PracticalDermatology

Lisa Swanson, MD, FAAD, a pediatric dermatologist at Saint Luke’s Children’s Hospital and Summer 2024 SDPA Conference Medical Director, presented a whirlwind tour of common and uncommon pediatric dermatological conditions, as well as the current treatments for the conditions. A partial list of important highlights the topics covered are presented here.

Psoriasis

Dr. Swanson acknowledged the systemic nature of psoriasis and implored the attendees to treat children with bad psoriasis and offered up a number of pearls for dealing with the systemic disease. She pointed to trends in recent decades showing pediatric psoriasis increasing in prevalence, noting that the condition is often misdiagnosed. Dr. Swanson also pointed to research indicating that gradual changes over the decades (and even centuries) in gut microbiomes impacted immune regulation. Additionally, knock-on effects of climate change on the food supply were also shown to play a role. Recommended treatments included standard topical steroids as well as new topical treatments like tapinarof (Vtama) and roflumilast (Zoryve).

Perioral Dermatitis

Dr. Swanson said that this condition is very common in children and also commonly misdiagnosed. She noted that topical ruxolitinib, although used off-label, is very effective at treating and reducing perioral dermatitis. She also recommended additional treatment options like clindamycin (topical), metronidazole cream, sodium sulfacetamide products, topical dapsone, gentamicin 0.3% ophthalmic ointment, oral ivermectin and azithromycin. 

Alopecia Areata

When it comes to alopecia, Dr. Swanson said that there are generally three kinds: a “one-time deal” where it occurs once and not again, one that is recurrent, and one that progresses to alopecia totalis (in 2% of patients). For treatment, she recommended topicals, and even some “harmless things” such as vitamin D, daily Allegra, and other oral treatments.

Dr. Swanson also noted that while JAK inhibitors were an effective option, including baricitinib (2 mg or 4 mg daily), ritlecitinib (50 mg daily) and the often-in-combination minoxidil 2.5 mg pills. She also noted that JAK inhibitors as a class of drugs have well-known boxed warnings for side effects such as serious infections, mortality, malignancy, thrombosis, and major adverse cardiovascular events (MACE). Practitioners, she said, should become intimately familiar with those warnings and know when and in whom they would apply. should not be afraid to use JAK inhibitors on the whole because of the box warning.

Warts

Dr. Swanson focused part of her talk on what she saw as a very effective treatment for cutaneous wards in WartPeel. Active ingredients include salicylic acid plus 5-fluorouracil in a proprietary vehicle and retailing directly from Nucara Pharmacy in Iowa for $99. The before-after photos she presented as examples of treatment showed significant improvement in warts in several body locations. It can also be used on the face, but with some limitations.

Presented at: SDPA Annual Summer Conference. June 5-8, 2024. San Diego