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Multiple therapies available for treating dermatologic issues in children
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NEW ORLEANS — A knowledge of a wide array of therapies and understanding of patients’ behaviors are required when treating dermatology problems in children, according to a speaker here at the 2012 American Academy of Pediatrics National Conference and Exhibition.
Miriam Weinstein, MD, an associate professor of pediatrics and medicine at the Hospital for Sick Children in Toronto, offered several pearls on common pediatric dermatology treatments, including topical corticosteroids, antibiotics and topical calcineurin inhibitors.
She said when a pediatrician is considering topical corticosteroid therapy, it is important to first ask three questions: “Are corticosteroids the right treatment, are topical corticosteroids the right choice, and how do I make the correct choice?”
Regarding topical corticosteroids, she said inflammatory and pruritic conditions are typically steroid responsive. Infectious agents, such as molluscum contagiosum, herpes, impetigo and warts, are typically nonresponsive to corticosteroids, and in some conditions, such as tinea, corticosteroids may actually worsen the condition.
As far as whether topicals are the correct choice, Weinstein said many dermatoses can be treated topically, but there are some conditions that require systemic treatment.
She said there are many options, and it is important for pediatricians to keep in mind that these medications are divided into different categories and classes, with a rating of 1 (ultrapotent) to 7 (mild).
“It is important to know one or two options in each group,” Weinstein said. “You may get ‘handouts’ from pharmaceutical companies that compare steroids. It is important to remember these are often industry-sponsored and are designed to highlight their product. Therefore, they may not be comprehensive.”
Weinstein said corticosteroids can be delivered in several ways, including foams, sprays and impregnated adhesive tapes. Most dosing products can be applied one to three times a day. It is important to choose the appropriate cortisone strength for the patient, with the lesion, lesion placement on the body and, finally, patient acceptance often driving treatment choice. “The thicker lesions require greater penetration,” she said.
Weinstein offered a few pearls for treating different dermatology conditions often found in children. Regarding impetigo, she recommends that the condition be treated for 7 to 10 days. Topical antibiotics such as mupirocin are often used. For those patients with widespread infection, oral antibiotics are recommended, but the specific antibiotic depends on the severity of the infection and any known allergies or medical conditions.
For atopic dermatitis, Weinstein said the most important management is moisturizing twice daily “because these patients have a barrier defect,” adding that topical corticosteroids are the standard of care.
Regarding calcineurin inhibitors, Weinstein said tacrolimus and pimecrolimus have been shown to be safe in eczema management. Although there are black box warnings on these products, they have been “on the market for 11 years, and that has not proved to be a huge issue. But the warnings are something that is still of concern to people.”
Weinstein said clinicians must make sure in those patients who are failing treatment that they received the correct diagnosis.
“When therapy hasn’t been successful, I often ask myself if the patients have used it, if they used it in the right way, but I also question whether I got the diagnosis right,” she said.
For more information:
Weinstein M. Abstract S1104. Presented at: AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.
Disclosure: Weinstein report receiving honoraria from Astellas, Dermic, Galdema, Johnson & Johnson, Leo Pharma, Pediapharm and Sun Corp.