In her session, “What's New and Hot in Pediatric Dermatology,” presented at the 2022 Fall Clinical Dermatology Conference, Elizabeth Swanson, MD, shared her experiences and tips on treating pediatric patients within her clinic.

She started with atopic dermatitis (AD), noting how sleep is severely impacted by the disease. It also affects brain development because patients with AD have an increased risk of attention-deficit/hyperactivity disorder, anxiety/depression, and learning disabilities. She introduced the Aron Regimen, which is a compounded product that consists of 30 grams of betamethasone valerate 0.1, 24 grams of mupirocin cream, and 400 grams of vanicream or plastibase applied, at the start, 5 times a day for flares and then tapered with improvement. She also went over dupilumab by excitingly sharing that it has been approved for patients as young as age 6 months. She stressed that this treatment could turn eczema into something patients think about once a month rather than multiple times a day, every day.

To handle the administration of dupilumab shots for pediatric patients, Dr Swanson introduced HELP:

• Hug
• Electronic device
• Lollipop
• Prizes

She commented that, after creating a relaxed, calm environment, pediatric patients can be distracted by an electronic device. While distracted, they are then placed on the parent’s lap in a hugging position, facing the parent, which leaves their upper arm and posterior thigh exposed and easily to maneuver the shot. Before administering the shot, a lollipop is placed in the patient’s mouth and then immediately the shot is given. After, the patient is praised and then offered a prize from a prize box placed right in front of their face.

“The kids are going to cry. There’s no way around that, but they get over it very easily. So, by getting the prize box out there then they forget about the pain inflicted,” she stated.

Next, Dr Swanson touched upon pediatric psoriasis, remarking how it is often misdiagnosed every day despite its increase in prevalence. She reviewed which biologics are approved for pediatric patients with psoriasis, including:

• Etanercept - approved for patients as young as age 4
• Ustekinumab - approved down to age 6
• Ixekizumab - also approved down to age 6 and now citrate free
• Secukinumab - approved for patients as young as age 6

She also mentioned other biologics being looked at for pediatric psoriasis indications, such as apremilast, guselkumab, risankizumab, and tildrakizumab.

Finally, at the end of her presentation, Dr Swanson tearfully addressed the topic of prior authorizations, encouraging physicians to speak up against insurance companies because they are not the providers. She suggested actions that can be taken, such as sending letters and/or emails to medical directors’ insurance companies demanding change. She shared that she had taken a stand against Blue Cross of Idaho by pointing out the safety and liability concerns associated with their policy, which led to a successful change within their policy where they no longer require the failure of a systemic immunosuppressant before approving biologics.

She then concluded with the following quote, “You’re braver than you believe, and stronger than you seem, and smarter than you think,” said by Christopher Robin to Winnie the Pooh.

Reference
Swanson E. What's new and hot in pediatric dermatology. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.