Topical Conversations

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). Baby skin: unique needs and moisturization benefits 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. 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. Encouraging moisturization for infants and toddlers 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. 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. Shifting skin care recommendations in nurseries and NICUs 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.” Key takeaways for dermatologists 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 adolescent and young adult patients, Part 3 here for strategies to optimize skin health in adults and middle-aged patients, and Part 4 here for guidance on caring for the older adult patient population—all for National Healthy Skin Month!

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.Recognize tinea capitis as a leading cause of alopecia with scaling 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: 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. Address loose anagen syndrome (LAS) in young children 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: 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. 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. Take alopecia areata (AA) seriously in pediatric patients 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: 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. 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. 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. 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. 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.