Pediatric dermatology

Anatomy or system affected: Skin

Definition: The medical specialty that deals with the diagnosis and treatment of diseases and disorders of the skin that occur in infants and children

Science and Profession

A pediatric dermatologist is a skin doctor who has specialized training in the diagnosis and treatment of childhood skin disorders. The full course of training requires a medical degree followed by specialized residency training, usually at a large teaching hospital. Skin problems account for nearly one-third of all children’s doctor visits. Most skin problems, however, are diagnosed in the primary care setting, by a pediatrician, family physician, physician assistant, or nurse practitioner. Primary care clinicians typically refer children with those conditions most difficult to diagnose or treat to the pediatric dermatologist. In addition, many general dermatologists also diagnose and treat children with skin problems.

The skin is the largest organ of the body and serves many functions. It is the body’s first line of defense against infection, harmful substances, and radiation. It regulates body temperature. It conserves body fluids and serves as a barrier to water. It helps in the production of vitamin D. The skin is also important in helping individuals sense the environment around them through special receptors for touch, heat, pain, and vibration. Any or all of these functions of the skin can be disrupted by the diseases and disorders that are diagnosed and treated by the pediatric dermatologist.

Children have some skin problems that are unique to childhood and share some skin problems with adults. For example, people of almost any age can have a condition called seborrheic dermatitis. Yet, each age group, from infancy through adolescence, has its own characteristic skin conditions or problems. For example, newborns may have salmon patches (commonly known as stork bites), infants may have diaper rash, and adolescents may have acne. Some childhood diseases, such as chickenpox, are found mostly in toddlers and school-age children. Likewise, some skin conditions, such as seborrheic keratoses, are found primarily in adults.

Changes in the skin may represent diseases and disorders of the skin itself, as in diaper dermatitis (diaper rash) or sunburn. Skin changes may also reflect a systemic disease or disorder, as in the rash associated with scarlet fever. Some skin lesions are markers for serious underlying conditions, either congenital or acquired. For example, a condition called neurofibromatosis may be signaled by the presence of multiple café-au-lait spots on the trunk. Thus, the pediatric dermatologist must be knowledgeable not only about the skin but also about all systemic diseases that produce skin changes.

Diagnostic and Treatment Techniques

Most diagnoses relating to the skin are based on the appearance of the lesion itself. Lesions may be flat or raised, wet or dry, scattered or clustered, tender or non-tender. They may have characteristic colors. They may be on the skin surface or extend beneath it. Typically, skin lesions are described according to their location on the body, their configuration, color, any changes that may have occurred as the result of secondary infection or scratching, and what the individual lesion itself looks like. In general, the pediatric dermatologist will inspect the skin of the entire body, even though only a small area may seem to be involved. In addition, the dermatologist will obtain a history related to the skin lesion: how long it has been there, whether it comes and goes, any changes that have taken place, what the patient or parents have used to treat the problem, allergies, and other symptoms such as pain or itching.

Usually, a thorough history and physical examination are sufficient to make the diagnosis of skin problems; however, the pediatric dermatologist may need to perform certain diagnostic or confirmatory tests. These tests may include a culture if a skin lesion is thought to be the result of an infection by a virus or bacterium. The dermatologist may gently scrape a lesion (particularly when a fungus is suspected) and examine the scrapings under a microscope. Certain dermatoses require the performance of a skin biopsy. In some cases, dermatologists punch out a small part of the skin lesion; in other cases, they cut out the entire lesion and a certain amount of surrounding tissue.

Treatments used by pediatric dermatologists may be topical, systemic, or surgical. Diaper dermatitis, for example, is usually treated with a topical cream or ointment aimed at killing the fungus that causes it. Impetigo, a bacterial infection of the skin, is usually treated with systemic antibiotics. Many kinds of skin lesions are treated with steroid creams, gels, or ointments. The dermatologist may surgically remove a mole with changes suspicious of skin cancer or use a laser to remove a birthmark.

Perspective and Prospects

In the United States, many pediatric dermatologists (or general dermatologists with an interest in children’s problems) belong to the Society for Pediatric Dermatology. The purpose of this group, formed in 1975, is to promote, develop, and advance education and research on skin conditions in children and to improve care. The group meets twice a year to present the latest advances in this field. The American Academy of Dermatology, while not specifically devoted to children’s dermatology, also educates physicians about childhood problems. Another organization devoted specifically to children’s skin problems is the International Society of Pediatric Dermatology.

Bibliography

American Medical Association. American Medical Association Family Medical Guide. 4th rev. ed., John Wiley & Sons, 2011.

Cohen, Bernard A. Pediatric Dermatology. 5th ed., Saunders/Elsevier, 2022.

Middlemiss, Prisca. What’s That Rash? How to Identify and Treat Childhood Rashes. Hamlyn, 2010.

Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. 3rd ed., Merck Research Laboratories, 2009.

Schachner, Lawrence A., and Ronald C. Hansen, eds. Pediatric Dermatology. 4th ed., Mosby/Elsevier, 2014.

Schmitt, Barton D. Your Child’s Health: The Parents’ One-Stop Reference Guide to Symptoms, Emergencies, Common Illnesses, Behavior Problems, Healthy Development. 2nd rev. ed., Bantam Books, 2013.

"Skin Conditions." MedlinePlus, 9 May 2023, medlineplus.gov/skinconditions.html. Accessed 25 July 2023.

Thompson, June. Spots, Birthmarks, and Rashes: The Complete Guide to Caring for Your Child’s Skin. Firefly Books, 2003.

Titman, Penny. Understanding Childhood Eczema. Wiley, 2003.

Weston, William L., et al. Color Textbook of Pediatric Dermatology. 4th ed., Mosby/Elsevier, 2007.

Woolf, Alan D., et al., eds. The Children’s Hospital Guide to Your Child’s Health and Development. Perseus, 2002.