Neonatal, Pediatric, and Adolescent Dermatology at a Glance
- Many dermatologic diseases exhibit different manifestations in newborns, infants, and children.
- Some dermatoses are encountered only in neonates and infants and therefore require special attention.
- Obtaining a history and methods of clinical examination in infants and children differ from the approaches chosen for adults. In adolescents, different skills are required to enhance compliance.
- Many outpatient procedures in pediatric dermatology can be done easily with appropriate planning and age appropriate techniques. Necessary biopsies should not be avoided simply because of a patient's young age.
- The infant has increased risk for systemic toxicity from topically applied substances; the risk is even greater in premature infants. Children with disorders of barrier function are at high risk of excess percutaneous absorption and toxicity as well.
- Drug labeling for pediatric patients is different from that in adults and most therapeutic agents are prescribed off-label.
Just as dermatology cannot be separated from internal medicine, pediatric dermatology is inseparable from general pediatrics. Since most dermatologists have experience and training in internal medicine but less exposure to pediatrics and neonatology, an introduction to the special issues that can arise in pediatric dermatology is presented herein. As it is impossible to discuss all of pediatric dermatology in one chapter, the focus is instead on certain methods, diseases, and issues divided by three age divisions: neonates and infants, children, and adolescents. Topics of special importance such as pediatric medication use and biopsy pitfalls are discussed. Methods to enhance success in outpatient procedures in pediatric dermatology are also reviewed.
Successful care of the pediatric patient is best achieved via comanagement with the neonatalogist, pediatrician, or primary care physician. In addition, an understanding of the parental or family situation is important. For example, children living in two households (due to divorced parents) may do best with two sets of medications, one in each home, to enhance compliance. Table 107-1 reviews ten helpful tips in practicing pediatric dermatology. As an example, if Internet access exists, patients or parents will likely search online for medical information before or after the office encounter. Parents and patients should be warned that medical information on the Internet is often inaccurate.1 It is wise to direct them to specific Internet Web sites, support groups, or pamphlets, but these resources should be reviewed before recommending them.
Table 107-1 Ten Helpful Tips in Pediatric Dermatology |Favorite Table|Download (.pdf)
Table 107-1 Ten Helpful Tips in Pediatric Dermatology
The child is the patient, not the parents.
Biopsy when indicated, regardless of age. (Refer if necessary)
Be aware of the family situation: Does the child live in two homes? Are the parents going through a divorce?
Be aware of the parents’ perception of the child: Was there difficulty in conceiving? Prematurity? Significant early illness?
A team approach with the pediatrician, neonatologist, or family physician is most efficient. Psychiatrist comanagement may be ...