While general dermatologists have experience and training in a range of pediatric dermatological conditions, they may refer young patients to a pediatric dermatologist for evaluation and treatment of rare, genetic, or severe conditions or those unresponsive to current therapies.
A pediatric dermatologist specializes in evaluating and treating skin disorders in infants, children, and teenagers. Beyond their education in general dermatology, pediatric dermatologists typically complete a pediatric dermatology fellowship for further specialization.
What Skin Issues Do Pediatric Dermatologists Commonly Treat?
Common skin conditions that overlap between kids and adults can be seen by general dermatologists. However, a general dermatologist may refer you to a pediatric dermatologist for more specialized treatment when the patient has one of these or other conditions.
Although atopic dermatitis, or eczema, is one of the most common issues we see in general dermatology, we often refer kids with eczema to pediatric dermatologists because of how difficult it can be to treat.
The diagnosis of atopic dermatitis is very specific. The AAD’s criteria includes pruritus (a significant itch that reduces quality of life) as one of the key features. In these cases, kids scratch their arms, legs, head, or scalp incessantly, interrupting sleep and daily activities. This can cause loss of sleep for the child and his parents/caregivers.
If a child with severely dermatitic or itchy skin isn’t responding to common treatments, we may send them to a pediatric dermatologist for an opinion or management.
Genetic Skin Conditions
When a general dermatologist or pediatrician suspects a genetic condition (genodermatosis), they make a referral to a pediatric dermatologist and a geneticist for specialized evaluations and possible treatment.
Hemangiomas in early infancy are often referred to pediatric dermatologists if systemic treatment is needed. These red, non-cancerous growths appear on infants in their first weeks of life. Many shrink and disappear naturally over time, but some may grow large or cause rapid disfigurement or potentially inhibit proper vision or function if located in areas around the eyes or mouth. Some hemangiomas may even be associated with systemic disorders also involving the heart and central nervous system. Typically, observation is all that is needed.. If necessary, a pediatric dermatologist can treat these lesions with beta-blockers, topical or systemic blood pressure medications which have revolutionized the treatment of pediatric hemangiomas..
What Treatment Options Are Available For Pediatric Conditions?
Topical corticosteroids and emollients in combination are the main course of therapy for atopic dermatitis as they repair and protect the skin barrier often disrupted in this disorder. Because of the potential side effects that accompany these medications, many general practitioners under-treat eczema in young patients. Consequently, the disorder progresses, or intermittently flares up, resulting in sleeping difficulties and therefore potential trouble in school and social life.
While rarely needed due to our comfort and experience with this disorder, we may refer patients with atopic dermatitis to a pediatric dermatologist for a more aggressive treatment. After the initial inflammation subsides, the condition can be more easily managed with topical moisturizers, and intermittent topical steroids.
Genetic Skin Disorders
Genodermatoses is a broad term for any genetic disorder involving skin manifestations. Because each disorder is extremely unique, there is no one treatment option. Genodermatoses are typically diagnosed at birth but sometimes take years to manifest or get appropriately diagnosed. These patients are often referred to a specialist for genetic testing and counseling. After diagnosis, the doctor then works with the patient to manage the condition.
When treatment is needed for a hemangioma, we consider beta blockers (oral or topical). We often rely on pediatric dermatologists for proper dosage and initiation. Although any dermatologist would be able to prescribe this therapy, a pediatric dermatologist is better suited to monitor these patients long term.
What Should Parents Expect For Their Child’s First Visit?
Parents typically bring their child to dermatologists because of a specific concern such as warts, molluscum, non-specific rashes, acne, fungal infections, or atopic dermatitis.
For patients born with moles or other common skin lesions, parents may bring their child for a skin check — an important preventative measure for future conditions. While it’s extremely uncommon for a child to have a melanoma, early skin checks allow the dermatologist to document and monitor possible areas of concern or those that need monitoring.
Whether you’re bringing in your child for a general skin check or a specific concern, dermatologists do their best to make the child and parents feel at ease. We start with a general conversation about the child’s interests as we examine their skin. The family will remain in the room while the dermatologist checks the skin and verbally explains any areas of concern.
During the first visit, our goal is to build rapport — with you and your child. We know that children are perceptive to secrecy and tension. That’s not the environment we want to create. Instead, we aim to be honest, make them feel comfortable, and ask questions as necessary.
After this evaluation, we will recommend a patient-specific plan for future observation and/or treatments.
Typically, we’re able to diagnose conditions by clinical observation alone. However, If we need more information to make a diagnosis, we may ask to do a biopsy during this visit. Feel free to hold your child’s hand or otherwise help comfort them. We often bring in books or an iPad to put the child even further at ease.
If the condition doesn’t present an immediate threat to the patient, we choose an informed and empiric trial-and-error treatment. Based on clinical observation, we will recommend a medication and then ask to see the child for a follow-up. If it’s not working, we’ll change the treatment or do further evaluation at this follow-up visit.
Pediatric Dermatology FAQs
Is there a minimum age to visit the dermatologist?
No, a child can visit their dermatologist from infancy. We see common conditions such as “cradle cap” seborrheic dermatitis, miliaria, infantile acne, diaper rashes, and hemangiomas in newborns; warts, rashes, and infections in younger children; and eventually acne or chronic eczema in teenagers. General dermatologists treat and diagnose conditions of the skin no matter the patient’s age.
Is my child’s rash an allergy or eczema?
There’s a link between patients with seasonal allergies and eczema, but eczema does not always indicate an allergy. Just because your child is showing symptoms of eczema, it does not mean they also have an allergy to food, products, or outdoor conditions. Eczema research has shown a link between the skin’s immune system and barrier disruption. In rare cases, contact/irritant dermatitis (or a reaction to a product or environmental allergen) can be the cause or exacerbator of eczema, and for this reason, we may choose to do patch testing if empiric treatment does not work.
Some parents assume these rashes are symptoms of a food allergy and restrict certain foods. Food allergies are an uncommon cause of eczema. We first need to rule out other likely sources of the problem before eliminating foods. Unfortunately, atypical or non-traditional therapies may be recommended by online or non-medical resources, and although they may sound reasonable or even come from a positive experience, we recommend a discussion with a dermatologist prior to attempting food elimination or other treatments that may actually be counterproductive to the child’s development.
Does my child’s pediatrician need to know about medications prescribed by a dermatologist?
When we see children in dermatology, they have usually first visited their pediatrician for their condition. The pediatrician may then refer them to us for further evaluation and treatment.
In these cases, we consider the patient’s previous treatments as we form a patient-specific plan. If we want to prescribe a mediation of higher potential risk, we often consult directly with the pediatrician before doing so. As specialists, we owe our patients an individualized plan designed for their condition, associations, previous treatments, treatment goals, and health history.
How often does my child need to see a dermatologist?
While adults should visit the dermatologist annually, there is no set frequency necessary for pediatric patients. If a patient is completely healthy, we only see them every 2-3 years.
For patients with questionable moles, we may ask to see them every three months. If the mole doesn’t grow or change, we then decrease the frequency of visits.
If your child has a disorder or lesion of higher concern, we may see them every 1-3 months until the condition stabilizes or improves.
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