&nbsp;nevi in their&nbsp;children.&nbsp; She continues with her tips on counseling parents on sunscreen use in children. She ends the episode with a discussion of the use of propranolol&nbsp;in the treatment&nbsp;of pediatric hemangiomas and emphasizes&nbsp;how clinically safe this treatment is. FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). LISA SWANSON, MD: SPEAKER &nbsp;• Almirall• Amgen• Janssen• Lilly• Novartis• Ortho Dermatologics• Pfizer• Sanofi RegeneronADVISORY BOARD ATTENDEE• Janssen• Lilly• Ortho Dermatologics• Sanofi Regeneron• Cassiopea

Pertinent Pediatric Pearls That Will Make Your Life Easier

Navigating Treatment Challenges in Pediatric Dermatology

Lawrence F. Eichenfield, MD, provided an engaging overview of how pediatric dermatology is rapidly evolving, with a focus on improving long-term outcomes through earlier diagnosis and more targeted therapies. In pediatric psoriasis, he emphasized the growing demand for effective oral options beyond traditional immunosuppressants. Promising phase 2 data were presented for icotrokinra, a novel oral IL-23 receptor–blocking peptide that achieved clear or almost clear skin in nearly 90% of adolescents by 24 weeks, with a favorable safety and tolerability profile. These results signal a potential shift toward convenient, noninjectable systemic options for children.Juvenile lichen sclerosus was highlighted as a frequently underrecognized condition with important lifelong implications. Dr Eichenfield underscored that lichen sclerosus rarely resolves at puberty, with most patients continuing to have active disease and structural changes into adolescence and adulthood. He stressed the importance of early recognition and sustained treatment with super–high-potency topical corticosteroids, even in asymptomatic patients, noting that consistent therapy significantly reduces long-term anatomic damage.The session concluded with advances in precision medicine and evolving disease definitions. In atopic dermatitis, the Identity Study was introduced as a novel approach using noninvasive gene expression profiling to predict which children are most likely to respond to JAK inhibitors versus Th2-targeted therapies, allowing for faster clearance and improved itch control. Dr Eichenfield also discussed the shift from Mycoplasma-induced rash and mucositis&nbsp;to reactive infectious mucocutaneous eruption, reflecting the broader range of infectious triggers now recognized. Management focuses on treating the underlying infection and controlling severe mucositis with systemic anti-inflammatory or immunomodulatory therapies, reinforcing the need for timely diagnosis and aggressive intervention in complex pediatric cases.

Pediatric Dermatology – Who Has Better Pearls?

Lawrence F. Eichenfield, MD, started the session, delivering a highly informative lecture centered on practical pediatric dermatology pearls that enhance both diagnostic accuracy and patient care. Dr Eichenfield began by sharing a simple but effective clinical tip: using an otoscope to differentiate pilomatricomas from epidermal inclusion cysts or dermatofibromas. The illumination helps highlight the calcium deposits characteristic of pilomatricomas, allowing for a more confident bedside diagnosis without the need for advanced imaging. He continued with guidance on managing localized eyebrow alopecia, recommending a tiered tapering approach using clobetasol for seven days, followed by consideration of topical minoxidil or ruxolitinib as adjunctive therapies. Dr Eichenfield also provided practical strategies for improving pediatric procedures, including employing “iPhone hypnosis” for distraction and using a “spreadsheet method” to ensure efficiency and consistency during clinical interventions. To address parental hesitation toward treatment, he introduced the “unpack the backpack” method: an empathetic communication approach encouraging providers to explore and understand parental concerns before offering reassurance and education. The session concluded with an evidence-based review of pediatric hemangioma management, supported by clinical imagery that underscored treatment effectiveness and expected outcomes. Elizabeth (Lisa) A. Swanson, MD, then shared her top pearls—equal parts humor, empathy, and practical wisdom. She began with management strategies for atopic dermatitis (AD), emphasizing the growing array of new topical nonsteroidals such as tapinarof 1% cream (approved for ages 2+), roflumilast 0.15% cream (6+), and ruxolitinib 1.5% cream (2+). Dr Swanson highlighted how these agents offer steroid-sparing options that resonate with parents increasingly wary of topical corticosteroids due to misinformation circulating on social media. She also championed the value of compounded formulations for challenging pediatric cases. Two standouts included the Aron Regimen, a gentle yet highly effective combination of betamethasone valerate, mupirocin, and vanicream for severe facial AD in infants and toddlers, and a salicylic acid + 5-fluorouracil compound for recalcitrant warts, applied under occlusion for rapid clearance. Transitioning to communication pearls, Dr Swanson discussed the power of language in pediatric encounters. She reminded clinicians that words matter, urging them to avoid alarming or judgmental phrases (“shot,” “mutation,” “herpes”) and instead foster trust through reassurance (“I can help you,” “You came to the right place,” “I’m on your team”). She underscored that framing matters as much as pharmacology in building lasting therapeutic relationships.

Child’s Play: Late Breakers in Pediatric Dermatology

In what many audience members called their favorite session of the day, Elizabeth Swanson, MD, reviewed the latest updates in treatments for common pediatric conditions. Starting with atopic dermatitis, Dr Swanson reviewed the indications for recently approved nonsteroidal topical therapies such as tapinarof 1% cream and roflumilast 0.15% cream. Dupilumab is approved for patients as young as 6 months of age with moderate-to-severe atopic dermatitis, and Dr Swanson discussed what to do with vaccines for these patients on dupilumab. Non-live vaccines are safe and have been shown to be effective in patients who receive them while taking dupilumab, and no dose modification is needed. The measles, mumps, and rubella vaccine and varicella vaccine are live vaccines commonly given at age 1-2 years and 4-5 years. Dr Swanson recommends waiting four weeks after dupilumab to give a live vaccine and restarting four weeks after the vaccine. &nbsp; Moving on to hidradenitis suppurativa (HS), Dr Swanson reviewed the HS treatment landscape. Adalimumab is the only biologic approved for adolescent patients aged 12 years and older with HS, and Dr Swanson advocated for more treatment options for younger patients as HS now appears to be starting at younger ages. For alopecia areata, ritlecitinib 50-mg daily is the only oral JAK inhibitor approved in the adolescent population. Dr Swanson presented multiple cases of treatment success with JAK inhibitors in pediatric and adolescent alopecia areata. Ruxolitinib 1.5% cream is approved for nonsegmental vitiligo in patients 12 years of age and older and can be applied on up to 10% body-surface area. Dr Swanson recommended combining this treatment with oral polypodium leucotomos. While the polypodium capsules can be large, Dr Swanson gave a tip on opening the capsule and mixing the powder in juice for pediatric patients. To conclude, Dr Swanson presented a case of pediatric generalized pustular psoriasis and reminded the audience that spesolimab, an IL-36 receptor inhibitor, is approved for GPP in patients 12 years of age and older. &nbsp;

What's New Pediatric Infections

Rounding out the first day, Elizabeth Swanson, MD, presented an engaging review of emerging trends and treatments in pediatric infections, offering updates across various dermatologic conditions. She began with herpes zoster, noting an increase in cases among children due to waning immunity from chickenpox vaccination and emphasized the importance of antiviral treatments like acyclovir and valacyclovir, along with precautions for unvaccinated individuals and pregnant women. Dr Swanson also highlighted the efficacy of intralesional HPV vaccines for recalcitrant warts, outperforming intramuscular approaches. For molluscum contagiosum, she discussed the recently FDA-approved cantharidin and other treatment options like topical retinoids and Candida antigen injections, introducing pseudofurunculoid molluscum as a marker of resolution and cautioning against drainage. She also reviewed Gianotti-Crosti syndrome, emphasizing its viral triggers, self-limiting nature, and the use of topical steroids for symptomatic relief.Dr Swanson continued with practical insights on distinguishing impetigo from HSV through bacterial cultures and PCR testing, addressing recurrent cases by identifying nasal carriers. She explored severe cases of hand, foot, and mouth disease, particularly eczema coxsackium caused by coxsackie A6, which requires targeted eczema management and supportive care. Updates on fungal infections included strategies for managing resistant strains like Trichophyton indotineae and pediatric-friendly treatments for onychomycosis. Concluding her session, Dr Swanson provided practical clinical pearls, offering actionable insights and highlighting the importance of evolving, patient-specific therapies in managing pediatric infections.

National Healthy Skin Month: Supporting Healthy Skin in Babies 

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, pediatric dermatologist Dr Lisa Swanson shares her expert insights on caring for the skin of dermatology’s youngest patients—babies. Highlighting the unique needs of infant skin, she offers guidance for parents on how to promote healthy skin from birth, including tips for potentially lowering the risk of atopic dermatitis (AD).&nbsp;Baby skin: unique needs and moisturization benefits&nbsp;Newborn skin has distinct qualities compared to other age groups. Notably, it experiences a higher rate of transepidermal water loss, leaving it vulnerable to dryness and potential skin barrier issues. This increased water loss is thought to be a factor in the later development of atopic dermatitis. "Some studies suggest that the amount of transepidermal water loss in early life may be key in determining which kids develop eczema down the road," Dr Swanson explains.&nbsp;To support skin barrier health, moisturizing a baby’s skin with sensitive skin products early on has been associated with potential benefits, including a reduced risk of AD. Although study results have been mixed—some showing improvement in eczema rates through early moisturization and others showing minimal effect—Dr Swanson notes that she sees no downside to regularly moisturizing baby skin.&nbsp;Encouraging moisturization for infants and toddlers&nbsp;When advising parents, Dr Swanson emphasizes the value of gentle, daily moisturization using high-quality, sensitive skin products. For families of newborns and expectant parents, she provides recommendations for gentle products and accessible, good-quality moisturizers. “I encourage families with a newborn baby to go ahead and moisturize,” she says, noting that applying gentle products poses no risk and could potentially reduce a child’s chances of developing AD.&nbsp;For parents with older children who already show signs of AD, Dr Swanson makes a point to highlight the importance of early skin care for any future children.&nbsp;Shifting skin care recommendations in nurseries and NICUs&nbsp;Many nurseries and NICUs still advise against using products on newborn skin. Dr Swanson hopes to shift these guidelines to encourage regular moisturization for babies as a preventive strategy. Some of the studies exploring moisturization for AD prevention included accessible products, such as Vaseline, and demonstrated a reduction in eczema risk when used consistently during infancy. Dr Swanson’s advice to parents is straightforward: “If we moisturize a baby and turns out it's not a miracle to preventing atopic dermatitis, we've still done no harm.”&nbsp;Key takeaways for dermatologists&nbsp;Dr Swanson encourages dermatologists to discuss the importance of moisturizing with expectant parents and families of newborns. As dermatologists, supporting early skin health practices can have a lasting impact on the patient’s skin health across their lifespan.Watch Part 2 here for tips on managing <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-managing-adolescent-and-young-adult-patients">adolescent and young adult patients</a>, Part 3 here for strategies to optimize skin health in <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/national-healthy-skin-month-expert-strategies-skin-health-middle-aged-adults">adults and middle-aged patients</a>, and Part 4 here for guidance on caring for the <a target="_blank" rel="noopener noreferrer" href="https://dermsquared.com/videos/topical-conversations/maximizing-skin-health-for-older-adults">older adult patient population</a>—all for National Healthy Skin Month!

Tips for Managing Hair Loss Disorders in Pediatric Patients 

Hair loss in pediatric patients can be particularly challenging, both for the child and their family. In this episode of Topical Conversations, pediatric dermatologist Lisa Swanson, MD, shares 3 practical tips to help dermatologists effectively diagnose and manage the most common forms of hair loss in children.<ol><li>Recognize tinea capitis as a leading cause of alopecia with scaling&nbsp;When faced with a child presenting alopecia and scalp scaling, dermatologists should assume tinea capitis (scalp ringworm) until proven otherwise. Tinea capitis is a fungal infection that requires prompt treatment to prevent worsening of symptoms and further hair loss. Dr Swanson emphasizes:&nbsp;<ol><li>Oral antifungals are essential: Topical treatments alone will not resolve the infection. First-line therapies include oral terbinafine or griseofulvin, both highly effective against the dermatophyte fungi that cause tinea capitis.&nbsp;</li></ol></li><li>Address loose anagen syndrome (LAS) in young children&nbsp;Loose anagen syndrome (LAS) is another common cause of hair loss in young children, particularly females aged 3 to 4 who have never needed a haircut, with hair that rarely grows past their shoulders. LAS is characterized by hair that easily pulls out of the scalp due to improper anchoring in the follicle during the anagen phase. Dr Swanson offers several key points for managing LAS:&nbsp;<ol><li>Reassure families: While concerning, LAS is typically a benign condition that often improves with age. Dr Swanson reassures parents that if their child is to experience hair loss, LAS is relatively mild, as it usually resolves spontaneously over time.&nbsp;</li><li>Psychological impact: Despite its benign nature, LAS can still be distressing for children, particularly young girls who may struggle with short or thinning hair. Dermatologists should address this emotional aspect by providing families with reassurance and information on the condition’s self-limiting nature.&nbsp;</li></ol></li><li>Take alopecia areata (AA) seriously in pediatric patients&nbsp;Alopecia areata in children is an autoimmune condition with significant psychosocial consequences. Dr Swanson urges dermatologists to approach treatment for pediatric AA with the same seriousness as they would for adult patients, emphasizing that early intervention can make a profound difference. Key treatment strategies include:&nbsp;<ol><li>Topical corticosteroids and minoxidil foam: For younger children, intralesional corticosteroids are often avoided. Instead, Dr Swanson recommends topical corticosteroids, often combined with over-the-counter minoxidil foam to stimulate hair growth.&nbsp;</li><li>Pulse prednisone therapy: In certain cases, Dr Swanson suggests considering pulse prednisone therapy, where a large dose of prednisone is administered for one weekend a month. This regimen can help manage inflammation and potentially slow the progression of AA.&nbsp;</li><li>Low-dose oral minoxidil: For more severe or unresponsive cases, low-dose oral minoxidil may be used alongside pulse prednisone therapy to promote hair regrowth.&nbsp;</li><li>Off-label JAK inhibitors: In cases of severe or extensive AA, Dr Swanson highlights the potential use of oral JAK inhibitors for pediatric patients, although currently, no JAK inhibitors are FDA-approved for children under 12. However, she notes that dermatologists can work with insurance to obtain off-label approval for this treatment, which may offer life-changing results for certain patients.&nbsp;</li></ol></li></ol>Hair loss disorders in pediatric patients require a careful, individualized approach. By promptly diagnosing conditions like tinea capitis and appropriately managing others, such as LAS and AA, dermatologists can significantly improve both the clinical outcomes and quality of life for their young patients.

What's New in Pediatric Dermatology

I'm so happy today to have the opportunity to share with you some of the new arenas within pediatric dermatology. First and foremost, there is a registry for ichthyosis in the United States, and the testing for the type of ichthyosis will be free. That's available at ichthyosisregistry at yale.edu. Be sure to look into that. In addition, we have a new means to work up epidermalysis pelosa. I'm going to share with you today a number of companies that can give you the genetic basis of the disease in front of you and help these patients recover more quickly. In addition, we know that we have a new medication for the recessive dystrophic form of epidermalysis velosa. It's called barameggine giopera. I may have spelled it, pronounced it incorrectly, but it is a topical that works to help repair the type seven collagen, which is of course, defect in recessive dystrophic epidermalysis pelosa. Keep in mind that if a baby has five or more hemangiomas and all of a sudden decides not to eat, that baby may have hepatic hemangiomas that are impairing the ability to want to eat. Also, hepatic mangiomas are associated with thyroid disease, so make sure patients who have concomitant skin and hepatic commangiomas are assessed accordingly. We have a brand new medication called appellacib for pick three ca vascular malformations which cause overgrowth, in addition to the vascular malformations, which have a unique geographic pattern on the skin. So it's very exciting to have a medicine that can actually reduce the size of the overgrowth and also help control the pain that the patients suffer with. For a form of neurofibromatosis, where the patients have nonresectable neurofibromas, particularly the plexiform type. We have also a new medicine called cellumethinib. This is a drug that really can help patients prevent progression of their neurofibromas. 96% of those in a clinical trial had a two year lack of progression in size of their plexiform neurofibroma. They can also have side effects which dermatologists must be aware of. These include acne and 54%. They can have a rash in 91%. So we need to be aware of this new medication and help these patients with these side effects. In patients with tuber sclerosis, we have a new medicine, topical serolimus gel. 0.2% which can effectively manage their angiofibromas. This is a huge advance in this arena of a very challenging genetic condition. We have two new medicines on the frontier from Alaskum VP 102 and verdasma gel 10.3%. While neither of these medications is currently available, we're hopeful as they go through the FDA, we'll be able to use these to help these patients with viral infections. Most importantly, I want to share with you a publication that appeared in the allergy literature that currently elimination diets are very passe, and indeed, elimination diets in patients with atopic dermatitis, we increase the risk of food allergies. This was published in the Journal of Allergy and Clinical Immunology Practice in 2022.

In this session, Adelaide A. Hebert, MD, shares some important pearls for evaluating rare pediatric disorders as well as new therapies for some of the most common ones. She begins by discussing helpful resources to confirm a diagnosis of icthyosis or epidermolysis bullosa (EB). Dr. Hebert then updates the audience on a new treatment for dystrophic EB, topical beremagene geperpavec, which was approved by the FDA in May 2022. Patients as young as 6 months old have been treated weekly without any safety concerns. Next, Dr. Hebert discusses the treatment of infantile hemangiomas, which, if left untreated, have the potential to cause complications such as severe consumptive hypothyroidism or breast hypoplasia depending on the location. She recommends treatment with propranolol between weeks 3 and 8 of life twice or three times daily after feeding with dosing of 0.5 mg/kg/day for week 1, 1.0 mg/kg/day for week 2, and 2.0 mg/kg/day for week 3.Next, Dr. Hebert reviews PIK3CA-related overgrowth spectrum disorders. Alpelisib has shown promise in the treatment of PIK3CA-mutated, hormone receptor-positive advanced breast cancer. Alpelisib can also be used to treat Klippel-Trenaunay syndrome. However, Dr. Hebert emphasizes that you must monitor for hyperglycemia, pneumonitis, and severe diarrhea. She then discusses the efficacy of selumetinib for neurofibromatosis. In the clinical trials, 40% of patients had a partial response and 71% of patients had clinically meaningful improvement. The side effects are all dermatologic, ranging from dermatitis acneiformis to maculopapular eruption and eczema. Dr. Hebert finishes the session by discussing new investigational treatment options for molluscum contagiosum. This includes berdazimer gel 10.3% and VP-102 which have shown promise in phase 3 trials.

Pediatric Dermatology Condition Center

Featured in Pediatric Dermatology

Navigating Treatment Challenges in Pediatric Dermatology

Latest Pediatric Dermatology Videos

Pediatric Dermatology – Who Has Better Pearls?

What's New Pediatric Infections

Featured CME on Pediatric Dermatology

Pediatric Dermatology Episodes to Explore

Pediatric Dermatology Research: Doing the Right Things in the Right Way

Pediatric Dermatology: How to Match into a Fellowship and Improve Your Skills

Pediatric Dermatology News & Research

Study Characterizes the Variable Clinical Presentations of Measles in Pediatric Patients

ACAAI: Eczema Onset, Severity Can Affect Child's Ability to Outgrow Food Allergy

ACAAI: COVID-19 Vaccination Reduces Risk for Multiple Infections in Children With Atopic Dermatitis