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, 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
 <a class="rm-stats-tracked" href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-ongoing-studies-covid-19" target="_blank">
 announced
 </a>
 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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 The Washington Post
 
 Article
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
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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.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(22)00064-0/fulltext" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a class="rm-stats-tracked" href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 </a>

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 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

Derms and Conditions Podcast

Pertinent Pediatric Pearls That Will Make Your Life Easier

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

What's New in Pediatric Dermatology

Pediatric Dermatology Episodes to Explore

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

Pertinent Pediatric Pearls That Will Make Your Life Easier

Pediatric Dermatology News & Research

Educational Courses You Might Like on Pediatric Dermatology

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