搜索结果：Pediatric dermatology

Many dermatologic diseases, including vitiligo and other pigmentary disorders, vascular malformations, acne, and disfiguring scars from surgery or trauma, can be distressing to pediatric patients and can cause psychological alterations such as depression, loss of self-esteem, deterioration of quality of life, emotional distress, and, in some cases, body dysmorphic disorder. Corrective camouflage can help cover cutaneous unaesthetic disorders using a variety of water-resistant and light to very opaque products that provide effective and natural coverage. These products also can serve as concealers during medical treatment or after surgical procedures before healing is complete. Between May 2001 and July 2003. corrective camouflage was used on 15 children and adolescents (age range, 7-16 years; mean age, 14 years). The majority of patients were girls. Six patients had acne vulgaris; 4 had vitiligo; 2 had Becker nevus; and 1 each had striae distensae, allergic contact dermatitis. and postsurgical scarring. Parents of all patients were satisfied with the cosmetic cover results. We consider corrective makeup to be a well-received and valid adjunctive therapy for use during traditional long-term treatment and as a therapeutic alternative in patients in whom conventional therapy is ineffective.

BACKGROUND/OBJECTIVES: Store-and-forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center. METHODS: In this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings. RESULTS: One hundred eighty pediatric patients with 188 unrelated skin conditions ("cases") were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out-of-pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017). CONCLUSION: Pediatric dermatology eConsults reduce wait times for specialist care, triage cases for in-office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients.

BACKGROUND/OBJECTIVES: Up to 30% of pediatric primary care visits include a cutaneous complaint, yet the pediatric dermatology workforce has historically been too small to provide adequate specialized care. This study assesses the geographic distribution of pediatric dermatologists to determine physician-to-patient ratios, analyzes urban-rural disparities, and determines post-fellowship migration patterns. METHODS: Board-certified pediatric dermatologists were identified using the Society for Pediatric Dermatology's public database, and their demographics and credentials were subsequently verified by an online search. Analysis included physician density per 100 000 children for each state and region, along with geographic distribution for rural and urban areas, based on the United States Census Bureau's definitions. The distances between practice locations and the American Board of Dermatology-approved Pediatric Dermatology fellowship training sites were reviewed. RESULTS: An estimated 336 board-certified pediatric dermatologists currently work in the United States with 76.8% being women and 71.1% practicing within 50 miles of the nearest fellowship program. 96.4% are located in urban areas and 3.6% in rural areas with an average ratio of 0.54 and 0.09 per 100 000 children, respectively. The average ratio of pediatric dermatologists in the United States was 0.46 per 100 000 children. On average (standard deviation), there are 6.6 (8.8) pediatric dermatologists per state but with 7 states having zero. CONCLUSIONS: The demand for pediatric dermatologists continues to outpace the current physician availability with a disparity between urban and rural areas. Further awareness and emphasis on training and recruitment of additional pediatric dermatologists are essential to addressing this important issue.

PURPOSE OF REVIEW: To identify factors that impact accessibility to pediatric dermatology and review healthcare delivery models that improve access and address these barriers. RECENT FINDINGS: Up to one-third of pediatric primary care visits include a skin-related problem, yet pediatric dermatology subspecialist services are highly inaccessible. Workforce shortages and geographic, sociocultural, and economic barriers perpetuate inaccessibility. Teledermatology expands care, particularly to underserved or geographically remote communities, and reduces healthcare-related costs. Federal legislation to support telehealth services with adequate reimbursement for providers with parity between live, video, and phone visits will dictate the continued feasibility of virtual visits. Innovative care delivery models, such as language-based clinics, multidisciplinary teleconferencing, or embedded dermatology services within primary care are other promising alternatives. SUMMARY: Despite efforts to expand access, dermatology still ranks among the most underserved pediatric subspecialties. Improving access requires a multipronged approach. Efforts to expand exposure and mentorship within pediatric dermatology, diversify the workforce and clinical curriculum, recruit and retain clinicians in geographically underserved areas, and collaborate with policymakers to ensure adequate reimbursement for teledermatology services are necessary.

BACKGROUND AND OBJECTIVES: Timely access to pediatric dermatology care remains a challenge. While awaiting appointments, many patients and families utilize so-called health care touchpoints outside of the dermatology clinic such as primary care or emergency department visits to address dermatologic concerns. Long waiting periods also factor into nonattendance rates at pediatric dermatology appointments. This observational retrospective study investigated wait times, relevant health care touchpoints, and factors related to nonattendance at a pediatric dermatology clinic. METHODS: We reviewed demographic, health care touchpoint, and nonattendance data for patients referred by a primary care affiliate to the Children's Hospital of Philadelphia (CHOP) pediatric dermatology clinic from February 2016 to May 2017. Descriptive statistics were used to identify trends among analyzed variables. RESULTS: We reviewed 250 patient records. The average number of touchpoints per patient was 0.56, and factors that significantly correlated with increased numbers of touchpoints included younger patient age and longer wait time while payer, primary diagnosis, and time of year were not associated. The nonattendance rate was 26%, and factors significantly associated with increased nonattendance rate included longer wait times and winter and spring appointments. CONCLUSION: Long wait times impact numbers of touchpoints and appointment attendance rate when referring to pediatric dermatology. A platform such as teledermatology may represent an opportunity to improve access to care by allowing for earlier input from the pediatric dermatologist.

Background Children up to 15 years of age constitute a major portion of our population and do suffer from a wide variety of skin diseases. Pediatric dermatology is a separate subspecialty by itself hitherto non-existing inPakistan. The current work focuses on the audit of pediatric dermatological cases presenting in the outpatient department of Dermatology and Pediatrics,HamdardUniversityHospital,Karachi, during the calendar year 2005. Objective The current audit emphasizes the importance of separate pediatric dermatology setups. Patients and methods All patients aged below 15 years, belonging to both sexes suffering from dermatological diseases were included in the study. After a detailed history and clinical examination, a clinical diagnosis was made in each case. The patients enrolled were investigated, as well. Results A total of 830 cases of pediatric dermatology, 539 males (65%) and 291 females (35%) were seen during the calendar year 2005, accounting for 27.2% of all dermatological patients. The age range was 0.1-15 years with a mean age of 8.1 years. Scabies (24.5%) was the most common dermatosis reported followed by atopic eczema (16.3%), fungal infections (15.9%), urticaria (12.3%) and bacterial infections (9.5%). Hair loss (alopecia), pityriasis alba, vitiligo and a few miscellaneous disorders had a comparatively low frequency.  Conclusion Scabies remains the most common pediatric dermatosis followed by fungal infections, atopic eczema, urticaria and bacterial infections.

Up to 30% percent of pediatric primary care visits include a skin-related problem, and referrals are hampered by appointment wait times among the longest of any pediatric subspecialty. Despite the clear demand for pediatric dermatologists, there has been a long-standing shortage of providers, leaving dermatology as one of the most underserved pediatric subspecialties. Another consequence of the workforce shortage is the limited opportunity for pediatric dermatology training for residents and postgraduate general pediatricians and dermatologists. This review includes the evolution of the subspecialty from conception through the present, along with obstacles to workforce expansion and potential solutions to improve access to care for children with skin diseases.

Studies have suggested there is a shortage of pediatric dermatologists in the United States, but the workforce has not been well defined. The Society for Pediatric Dermatology (SPD) Workforce Committee sought to characterize the US pediatric dermatology workforce with a nine-question survey, sent to all 484 US SPD members in December 2016. The response rate was 30%. Most pediatric dermatologists were practicing in major metropolitan markets, seeing an average of 80 patients a week with an average 6-week wait time. These findings indicate that geographic maldistribution and long wait times for new patient appointments remain substantial hurdles for adequate access to subspecialty pediatric dermatology care.

BACKGROUND/OBJECTIVES: We evaluated the acceptance of synchronous (live video) telehealth for pediatric dermatology. METHODS: This was a prospective, single-center study of patient and dermatologist surveys paired at the encounter level for telehealth encounters with Children's Hospital Colorado Pediatric Dermatology Clinic between 21 April 2020 and 22 May 2020. RESULTS: Dermatologists were most receptive to a telehealth encounter for isotretinoin monitoring (96.6%) and non-isotretinoin acne (89.5%). In contrast, 71.8% and 58.8% of patients surveyed were open to telehealth for isotretinoin encounters and non-isotretinoin acne encounters, respectively. There was no significant correlation between patient and dermatologist satisfaction regarding a telehealth encounter (r = 0.09, CI [-0.09, 0.26], p = .34) or between patient and dermatologist preference for telehealth encounter (r = 0.07, CI [-0.11, 0.25] p = .46). Dermatologists reported needing a photo to aid their physical examination in 38/363 (10.7%) of encounters and preferred in-person examinations when an encounter would have benefitted from laboratories, procedures, dermatoscopic examination, examination by palpation, and accurate weights in infants. CONCLUSIONS: Synchronous, live-video telehealth is an effective method of healthcare delivery in certain situations for pediatric dermatology, but it does not replace in-person encounters. Families and dermatologists have different perceptions about its acceptance.

Pediatric dermatology is a new topic and no epidemiologic data exist from Switzerland. Therefore we performed a survey of the pediatric population referred to the hospital of Aarau, Switzerland, between 1998 and 2001. All inpatients and outpatients less than 16 years old with a dermatologic diagnosis were included prospectively in our study. Demographic data (age, mean age, sex distribution), referral method, pattern and frequency of the different diagnoses in various age groups, diagnostic pattern, and therapy were analyzed. A total of 1105 children were included, with a slightly higher proportion of girls (53.8% versus 46.2%). The average age was 6.8 years and infants and school children represented 60% of the study population. Half of the patients (51%) were external referrals, almost one-third (29%) presented spontaneously, and the remaining 20% were sent from other hospital departments. With a frequency of 25.9%, atopic dermatitis was the most frequent diagnosis, followed by pigmented nevi (9.1%) and warts (5.0%). Local therapy was prescribed in 66% of patients and systemic therapy in 18.6%. Other treatments such as curettage, surgery, cryotherapy, ultraviolet therapy, and electrotherapy were rarely performed (2%). We found that atopic dermatitis was the most frequent skin disorder seen in all age groups. As this was a dermatologic subspecialty clinic, higher frequencies of chronic and uncommon dermatoses such as genetic and autoimmune diseases were seen, whereas frequent diagnoses such as diaper rash and miliaria were rarely seen and the frequencies of other common skin disorders such as scabies, pediculosis, impetigo contagiosa, warts, and molluscum contagiosum were expected to be higher compared with the figures in the literature. In our study these dermatoses are underreported, as most patients are treated by general practitioners and pediatricians. Our survey documents the most common skin diseases in childhood primarily seen by pediatricians. We emphasize that dermatologic education of medical students, primary care physicians, and pediatricians should focus on allergic skin diseases, skin infections, pigmentary disorders, and vascular lesions.

Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.

Clinical Pediatric Dermatology, by Amy S. Paller, MD and Anthony J. Mancini, MD, gives you easy access to the practical, definitive guidance you need to expertly identify and manage all types of skin disorders seen in children. Continuing the legacy of Dr. Sidney Hurwitz's beloved reference, it covers all pediatric dermatoses in a thorough, yet efficient and accessible way, enabling you to get the answers you need quickly and provide your patients with the most effective care. This edition brings you up to date on the latest classification schemes, the molecular basis for genetic skin disorders, atopic dermatitis, hemangiomas, viral disorders, bites and infestations, hypersensitivity disorders, collagen vascular disorders, bacterial and fungal infections, psoriasis, contact dermatitis, and much more. A thousand full-color photographs help you to recognize the characteristic manifestations of every type of skin disease. And, full-text access online allows you to rapidly search the book online and download all of its illustrations. Hurwitz remains the indispensable pediatric dermatology resource you need for optimal practice.

2nd ed, by Sidney Hurwitz, 744 pp, with 719 illus, $115, Philadelphia, Pa, WB Saunders Co, 1993. The pediatric community has been awaiting the arrival of the new edition of<i>Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence</i>. The first edition was published in 1981, and the 1993 version was clearly worth the wait. The new book discusses many of the more recently described skin diseases of children as well as novel therapies available to pediatricians and dermatologists. Much of the original format is preserved, with updated chapters on diseases such as cutaneous disorders of the newborn, genodermatoses, infections, and bullous disorders. In addition, the new version (which is a hefty 246 pages longer than the original) now includes chapters covering hypersensitivity syndromes, vasculitis disorders, collagen vascular disorders, endocrine disorders, and neurocutaneous disease. Discussions of some recently described conditions, such as acute hemorrhagic edema of infancy,

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n = 377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.

Background. Skin diseases among pediatric patients differ from those in adults. Epidemiological studies are scarce, and those performed in Mexican population date back thirty years. It is likely that these diseases might have changed their frequency. Material and Methods. Retrospective study in first-time patients referred to a pediatric dermatology service between January 1994 and December 2003. Demographics and diagnosis were recorded and compared with the results of a previous study performed in the same institution. Results. We included 5250 patients (52.55% female, 47.47% male) with 6029 diagnoses. The most frequent dermatoses found were atopic dermatitis (14.59%), viral warts (6.62%), acne (5.53%), pityriasis alba (3.98%), melanocytic nevi (3.85%), xerosis (3.57%), keratosis pilaris (3.19%), seborrheic dermatitis (2.37%), hemangioma (2.26%), and papular urticaria (2.24%). Most dermatoses increased their frequency when compared to the previous study. Conclusion. The frequency of pediatric dermatoses in our institution has changed in the last two decades. Environmental and sociocultural factors and institutional policies might account for these results.

Statistical analysis was performed of the diseases seen and therapies utilized during the first two years of the Pediatric Dermatology Clinic at the University of Miami School of Medicine, Miami, Florida. This survey includes 2,821 patient visits made by 1,578 patients. This analysis classifies patients by diagnosis, sex, age, race, and treatment. Diagnostic and treatment frequencies, sex and race ratios, and trends in the patient's age at presentation are also noted. This survey reveals a wide spectrum of pediatric dermatologic disease with 154 different diagnoses made. A review of the 86 different therapeutic modalities utilized is also presented.

Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia.

OBJECTIVE To investigate the frequency, epidemiology, clinical features, and prognostic significance of inflamed molluscum contagiosum (MC) lesions, molluscum dermatitis, reactive papular eruptions resembling Gianotti-Crosti syndrome, and atopic dermatitis in patients with MC. DESIGN Retrospective medical chart review. SETTING University-based pediatric dermatology practice. PATIENTS A total of 696 patients (mean age, 5.5 years) with molluscum. MAIN OUTCOME MEASURES Frequencies, characteristics, and associated features of inflammatory reactions to MC in patients with and without atopic dermatitis. RESULTS Molluscum dermatitis, inflamed MC lesions, and Gianotti-Crosti syndrome-like reactions (GCLRs) occurred in 270 (38.8%), 155 (22.3%), and 34 (4.9%) of the patients, respectively. A total of 259 patients (37.2%) had a history of atopic dermatitis. Individuals with atopic dermatitis had higher numbers of MC lesions (P &lt; .001) and an increased likelihood of molluscum dermatitis (50.6% vs 31.8%; P &lt; .001). In patients with molluscum dermatitis, numbers of MC lesions increased during the next 3 months in 23.4% of those treated with a topical corticosteroid and 33.3% of those not treated with a topical corticosteroid, compared with 16.8% of patients without dermatitis. Patients with inflamed MC lesions were less likely to have an increased number of MC lesions over the next 3 months than patients without inflamed MC lesions or dermatitis (5.2% vs 18.4%; P &lt; .03). The GCLRs were associated with inflamed MC lesion (P &lt; .001), favored the elbows and knees, tended to be pruritic, and often heralded resolution of MC. Two patients developed unilateral laterothoracic exanthem-like eruptions. CONCLUSIONS Inflammatory reactions to MC, including the previously underrecognized GCLR, are common. Treatment of molluscum dermatitis can reduce spread of MC via autoinoculation from scratching, whereas inflamed MC lesions and GCLRs reflect cell-mediated immune responses that may lead to viral clearance.

A postal questionnaire, completed by parents, was used to study the prevalence of respiratory symptoms in 250 children with atopic dermatitis who had attended pediatric dermatology clinics in London within the past 5 years. A response rate of 84% was achieved. Each child had a control matched for age and sex, whose parents filled in an identical questionnaire. The prevalence of wheezing was 76% in the atopic dermatitis group and 12% in the control group. Of the children with atopic dermatitis who wheezed, 87% had been given a diagnosis of asthma by a doctor, compared with 40% of the control children who wheezed. Overall, 68% of the children with atopic dermatitis had been given a diagnosis of asthma by a doctor. This prevalence of respiratory symptoms and of diagnosed asthma is substantially higher than has been shown in previous studies. As the test population consisted of children who had been referred to a tertiary center for management of their skin disease, this higher prevalence may partially reflect the increased severity of atopic dermatitis in the study group, as well as the heightened awareness of the association between these two diseases by their parents and physicians.