Dr. Lisa Swanson Presents on Communication, Therapeutics, and Confidence in Treating Children at Noah
Key Takeaways
- Language and communication significantly impact pediatric patient experience and treatment adherence
- New topical and systemic therapies have expanded safe and effective options for pediatric atopic dermatitis
- Practical, experience-based strategies can help clinicians confidently manage complex pediatric cases
At the 67th Noah Worcester Dermatological Society Annual Meeting, Practical Dermatology Associate Medical Editor Lisa Swanson, MD, FAAD, delivered the Alfred L. Weiner Lecture titled “Afraid to Treat Kids? Here are some Pearls to Help!” The session focused on practical, clinic-ready strategies to improve care for pediatric patients, emphasizing communication, therapeutic updates, and clinician confidence. Drawing on real-world experience and case-based insights, Dr. Swanson emphasized that lessons from pediatric dermatology often extend to patients of all ages, noting that “a lot of the lessons that peds derm teaches us are applicable to patients of all ages.”
REFRAMING COMMUNICATION IN PEDIATRIC DERMATOLOGY
A central theme of the lecture was the importance of language in clinical encounters. Dr. Swanson noted that word choice can significantly influence patient and caregiver perception, particularly in pediatrics. She advised avoiding potentially distressing or stigmatizing terminology such as “shot,” “herpes,” or “mutation,” recommending more patient-friendly alternatives such as “s-h-o-t,” “cold sore virus,” and “variants.”
“The words we use in clinic matter,” she said.
Equally important is the use of affirming, partnership-driven language. Statements such as “I can help you,” “You came to the right place,” and “I’m on your team” reinforce trust and shared decision-making, she said. These approaches, she added, help build confidence even when treatment requires iteration.
“If we don’t hit a home run the first time, we’ll be up to bat again,” she suggested telling patients.
Dr. Swanson also highlighted the value of adopting terminology from integrative medicine, describing words such as “balancing,” “restoring,” and “enriching” as more comforting compared with conventional medical language such as “blocking” or “destroying.”
PRACTICAL UPDATES AND EMERGING THERAPIES IN ATOPIC DERMATITIS
Dr. Swanson provided an overview of evolving management strategies for atopic dermatitis (AD), emphasizing both new guidelines and therapeutic advances. She noted that updated pediatric-focused recommendations not only guide clinical care but also support insurance navigation.
One highlighted approach was the Aron Regimen, a compounded topical therapy consisting primarily of moisturizer with small amounts of topical corticosteroid and antibiotic. Describing it as “super dilute” yet “strangely effective,” Dr. Swanson emphasized its utility in infants and toddlers with severe facial dermatitis.
“Families tell me it works within 72 hours,” she said.
She stressed that compounded formulations appear to outperform do-it-yourself mixtures due to more uniform drug distribution.
NONSTEROIDAL TOPICALS EXPAND PEDIATRIC OPTIONS
The therapeutic landscape for AD has expanded with multiple nonsteroidal topical agents now approved down to age 2 years, and Dr. Swanson highlighted several options.
Tapinarof: A once-daily, steroid-free agent with particular utility for hand and foot dermatitis, especially in younger children due to minimal systemic absorption risk.
Roflumilast: A phosphodiesterase-4 inhibitor with improved tolerability compared with earlier agents, offering reduced burning and stinging.
Ruxolitinib: A topical JAK inhibitor notable for rapid antipruritic effects.
“We see itch improvement in the first 15 minutes,” Dr. Swanson said of ruxolitinib, describing its speed as “like a greyhound.”
She also emphasized practical considerations, including treatment of up to 20% body surface area and the importance of counseling families about class-wide boxed warnings, even when clinical risk with topical use is low.
SYSTEMIC THERAPY: DUPILUMAB AND EVOLVING PERSPECTIVES
Dupilumab remains a cornerstone for moderate-to-severe pediatric AD, now approved down to 6 months of age. Dr. Swanson reflected on its transformative impact.
“Do you guys remember how awful it was before we had dupilumab?” she said. “It was awful to manage moderate-to-severe atopic dermatitis.”
She contrasted prior systemic options with the current therapeutic landscape, noting that clinicians are no longer limited to less favorable treatments. Dupilumab, she said, “turns eczema into something families are having to think about once or twice a month rather than every single day.”
Regarding vaccinations, she acknowledged that current labeling advises avoiding live vaccines but noted emerging data suggesting this precaution may be overly conservative. She cited case series data demonstrating safe administration without interruption, saying, “In clinical practice, I do not worry about live vaccines.”
Treatment duration remains individualized. Dr. Swanson described a gradual tapering approach after disease control, spacing injections incrementally before discontinuation when possible.
ADDRESSING CLINICAL CHALLENGES AND BUILDING CONFIDENCE
Throughout the lecture, Dr. Swanson emphasized that pediatric dermatology requires adaptability and resilience. She framed common challenges, such as examining uncooperative children, as part of the clinical process rather than barriers.
“We have to endure these obstacles to benefit our patients,” she said, reinforcing a mindset that prioritizes persistence and creativity in care delivery.