PEDIATRIC DERMATOLOGY

Jun
2010
Vol. 29. No. 2

Introduction

Pediatric dermatology lends itself beautifully to application of both the science and the art of medicine. Pediatric patients often present a unique set of challenges apart from complex cutaneous diseases. This subset of patients demands both sophisticated knowledge of medical dermatology and skillful delivery of care to newborns accompanied by anxious parents, wiggly 2 year-olds, delightful but terrified toddlers, and occasionally ambivalent adolescents. The diversity of ages, diseases, and family dynamics faced by dermatologists caring for children requires both intellectual and emotional engagement in the pursuit of practical, safe, and effective diagnostic and management strategies. Evidence-based medicine, which aims to apply the best available evidence to medical decision making, is lacking for most pediatric skin disorders. When quality evidence is not available, expert consensus often serves as the gold standard of care. This group of articles represents that reality. Within the following pages, you will find a compelling combination of state-of-the-art, evidence-based reviews admixed with expert opinion from leaders in the field of pediatric dermatology. True to the mission of Seminars in Cutaneous Medicine and Surgery, this edition delivers the most current information on diagnosis and management as well as application of the latest scientific advances in the vibrant and rapidly evolving field of pediatric dermatology. It has been an honor and a privilege to assemble and collaborate with the group of passionate and knowledgeable authors whose intellectually rigorous work fills these pages. The pieces are presented in no particular order and include thorough discussions of challenging pediatric topics, such as the true role of food allergy in atopic dermatitis, state-of-the-art management of infantile hemangiomas, autoimmune blistering diseases, and hyperhidrosis. In addition, you will find in-depth reviews of large congenital melanocytic nevi, graft-versus-host disease, phototherapy in children, genetics for the dermatologist, and the difficult issue of compliance in pediatric patients. I invite you to enjoy the material presented herein. The ultimate beneficiaries of this work are our patients and their families.

Large Congenital Melanocytic Nevi: Associated Risks and Management Considerations

Alisa N. Femia, MD | Ashfaq A. Marghoob | Jeffrey M. Barr, MD | Jordan B. Slutsky, MD

Large congenital melanocytic nevi (LCMN) in neonates can cause considerable concern for
parents, family members, and physicians. A detailed understanding of the medical risks,
including cutaneous melanoma (CM), extracutaneous melanoma (ECM), and neurocutaneous
melanocytosis (NCM), as well as the psychological stress that these lesions can cause
in patients, will guide informed management decisions as well as provide comfort to
parents. Current data indicate that LCMN greater than 20 cm, and more likely greater than
40 to 60 cm, are the lesions at greatest risk for complications such as CM, ECM, and NCM.
Additionally, lesions on the trunk are at greater risk for developing CM, and LCMN in
association with numerous satellite nevi are at greatest risk for NCM. Individualized
management plans, including clinical observation, magnetic resonance imaging (MRI), and
possibly surgery should be based on the risk versus benefit ratio, taking into account the
size of the LCMN, its location, the number of satellite nevi, symptoms, and numerous other
factors which will be reviewed. This paper will provide a detailed analysis of the risks
associated with LCMN, as well as a discussion regarding management and treatment
options.
Semin Cutan Med Surg 29:79-84 © 2010 Published by Elsevier Inc.

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Phototherapy in Pediatric Patients: Choosing the Appropriate Treatment Option

John Koo, MD | Rupa Pugashetti, MD

Phototherapeutic modalities, including narrowband-UVB, broadband-UVB, PUVA photochemotherapy,
and excimer laser therapy are valuable tools that can be used for photoresponsive
dermatoses in children. As a systematically safer alternative compared with
internal agents, including the prebiologic and biological therapies, phototherapy should be
considered a possible treatment option for children with diseases including psoriasis,
atopic dermatitis, pityriasis lichenoides chronica, and vitiligo.
Semin Cutan Med Surg 29:115-120 © 2010 Published by Elsevier Inc.

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Understanding and Improving Treatment Adherence in Pediatric Patients

Huang-Tz Ou, MS | Rajesh Balkrishnan, PhD | Steven R. Feldman, MD, PhD

Many common skin diseases of children are easily diagnosed by dermatologists and have
straightforward treatments. Nevertheless, sometimes these conditions are frustratingly
difficult for both patients and physicians to control. Poor adherence to treatment may be the
underlying cause of poor outcomes in many situations. Studies of pediatric patients’ use of
medication show poor use across a broad array of medical illnesses. Studies of adherence
in children with acne and atopic dermatitis show similar findings. The reasons for poor
adherence likely vary across the pediatric age range, with fears of side effects being
pre-eminent in the care of infants and interpersonal interactions playing a greater role in
adolescents. By recognizing the major hurdles to adherence across the different ages,
dermatologists may be better able to tailor interventions to improve the outcomes of
children with skin disease.
Semin Cutan Med Surg 29:137-140 © 2010 Published by Elsevier Inc.

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Genetics for the Practicing Dermatologist

A. Paul Kelly, MD | Dawn H. Siegel, MD | Hensin Tsao, MD | Jamison D. Feramisco, MD, PhD

In the era of robust genome sequencing, a working understanding of genetics has become
important for the clinician. For the dermatologist, understanding the flow of genetic
information from genotype to phenotype can aid in the delivery of effective patient care. In
this article, we will review concepts in genetics and the human genome and how they
contribute to clinical dermatology.
Semin Cutan Med Surg 29:127-136 © 2010 Published by Elsevier Inc.

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