Dawn Eichenfield, MD, PhD, is a dermatologist at Rady Children's Hospital-San Diego and an assistant clinical professor of dermatology at UC San Diego School of Medicine.

Dawn Eichenfield, MD, PhD

, randomized controlled trial data simply do not exist. Clinicians must instead build treatment rationales from disease pathophysiology, case series, registry data, and expert consensus, while remaining transparent with families about the limits of available evidence.

 in Colorado Springs, Dawn Eichenfield, MD, PhD, of Rady Children's Health, presented the session, “Outside the Box: Treating the Uncommon Dermatosis.” In the Q&A below, Eichenfield outlines how she approaches off-label treatment decisions and informed consent when the evidence base is thin and how advances in targeted biologics and JAK inhibitors have reshaped thinking about inflammatory skin diseases even in the absence of formal pediatric indications.

She also addresses where the field has made progress, including expanded hormonal therapy options for adolescent acne, and where gaps remain, particularly in hormonally driven disease in younger patients and rare inflammatory and genetic skin disorders that still lack prospective data, validated outcome measures, and approved therapies. This is part 2 of a 2-part Q&A; 

part 1 covered differential diagnosis and recognizing atypical presentations

 When there are no approved therapies and no controlled trial data, how do you build a treatment rationale? What evidence sources do you lean on?

 This is a common challenge in pediatric dermatology. I build a treatment rationale using multiple layers of evidence: disease pathophysiology, adult literature, case series, registry data, expert consensus statements, and mechanistic understanding of available therapies. The rarity of many pediatric conditions means that randomized controlled trials are often unavailable. We frequently rely on thoughtful extrapolation while being transparent about the limitations of the evidence.

 How do you approach off-label use with your patients, particularly the informed consent conversation when the evidence base is thin?

 Transparency is critical. I explain what is known, what is unknown, why I think the treatment may be beneficial, and what alternatives exist. Families appreciate understanding the rationale behind a recommendation, especially when formal approvals are lacking. I discuss expected benefits, potential risks, monitoring requirements, and the uncertainty surrounding outcomes. Shared decision-making becomes particularly important in these situations.

 Has the emergence of targeted biologics and JAK inhibitors changed how you think about some of these conditions, even without formal indications?

 Absolutely. Advances in immunology have fundamentally changed how we conceptualize many inflammatory skin diseases. Even when a biologic or JAK inhibitor does not have a formal indication, understanding the relevant cytokine pathways can help guide treatment decisions and identify therapeutic targets. These medications have also demonstrated that diseases previously thought to be heterogeneous may actually share common inflammatory mechanisms.

 Are there one or two conditions in this category where you feel the field has made meaningful progress in the last few years, even without formal approvals?

 In acne, the growing evidence supporting hormonal therapies, including combined oral contraceptives and spironolactone in appropriately selected adolescent patients, has expanded our ability to individualize treatment and reduce reliance on prolonged antibiotic use.

 Conversely, are there conditions where you feel clinicians are most under-equipped—where you see the biggest gap between what patients need and what we currently have to offer?

 In acne, one important gap is the recognition and management of hormonally driven disease in younger adolescents. We still have limited pediatric-specific data regarding optimal hormonal treatment strategies, long-term outcomes, and predictors of response.

More broadly, rare inflammatory and genetic skin disorders continue to suffer from a lack of prospective studies, validated outcome measures, and approved therapies.

 How much does multidisciplinary collaboration factor into managing these patients—rheumatology, hematology, and pathology—and how do you structure those relationships in practice?

 Multidisciplinary collaboration is often essential. For example, for disease states such as Crohn’s disease presenting as vulvar edema or Langerhans cell histiocytosis mimicking diaper dermatosis, we need multidisciplinary care to deliver the best clinical care. For hormonally mediated acne, endocrinology and adolescent medicine can be invaluable, particularly when evaluating hyperandrogenism or menstrual abnormalities.

 Are there resources—networks, registries, or literature sources—you would point colleagues to when they encounter a case that stumps them?

 Pediatric dermatologists are fortunate to have a highly collaborative community. I encourage colleagues to leverage professional networks such as the Society for Pediatric Dermatology and Pediatric Dermatology Research Alliance, which provide opportunities for case discussion and collaboration.

Disease-specific registries, multidisciplinary specialty clinics, and consultation with experienced dermatopathologists are also invaluable. Finally, carefully reviewing recent case series and expert consensus statements can often provide practical guidance when high-level evidence is unavailable.

Eichenfield D. Outside the Box: Treating the Uncommon Dermatosis. Session presented at Maui Derm Summer 2026 in Colorado Springs on June 25.

Eichenfield D. Diagnosing Uncommon Dermatoses in Children: LCH, Psoriasis, and More. HCPLive. Published June 25, 2026. Accessed June 25, 2026. 

https://www.hcplive.com/view/diagnosing-uncommon-dermatoses-children-lch-psoriasis

Videos

Dawn Eichenfield, MD, discusses off-label treatment rationale, biologics, JAK inhibitors, and care gaps in rare pediatric skin conditions.

Treating Uncommon Dermatoses in Children: Off-Label Strategies, Biologics

When a pediatric patient has cycled through multiple providers without a diagnosis, the problem is rarely that the condition is extraordinarily rare.

More often, a common disease is presenting atypically, and accumulated diagnostic assumptions are standing in the way. That distinction shapes how Dawn Eichenfield, MD, PhD, of Rady Children's Health, approaches the most diagnostically challenging cases in her practice.

Eichenfield presented “Outside the Box: Treating the Uncommon Dermatosis” at 

in Colorado Springs on June 25. Her session addressed the clinical features that signal an atypical presentation, the role and limits of biopsy, and how to build a treatment rationale when controlled trial data are unavailable.

 most prone to misdiagnosis, including Langerhans cell histiocytosis (LCH), perianal streptococcal dermatitis, and hormonally driven acne. She also outlines the mindset shift she wants clinicians to leave with: when a disease does not behave as expected, reassess the diagnosis rather than escalate treatment under the same assumption.

 When a patient arrives at your clinic having already seen multiple providers without a diagnosis, what is your general approach to working through a differential for a rare or uncommon dermatosis?

 My first step is to revisit the history and physical examination with fresh eyes and challenge the assumptions that may have accumulated along the diagnostic journey. In pediatric dermatology, uncommon diseases are often not rare diseases—they are common diseases presenting atypically. In acne, I consider whether the presentation is consistent with typical adolescent acne or whether endocrine, medication-induced, genetic, or syndromic factors warrant investigation.

 Are there particular clinical features or patterns that prompt you to think "this is outside the usual" early in an encounter?

 Absolutely. In diaper dermatitis, red flags include ulceration, purpura, erosions, refractory disease despite appropriate barrier care, involvement outside the diaper area, systemic symptoms, failure to thrive, or unusual age of presentation. Findings such as sharply demarcated plaques, persistent perianal disease, or recurrent infections may suggest alternative diagnoses such as psoriasis, Langerhans cell histiocytosis, nutritional deficiency, inflammatory bowel disease, or immunodeficiency.

 How much does biopsy inform your diagnosis versus clinical presentation alone, and where does biopsy tend to fall short?

 Most pediatric dermatologic diagnoses remain fundamentally clinicopathologic correlations, with the clinical examination driving the diagnosis. Biopsy can be extremely helpful when considering rarer entities such as Langerhans cell histiocytosis. However, biopsies often provide pattern recognition rather than a definitive answer. The pathology report must always be interpreted within the broader clinical context.

 Are there uncommon dermatoses that are especially prone to mimicking more common conditions, and how do you avoid anchoring on the wrong diagnosis?

 Many are. Langerhans cell histiocytosis can resemble refractory diaper dermatitis. Psoriasis may be mistaken for candidiasis. Perianal streptococcal dermatitis can be misdiagnosed as irritant dermatitis. Zinc deficiency may mimic severe eczema or persistent diaper rash.

Similarly, endocrine-driven acne can initially resemble routine adolescent acne. Avoiding anchoring requires reassessing the diagnosis whenever the disease behaves differently than expected. Failure of an appropriate therapy should prompt reconsideration rather than escalation of treatment under the same diagnostic assumption.

 For a general dermatologist who may only see one or two of these cases per year, what is the most important shift in mindset or approach you want them to leave this session with?

 The most important lesson is to pay attention when a disease does not behave as expected. Most missed diagnoses occur not because a condition is extraordinarily rare, but because we continue treating a presumed diagnosis despite evidence that it may be incorrect. Reassessing the diagnosis, broadening the differential, and seeking additional expertise early can substantially improve outcomes.

Onsoi W, Chaiyarit J, Techasatian L. Common misdiagnoses and prevalence of dermatological disorders at a pediatric tertiary care center. 

Articles

Dawn Eichenfield, MD, PhD, discusses differential diagnosis, off-label treatment rationale, and multidisciplinary care for rare and atypical skin conditions in children.

Diagnosing Uncommon Dermatoses in Children: LCH, Psoriasis, and More

What’s Next in Dermatology? Dermatologists Weigh In On 2026

 are looking ahead to a year defined by expanding oral therapeutics, immunologic insights, next-generation biologics, and the increasing artificial intelligence (AI) integration into clinical settings. At the 

 team spoke on-site with several leaders in the field of skin health about new data and therapeutic advances they anticipate shaping the field in the year ahead.

Featured leaders included Linda Stein Gold, MD, director of dermatology clinical research at Henry Ford Health System; Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital and professor of dermatology and pediatrics at the University of California (UC), San Diego School of Medicine; Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego; Dawn Eichenfield, MD, PhD, associate professor of dermatology and pediatrics at UC San Diego School of Medicine and Rady Children’s Hospital-San Diego; Philip J. Mease, MD, director of rheumatology research at Providence Swedish Medical Center and clinical professor at the University of Washington (UW) School of Medicine; Paul Nghiem, MD, PhD, George F. Odland Endowed Chair in Dermatology at the UW School of Medicine; and Walter J. Liszewski, MD, dermatologist and clinical educator specializing in complex medical dermatology.

Stein Gold noted 2026 may mark “the year of the oral psoriasis therapy,” highlighting anticipation surrounding the potential approval of the oral interleukin (IL)-23 inhibitor icotrokinra and continued development of next-generation TYK2 inhibitors. She pointed to the expansion of oral options as potentially providing patients with efficacy comparable to biologics without compromising safety or tolerability, broadening flexibility in systemic psoriasis.

Lawrence Eichenfield focused on atopic dermatitis, noting several unanswered questions surrounding long-term immunologic modulation. He pointed to differences among biologics targeting IL-4/IL-13 pathways, IL-13 alone, IL-31, and upstream mediators such as OX40 and OX40 ligand. Although clinical endpoints such as Eczema Area and Severity Index (EASI) scores remain central, Eichenfield indicated understanding immunologic “rebooting” after prolonged therapy may shape treatment paradigms in the future, especially among pediatric and adult patients.

Bhatia pointed to excitement around a novel systemic acne therapy, denifanstat, a fatty acid synthase inhibitor targeting de novo lipogenesis to reduce sebum production. Unlike isotretinoin or antibiotics, Bhatia describes this mechanism as addressing a key driver of the pathogenesis of acne without retinoid-associated adverse effects, representing a potential paradigm shift in moderate-to-severe acne management. It is pending additional US-based research.

Dawn Eichenfield highlighted advances in the pediatric dermatology space, particularly highlighting genetic diagnostics and evolving biologic platforms. She suggested oral biologics and medications with extended dosing intervals could improve patient adherence as well as the quality of life of children and adolescents who prefer not to experience injections at an increased frequency.

In Mease’s segment of this interview, he described continued innovation across dermatology and rheumatology, noting small-molecule and biologic therapies aimed at IL-17A/F, IL-23, and TL1A pathways. Mease additionally referenced emerging long-acting biologic options potentially requiring administration only once or twice per year. This development of emerging options reflects efforts to refine molecular configurations for sustained treatment efficacy.

Nghiem spoke in his interview about AI’s growing role in dermatology, particularly in complex malignancies such as Merkel cell carcinoma. While he acknowledged potential overhype, Nghiem emphasized AI’s potential value in expanding patient access to multidisciplinary insights and surfacing considerations clinicians may not initially identify.

In his segment, Liszewski highlighted increasing awareness of chronic hand eczema (CHE) and renewed dermatology engagement in chronic spontaneous urticaria (CSU) management, especially with the emergence of newer agents such as remibrutinib and dupilumab. These drugs, Liszewski highlighted, are reshaping treatment algorithms.

Collectively, these leading experts at Maui Derm Hawaii 2026 signaled a year defined not only by new research and emerging treatment options, but by deeper immunologic understanding, improved personalization of medications, and expanded tools to enhance patient-centered care in the field of dermatology.

For more information on research covered at the 2026 Maui Derm conference, view the full video above or check out the 

Disclosures: Stein Gold has reported serving as an investigator, advisor, or speaker for Johnson & Johnson. Lawrence Eichenfield previously reported receiving personal fees from Pfizer; grant support from AbbVie, Arcutis Biotherapeutics, Castle Biosciences, Dermavant Sciences, Galderma, Pfizer, Regeneron, and Sanofi; consulting fees from multiple pharmaceutical companies; and serving on the board of directors of Forté Pharma. Bhatia has reported serving as an advisor, consultant, and investigator for AbbVie, Almirall, Arcutis Biotherapeutics, Beiersdorf, Biofrontera, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant Sciences, EPI Health, Ferndale, Galderma, Incyte, ISDIN, Johnson & Johnson, La Roche-Posay, LEO Pharma, Lilly, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi, Sun Pharma, and Verrica Pharmaceuticals. Dawn Eichenfield had no relevant disclosures of note for this interview. Mease has previously reported receiving research grants from AbbVie, Amgen, Bristol Myers Squibb, Janssen, Lilly, Novartis, Pfizer, Sun Pharma and UCB; and serving as a consultant and/or receiving speaker fees from AbbVie, Acelyrin, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Galápagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sun Pharma, UCB, Ventyx Biosciences, and XinThera. Liszewski has no disclosures of note.

Stein Gold L, Hawkes J. Best of the Best at Maui Derm. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Eichenfield L, Silverberg J, Chovatiya R. Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Rosen T, Bhatia N. New Drugs and Therapies in 2026. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Eichenfield D, Fallon Friedlander S, Treat J, et al. Pediatric Dermatology 2026. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Stein Gold L, Song E, Gordon K, et al. Psoriasis Update 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Liszewski W. Contact Dermatitis Update 2026. Presented at: Maui Derm Hawaii 2026; January 25-29, 2026; Maui, Hawaii.

Dermatology leaders preview 2026 breakthroughs including oral psoriasis drugs, new biologics, novel acne drugs, and AI tools transforming patient care.

, Dawn Eichenfield, MD, PhD, of Rady Children’s Hospital–San Diego and the University of California San Diego School of Medicine, spoke on-site with the 

 team regarding the rapidly shifting pediatric dermatology landscape, highlighting both therapeutic updates and various types of practical clinical considerations.

, Eichenfield emphasized the expanding set of potential systemic options now available for children, especially biologics for psoriasis.

 In this interview segment regarding additional sessions Eichenfield participated in, she pointed to the value of understanding a biologic’s mechanism of action, ongoing questions around disease modification in atopic dermatitis, and various practical pearls, including strategies to reduce injection-related anxiety and discomfort among children.

The following transcription summarizes Eichenfield’s on-site interview with 

 We would like to know more about some of the biggest takeaways from your Maui Derm workshop, the master class in pediatric dermatology.

Today, we did a workshop where we got to talk a lot more about taking care of kids. I actually talked about hair disorders, and based on looking at kids with telogen effluvium as well as alopecia areata. Actually, rarely, we sometimes get scarring disorders in pediatric dermatology as well. Then it was really nice, because we had a round table discussion with the other folks who were talking during the pediatric master class workshop. We got a chance to kind of see how other people approach really bad cases of androgenetic alopecia or alopecia areata, and how they dose their minoxidil. What do they do? First, topical minoxidil, then oral minoxidil. So it was a really, it was a really great, intriguing discussion that we had.

Would you go a bit more into depth on the dosing of minoxidil that you discussed there?

You look at the pediatric literature…there was actually a recent PD study where they looked at it, and it was an international study looking at androgenetic areata. It was really interesting because in that study, most people were on topical minoxidil. Nowadays, we're starting to use a lot more oral minoxidil. So I would say, if you looked at things like five, ten years ago, people were probably just doing topical minoxidil. But now, [we use oral minoxidil more], just because we feel like low-dose oral minoxidil is a lot safer and we have a lot more evidence for its use.

Also, we're definitely using it more in our pediatric and adolescent populations. So generally, for a girl, we probably would start with a quarter of a tablet. A tablet is like 2.5 milligrams. So a quarter is like 0.625. Then for males, we would start probably with 1.25, and of course, this is in kids who don't have other medical issues. No heart issues, no issues with their blood pressure, not on other concurrent medications that would interfere or have other side effects that are related to the minoxidil.

I think the big [takeaway] is really just the fact that we sometimes underdiagnose pediatric androgenetic alopecia, and sometimes we can misdiagnose some of our pediatric hair disorders. It's also very important to come to the correct diagnosis so that we can facilitate the correct management.

What are some of the key takeaways about HSV that you hope clinicians walk away with?

 I think the case that I presented is a very interesting case in that the clinical presentation is of an immunocompromised patient. It's always when you're looking at blisters, hemorrhagic blisters, hemorrhagic crusting, or ones that look punched out when you definitely want to consider HSV. Sometimes it could be something you're not even thinking of, and it can mimic some other diseases as well. So, that's definitely something to think about for the measles case. I think in our in this day and age, when some parents are not sure about vaccinations, and when it's kind of political and controversial, I think it's important for healthcare providers to know what measles looks like, and to really consider that in their differential where they're approaching pediatric patients with rashes.

Then, finally, we covered Leishmania. It's really interesting because I live in San Diego, and we definitely get a lot of patients who kind of come across the border. We've had a number of refugees who come through, who've actually had more kinds of tropical or exotic diseases. Leishmania is one of them, because they kind of came through the Darién Gap, while we were getting some refugees from that area.

Moving to a broader subject, what are you most excited or intrigued about in the field of dermatology in 2026 and beyond?

I think there's a lot that's in development, both in science and in clinical medicine, that we're going to be excited about for pediatric dermatology. Anything genetic-related is always exciting, because we always want to be able to better diagnose our patients before we start treatments. Then finally, as I had mentioned before, our patients don't like shots. So, some of the oral biologics coming out that will be very exciting to us, there are companies that are working on looking at biologics where you're going to be able to space out how often you get the shots. That, of course, will be very interesting to our patients, because no one likes shots. I think we have so much to look forward to this year and the coming years in dermatology.

The quotes used in this interview transcript were edited for clarity.

Eichenfield had no relevant disclosures of note for this discussion.

Eichenfield D, Frieden I, Treat J, et al. Fallon Friedlander S, Treat J, et al. Master Classes in Pediatric Dermatology. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Eichenfield D. Spotlighting Pediatric Dermatology Updates for 2026, With Dawn Eichenfield, MD, PhD. HCPLive. January 29, 2026. Accessed February 13, 2026. 

https://www.hcplive.com/view/spotlighting-pediatric-dermatology-updates-2026-dawn-eichenfield-md-phd

Eichenfield speaks in this interview about several key takeaways drawn from her master class in pediatric dermatology at Maui Derm Hawaii.