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.