Advances aid treatment in pediatric dermatology

There have been a number of important advances in pediatric dermatology, ranging from finding the optimal use for tissue adhesives to gaining a better understanding of general and local anesthetic use in the pediatric population and a greater appreciation for dermatologic surgeons' roles in treating vascular lesions and birthmarks.

In a published study, Dr. Cunningham and colleagues reported that for high-tension excisional surgery in children, there were no cosmetic outcome advantages of skin glue over suturing.

Other advantages of the skin glue compared to suturing are that there are fewer woundcare postoperative requirements, and the wound can get wet.

Dr. Cunningham uses skin glue in the diaper region without the risk of infection that one might have with suturing. There also are antibacterial properties of skin glue, though it remains to be seen whether that will translate into less postoperative infection, she says.

Since their first study comparing the efficacy of skin glue to suturing, Dr. Cunningham and colleagues have designed a three-arm prospective trial comparing the use of Dermabond in children to suturing with regular nonabsorbable and absorbable sutures.

"In that study, we are looking at the cosmetic outcome and complication rate of skin glue versus stitches. But, specifically, we are using it in low tension lesions on the heads and necks of children," she says. "The manufacturer of Dermabond estimates that its strength is about the same as a 5.0 suture; so, we designed our trial looking specifically at wounds that would require a 5.0 or smaller suture, in an attempt to be more realistic and fair toward the Dermabond arm."

General anesthesia Gone are the days when dermatologic surgeons and nurses would hold down children as they endured sometimes painful dermatologic procedures, according to Dr. Cunningham. Today, more dermatologists are turning to their anesthesia colleagues for help.

Children who receive general anesthesia for dermatologic procedures given at children's hospitals fare well, according to Dr. Cunningham, who cites a retrospective study she authored with colleagues from UCSD and Northwestern University, looking at the complications of general anesthesia in pediatric dermatology.

She says the study, which has been accepted for publication in the Archives of Dermatology, is the largest multicenter retrospective review of the risks and complications of general anesthesia in pediatric dermatology. Capturing 881 procedures done on children under general anesthesia, Dr. Cunningham and colleagues reported that risks of postoperative nausea and vomiting were most often reported, at 4 percent to 5 percent. There were no serious complications of general anesthesia, including cardiac arrest or severe allergic reaction.