Clinical Pearls in Pediatric Dermatology Highlighted in 2025 Fall Clinical Conference

A session providing clinical pearls to clinicians in the pediatric dermatology care space, titled ‘Pediatric Dermatology – Who Has Better Pearls?’ was presented at the 2025 Fall Clinical Dermatology Conference by Lawrence F. Eichenfield, MD, and Lisa A. Swanson, MD.1

Eichenfield is known for his work as chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics at UC San Diego’s School of Medicine. Swanson is known for her role as a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology.

“Doing a cutthroat competition between two pediatric dermatology doctors is kind of like watching pandas fight,” Swanson joked.

Eichenfield highlighted his and Swanson’s aim, which was to provide procedural pearls on treating children with various dermatologic conditions. He began their session by discussing the treatment of various bumps and cysts identified on children in dermatology practices. He presented an image to the audience depicting what he described as ‘typical keratosis pilaris’ on a child, and a concerning bump highlighted by the child’s family

“So the question is what this is,” Eichenfield said. “Is it sebaceous cysts, pilomatricoma? One pearl is that an otoscope can help you make the diagnosis of a pilomatricoma, because this is a pilomatricoma, otherwise known as calcifying epitheliomas, and calcium does not transmit light. This is unlike a sebaceous cyst. So if you take an otoscope and put it to the skin, you’ll commonly see this bluish discoloration, and it doesn't illuminate through. Then you can make the diagnosis of pilomatricoma and reassure the family.”

The procedure can also be potentially planned differently, Eichenfield said, as pilomatricomas can be popped out of the skin. Next, Eichenfield discussed localized alopecia areata, highlighting a male patient with a quarter-sized alopecia spot on his scalp, but then developed rapid loss of a single eyebrow.

“We have these incredible new therapies,” Eichenfield said. We have oral ritlecitinib for patients who are twelve years of age or older. We have oral and topical minoxidil, but they’re not really relevant for localized alopecia…I treated him with topical clobetasol. A super potent topical corticosteroid, but not for a long period of time. Seven days, and then I did only a few days after that.”

Eichenfield also highlighted pediatric procedures, noting the difficulties commonly encountered in treating or examining certain younger children in pediatric dermatology practices. He pointed to using an iPhone to distract a child during such events as a simple yet helpful practice.

“I put forward ‘IPH’ as something you should adopt,” Eichenfield explained. “What is IPH? IPH is iPhone hypnosis. It’s really helpful in pediatric practice. Screentime might be an issue over a child’s lifetime of development, but it’s fine during a dermatology visit.”

Eichenfield also highlighted the use of a sheet wrap, or what he nicknamed a ‘burrito wrap’ for a young patient, as a way to immobilize a child’s joints for procedures. Eichenfield went on to discuss systemic treatment plans with caregivers of patients with atopic dermatitis.

“I ask, ‘When was the skin last totally clear?’” Eichenfield said. “...Of course I ask about sleep. I always ask about going to sleep and staying asleep. Two different aspects, allowing a little bit more conversation about that. I like to know the infection history because if you have an infectious history, you can explain that the consequences can be more serious. Sometimes family history is important. It's not just a document. Family history means they may have preconceived notions about therapy. They may have preconceived concerns about topical steroids.”

Swanson later discussed some of her biggest clinical pearls for pediatric practices, adding to the discussion of aversion to topical steroids. Swanson highlighted a variety of alternatives for patients’ requests.

“All of these are approved down to the age of two years now, which is really special,” Swanson said. “Tapinarof is great for hands and feet, and it doesn't get orally absorbed. So if a two-year-old puts their hands in their mouth, it's no big deal. I have found in clinical practice that tapinarof either works super, super awesome or not as well. There's kind of nothing in between. For roflumilast, we now have two strengths approved down to the age of two. It's a whole new phosphodiesterase-4 in a very special vehicle. People like the way it feels.”

Swanson highlighted roflumilast as a bit slower, though she also noted its consistency and its helpfulness to patients with atopic dermatitis. She added its use twice a week for maintenance.

“Fifty-seven percent of patients didn't have to go back to daily use for a year by using it twice a week,” Swanson explained. “Topical ruxolitinib is also approved down to two years of age. Super fast. Super effective. Great for patients with tactile sensitivity. It does have the boxed warning, but I tell people that this is in a family of medicines called the JAK inhibitor family. The family has the warning.”

Swanson added that she feels topical ruxolitinib is the one topical option that can take a patient who may be ready for dupilumab and keep them in the topical category.2 She added her view on topical ruxolitinib, potentially taking patients on dupilumab and putting such patients back into the topical realm.

“Pearl number two, compounds to the rescue,” Swanson said. “My two favorite compounds. The first is the Aron Regimen. This stuff is super dilute. It's an eight-ninths moisturizer, but it works like magic. At the pharmacy I use in Idaho called Portico, it costs forty-five dollars for a half-pound tub. They charge eight dollars to ship. So if your local compounding pharmacy wants to charge more than fifty-three dollars for it, get it from Portico. I have a vested interest in them. It can be applied up to five times a day for bad flares, and it can safely be used every night at bedtime for prevention and maintenance. And it's safe anywhere on the body.”

For any additional information on topics such as these, view the latest coverage of the Fall Clinical Dermatology Conference.

The quotes contained in this session summary were edited for clarity.

References

1. Swanson L, Eichenfield L. Pediatric Dermatology – Who Has Better Pearls? Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

2. Incytye. Incyte Announces Additional FDA Approval of Opzelura® (Ruxolitinib) Cream in Children Ages 2-11 with Atopic Dermatitis. September 18, 2025. Accessed November 19, 2025. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-additional-fda-approval-opzelurar-ruxolitinib.