Insights on Pediatric Dermatology: Atopic Dermatitis and Needles

During her session, “Big Medicines in Little People: Systemic Therapies in Pediatric Dermatology,” presented at Dermatology Week 2022, Brittany Craiglow, MD, shared the evolving treatment options in pediatric dermatology and how physicians can navigate examination room conversations with families.

She opened by pointing out particular pediatric considerations, such as:

• Pharmacokinetics
• Formulation
• Safety (especially in the long-term)
• Effects on growth/development
• Ethical concerns

With these highlighted, Dr Craiglow emphasized that kids, like adults, deserved to be treated. “Skin disease has the potential to change a child’s trajectory,” she stated.

She continued by covering a range of dermatologic conditions commonly impacting pediatric patients, starting with atopic dermatitis (AD). She noted that “AD may affect 10% to 30% of pediatric patients and is commonly linked to other atopic comorbidities, including intense pruritus.”

She then went on to share her insights into the systemic therapies used to treat AD. She started with prednisone, which is “not appropriate unless the disease state showcases severe flare or if it’s to be a bridge for other systemic therapies,” she stated. Dr Craiglow further covered traditional systemic immunomodulators (cyclosporine, methotrexate, etc.) alongside JAK inhibitors, but she delved deeper into dupilumab by sharing the following:

• It held an Eczema Area and Severity Index (EASI) score of 75 (roughly 38 to 75 after 16 weeks).
• It has demonstrated itch improvement as early as 2 weeks.
• There is no black box warning.
• The most common adverse events include conjunctivitis and injection-site reactions.
• There is no laboratory monitoring required.

Next, Dr Craiglow addressed one of the touchiest topics in pediatric dermatology: needles. For this, she offered her colleagues some helpful tips, such as:

• Keep your tools hidden.
• Distract the patient.
• Get the parent more involved.
• Find and utilize a “comfort position.”
• Make sure to choose your words wisely.

On a final note, she empathized that physicians should be “telling [the patient], preparing them but using language that’s not going to make them more anxious.”

Reference
Craiglow B. Big medicines in little people: systemic therapies in pediatric dermatology. Presented at: Dermatology Week 2022; May 11–14, 2022; Virtual.