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AT-A-GLANCE

AT-A-GLANCE

  • The infant or child is the patient, but working with the parents/caregivers and home situation is crucial in diagnosis and management.

  • 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 communication and compliance.

  • Many outpatient procedures in pediatric dermatology can be done with appropriate planning and age-appropriate techniques. Patch testing or biopsies should not be avoided simply because of a pediatric patient’s age.

  • The infant has increased risk for systemic toxicity from topically applied substances. 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.

  • Autism spectrum disorders are now common. Dermatologists must be aware of special issues involved in caring for these patients.

Just as dermatology cannot be separated from internal medicine, pediatric dermatology is inseparable from general pediatrics. Most dermatologists have experience and training in internal medicine but less exposure to pediatrics, therefore an introduction to the special issues that can arise in pediatric dermatology is presented here. As it is impossible to discuss all of pediatric dermatology in a single chapter, the focus is instead on certain methods, diseases, and issues divided by age divisions: infants, children, and adolescents. This chapter discusses topics of special importance, such as pediatric medication use and biopsy pitfalls, and reviews methods to enhance success in outpatient procedures in pediatric dermatology.

Table 104-1 reviews 10 helpful tips in practicing pediatric dermatology. Successful care of the pediatric patient is best achieved via a partnership with the parents or caregivers, along with comanagement with the pediatrician or primary care physician. An awareness of the child’s living situation is always relevant. For example, children living in 2 households because the parents are separated or divorced often do best with 2 sets of medications, 1 in each home, to enhance compliance. In the age of internet access, patients and caregivers will likely search online for medical information before or after the office encounter. They should be reminded that medical information on the internet is often inaccurate.1 Instead, directing patients and families to specific internet websites, support groups, or pamphlets is valuable, but these resources should be reviewed before recommending them.

Table 104-1Ten Helpful Tips in Pediatric Dermatology

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