At the Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021, taking place live in Chicago, IL, Lisa Swanson, MD, touched on a little bit of everything in pediatric dermatology. Dr Swanson moved through atopic dermatitis (AD), psoriasis, infantile hemangiomas, and viral rashes and lesions in children.

Recent research has explored the association between AD and early life experiences and exposures. While the science is still not sure what factors are most important, there is some thought that it could be transepidermal water loss, the microbiome, or even antibiotic use, said Dr Swanson. She recommended that dermatologists who are treating young patients (aged 4-6 months) with severe eczema refer their patients to an allergist to talk about food introductions, given the recent research into food allergies potentially being caused by AD.

“I wound highly recommend giving out a ‘favorite things’ list,” said Dr Swanson. She uses it to give patients recommendations for appropriate skin care products made for sensitive skin. She also often uses a topical steroid burst (clobetasol 0.05% for 5 days, fluocinonide 0.05% for 10 days, and triamcinolone 0.1% until clear or follow-up) as alternative to oral steroids. Dr Swanson also shared that when it comes to dupliumab in her patients, she typically does not do a loading dose in children, finding it to be somewhat traumatic for patients, and does not adhere the dosing schedule strictly. However, most children prefer the temporary injections to the effects of their AD.

For psoriasis, Dr Swanson shared that the incidence is on the rise in pediatric patients. She highlighted the JAMA Dermatology screening guidelines, noting it is important to screen for and talk to patients and caregivers about obesity and weight management. Several biologics are approved for children with psoriasis, including etanercept (>4 years), ustekinumab (>6 years), ixekizumab (>6 years), and secukinumab (>6 years), with several others currently seeking pediatric indications. She shared that for patients who may be candidates for IL-17 inhibitors, she does ask screening questions for inflammatory bowel disease, growth issues, nocturnal diarrhea or bowel movements, and perianal issues, and will consider laboratory testing for anemia and fecal calprotectin.

Infantile hemangiomas can be severely distressing to parents due to their appearance, despite being relatively benign vascular neoplasms. These are easily treated by a 20 mg/5 mL suspension of propranolol, given as 2 mg/kg divided into twice-daily dosing. Parents should administer the propranolol with food to prevent hypoglycemia. Good candidates for propranolol treatment include large hemangiomas, ulcerating hemangiomas, hemangiomas in functional (eg, knees, hands) or sensitive (eg, eyelids, nose, genitals) areas, and dome-shaped hemangiomas.

Viral lesions can be one of the more difficult dermatologic conditions to treat, but Dr Swanson shared a few of her favorite techniques. For warts, she has great success with WartPeel, a salicylic acid and 5-fluronacil product. She also recommends patients get the HPV vaccine, based on case reports of warts going away after pre-teens and teens receive the vaccination. In addition, molluscum can be left alone, as many of the treatments are only marginally effective.

Dr Swanson shared some of her favorite fast pediatric dermatology tips, including:

• Big asymmetrical facial rash or scalp is fungal until proven otherwise.
• Diaper rash is mostly caused by irritant contact dermatitis (ICD) or yeast. If the patient is Itchy, then the diaper rash is likely ICD, whereas if the patient/caregiver reports their diaper rash is “ouchy,” then it is likely a yeast infection.
• Pustules on the hands or feet of babies is scabies until proven otherwise.
• Think about using topical timolol for pyogenic granulomas, but it’s important to follow up after 1 month these patients to ensure improvement.
• Eclipse nevi are very common on the scalp of mostly blonde children, and they’re benign and okay to leave alone.
• Spitz nevi can be observed instead of excised. A small, recent study showed that Spitz nevi tend to go away in children.
• Congential nevi come in four sizes, but generally the only size to be concerned about is giant congenital nevi, which has a higher risk of neurocut melanosis. The lowest risk spot for a congenital nevus is on the scalp.
• Extensive epidermal nevi are not dangerous themselves but should be biopsied at some point.
• The way a child grows up to feel about their birthmark is directly related to how the family feels, so reassure their caregivers.

Reference
Swanson L. Peds dermatology potpourri. Presented at: Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021; July 22-25, 2021; Chicago, IL.