Optimizing Rural Dermatology: Lisa Swanson, MD, FAAD, on Effective Care Strategies

At the 2025 Masters of Pediatric Dermatology, held in Miami Beach, Florida, Lisa Swanson, MD, FAAD, a dermatologist and pediatric dermatologist based in Boise, Idaho, delivered an insightful presentation at the Masters of Pediatric Dermatology session. Drawing from her extensive experience in a predominantly rural state, Swanson spoke with Dermatology Times about the unique challenges and strategies involved in treating dermatology patients from rural areas.

Swanson emphasized the critical importance of effective initial treatment for rural patients, noting, "When you're treating patients from rural environments, you only get one shot to do the right thing to help them with their skin disease because they've traveled from really far away to come to see you."

The logistical and financial burdens of long-distance travel make frequent follow-ups impractical, she noted.

In her presentation, Swanson discussed practical solutions for managing common dermatological conditions in rural settings:

• Warts: She highlighted the use of a prescription topical medication available through an Iowa pharmacy, allowing patients to self-administer treatment at home without the need for follow-up visits.
• Ringworm: Swanson pointed out the increasing complexity in diagnosing and treating ringworm due to resistant fungal species. She advised obtaining a fungal culture during the initial appointment to determine speciation and susceptibilities. This proactive step enables clinicians to adjust treatments over the phone if initial therapies are ineffective.
• Guttate Psoriasis: Recognizing the limitations of topical treatments and the impracticality of light therapy for distant patients, Swanson shared her approach of using ixekizumab (Taltz; Eli Lilly), a monthly injection administered for 3 to 4 treatments, to effectively clear guttate psoriasis.

Swanson advocated for the use of telehealth as a crucial tool in managing follow-up care for rural patients.

"Practicing in rural communities using telehealth can be a really important tool to help you enable follow-up appointments when otherwise the distance would be too great for the family to travel or it might incur too high of an economic cost," she said. The COVID-19 pandemic accelerated the adoption of telehealth, and many practitioners became adept at utilizing this technology.

However, Swanson noted a post-pandemic decline in insurance coverage for telehealth services, presenting a significant barrier. She urged health care providers to advocate for their patients by encouraging insurers to continue covering telemedicine, especially for those residing far from medical facilities.

By implementing effective initial treatments, utilizing telehealth for follow-ups, and advocating for supportive insurance policies, clinicians can significantly improve outcomes for patients in remote areas, she concluded.

Stay tuned for more coverage from Masters of Pediatric Dermatology, including session highlights and expert insights.