Childhood skin disease has unique challenges

I am pleased to introduce this issue of Dermatology Times, focusing on topics related to pediatric dermatology.  

I became aware of pediatric dermatology as a medical student. Way back then, I chose an elective in dermatology because I thought it would support my goal of becoming a well-rounded pediatrician. In 1984 the University of Missouri-Columbia Medical School offered only a two-month rotation, because our chief, Dr. Phil Anderson, accepted nothing less. Fortunately, that interval gave me the opportunity to fall in love with dermatology. And it gave Dr. Anderson a chance to recognize my interest. At the time, he advised me against pursuing a residency in pediatrics, because he knew it could negatively impact my chances of winning a residency in dermatology. But while I loved dermatology, I was also committed to caring for children. So, although the great majority of Dr. Anderson’s advice was sage, I chose to complete a residency in pediatrics.

At the end of two years, I recognized my interest in subspecialty, rather than general pediatrics. But there was no established route to becoming a pediatric dermatologist, so I had to bushwhack my own. Luckily, Dr. John Strauss gave me a chance to train in the department of dermatology at the University of Iowa. Among the faculty, Dr. Mary Stone served as my strongest pediatric guide and support to help fill a much needed niche for treating children with skin disease. In the two-plus decades since, I have been very busy learning, adapting and doing my best to meet the clinical demand.

The subspecialty has dramatically evolved since its inaugural meeting in 1972.¹ We earned ACGME recognition in 2000, and established board certification with the first examination held in October 2004. The body of knowledge is large and growing, in contrast to the workforce. Many dermatologists are rewarded by the privilege of seeing children, but only about 2 percent of us are board-certified in pediatric dermatology. The group may be small, but the collegiality is outsized.

First-time attendees to the annual meeting of the Society for Pediatric Dermatology often comment on the unique ambience. For most of the other participants, it is our favorite conference. Every year that I attend, I am humbled by the new insights, and the brilliance of my colleagues. We have long-recognized that children are not simply small adults. While they sometimes suffer similar diseases, the spectrum of pediatric illness and abnormality is often unique, as documented by an expanding foundation of abstracts, journal articles and textbooks.

Therapeutics is one of the most significant challenges in pediatric dermatology. Children have been identified as “therapeutic orphans,” with few options that have FDA-approved pediatric indications. Access to new and novel treatments like biologics is especially limited. Supportive legislation, beginning with the Best Pharmaceuticals for Children Act (bpca.nichd.nih.gov), has marked the dawn of a new era.

Recent FDA-approval of propranolol for infantile hemangioma (Hemangeol, Pierre Fabre) is a game-changing therapeutic advance.  

This issue of Dermatology Times includes information on many other important innovations in the field, including approach to wound care for epidermolysis bullosa, update on atopic dermatitis, new sources of pediatric allergic contact dermatitis, review of the recently published guidelines for acne in children, aesthetic trends for adolescents and how to weigh the risk-benefit ratio for anxious patients and their parents, the rising incidence of pediatric melanoma, and skin findings in kids with cancer. Enjoy.

1. Prindaville B, Antaya RJ, Siegfried EC. Pediatr Dermatol. 2014;31(6) [Epub ahead of print]