Nika Finelt, MD, is a pediatric dermatologist at Northwell Health in New Hyde Park, NY. She is Assistant Professor, Hofstra Northwell School of Medicine.
What is the biggest challenge facing pediatric dermatologists today?
“Often times in pediatric dermatology, we are using medications off label as they have only been studied in adults. It can be challenging to get insurance to approve the use of these agents. There are so many different examples including the use calcineurin inhibitors to treat vitiligo. This scenario typically requires that patients have failed treatment with topical steroids, but for lesions on the face it is inappropriate to use steroids due to potential negative sequelae.
“Prior authorization is also an issue when we want to prescribe medications whose cost has recently sky rocketed such as oral erythromycin for periorificial dermatitis. It can also be a challenge when trying to obtain imaging tests to assess vascular malformations. This all requires jumping through hoops and takes a great deal of time. It is extremely frustrating for our patients, their families and us. As a result, some practices are outsourcing prior authorization or choosing pharmacies that can take care of the bureaucracy part.”
What therapeutic areas need more research and/or awareness?
“Alopecia can be heartbreaking. The treatment options that we have today are not great and they can be painful like injections or irritating to the scalp such as with contact therapy, but JAK inhibitors may be game changers. Two are already approved by the US FDA, XELJANZ® (tofacitinib citrate) for rheumatoid arthritis and Jakavi® (ruxolitinib) for bone marrow malignancies. Recent studies show that they may hold a great deal of promise for our alopecia patients. I am looking forward to seeing the research borne out.
“There is also so much work we need to do for children with genodermatoses. There is a lot of research going on but the therapeutic options that we have today are Band-Aids. I am hopeful that we will turn a corner soon.”
What research are you most excited about today?
“Atopic dermatitis (AD) for kids and adults has detrimental effects on quality of life and the therapies that we have are not ideal. A targeted, biologic therapy for AD could be revolutionary in terms of we approach this disease. I am excited about potential new therapies including Sanofi and Regeneron’s dupilumab.”
Is the skin cancer prevention message finally resonating with tweens and teens?
“Overall skin cancer awareness is much higher today, but I don’t know if behavior has really been altered yet. As adults and as parents, we have to model behaviors that we want to stick including proper use of sunscreen and sun-protective clothing. Tanning is still en vogue and parents are a part of this as they likely provide financial resources to tan. We need to take a lifelong approach to modeling positive behaviors for the whole family.” n
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