Pediatric Dermatology
Preface Pediatric Dermatology for the Primary Care Provider
Kara N. Shah, MD, PhD Editor
It is my great pleasure to highlight selected topics in Pediatric Dermatology in this issue of Pediatric Clinics of North America. Dermatologic concerns, including rashes, birthmarks, and skin infections, are very common in children and adolescents and are a frequent reason for ambulatory visits to pediatric primary care providers. In addition, referrals to Dermatology are one of the most common subspecialty referrals made by pediatric primary care providers and were the third most common subspecialty referral, behind Ophthalmology and Orthopedics, in a review of referral practices from a large network of private pediatric practices affiliated with the Children’s Hospital of Boston.1 In the United States, access to pediatric dermatologists and general dermatologists with interest and expertise in pediatric dermatology is limited. In a recent survey conducted in collaboration with the AAP Committee on Pediatric Workforce, 81.6% of primary care pediatricians reported a lack of access to pediatric dermatologists, ranking behind only subspecialty care access to child/adolescent psychiatrists and developmental-behavioral pediatricians.2 Specific barriers to subspecialty care include long wait times for subspecialty appointments and significant distance from subspecialty care. However, a recent review of data from the National Ambulatory Medical Care Survey for the years 2002 to 2006 revealed that a significant proportion of care provided to children and adolescents by subspecialists, including dermatologists, was for routine follow-up or preventative care for common conditions, suggesting that at least a proportion of this care could be provided by the primary care provider.3 Although there are multiple factors contributing to the large demand for pediatric dermatology subspecialty care, one of these factors is the paucity of pediatric dermatology education provided during pediatric residency training, in particular, to pediatric residents intending to practice primary care. Unfortunately, despite the fact that dermatologic issues are common in pediatric practice, there are no ACGME Pediatr Clin N Am 61 (2014) xv–xvi http://dx.doi.org/10.1016/j.pcl.2014.01.002 pediatric.theclinics.com 0031-3955/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
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requirements for education in pediatric dermatology during pediatrics residency training and limited or no access to teaching faculty in pediatric dermatology in many residency programs, and therefore, most pediatrics residents receive little or no formal training in pediatric dermatology. Educational opportunities for pediatric residents and primary care providers that contribute to increased competence in pediatric dermatology are an important component of improving the quality and efficiency of dermatologic care provided to children and adolescents. The 13 articles that comprise this issue have been selected to capture a significant proportion of the most common skin diseases that are seen in children and adolescents. They are intended to provide practical information on diagnosis and initial management that can be performed by the primary care provider and to provide a framework for allowing for more active involvement by the primary care provider with regards to ongoing management of these conditions. From atopic dermatitis to vitiligo, the pediatric primary care provider is guaranteed to see these conditions in their practice. Of note, pediatric acne, despite being a very common skin disease in children and adolescents, was not included due to the recently published guidelines entitled, “Evidence-based Recommendations for the Diagnosis and Treatment of Pediatric Acne,” which are an excellent resource for the pediatric primary care provider.4 Pediatric dermatology is a diverse and exciting field. Although given the breadth and depth of skin disease seen in children and adolescents it can be somewhat intimidating, a working knowledge of the more common skin conditions is well within the scope of care that can be provided by the primary care provider, thus ensuring that all children and adolescents receive appropriate initial evaluation and management of these disorders. Kara N. Shah, MD, PhD Director, Division of Pediatric Dermatology Cincinnati Children’s Hospital 3333 Burnet Avenue MLC 3004 Cincinnati, OH 45229, USA Pediatrics and Dermatology University of Cincinnati College of Medicine Cincinnati, OH 45229, USA E-mail address: [email protected] REFERENCES
1. Vernacchio L, Muto JM, Young G, et al. Ambulatory subspecialty visits in a large pediatric primary care network. Health Serv Res 2012;47(4):1755–69. 2. Pletcher BA, Rimsza ME, Cull WL, et al. Primary care pediatricians’ satisfaction with subspecialty care, perceived supply, and barriers to care. J Pediatr 2010; 156(6):1011–5, 1015.e1. 3. Valderas JM, Starfield B, Forrest CB, et al. Routine care provided by specialists to children and adolescents in the United States (2002-2006). BMC Health Serv Res 2009;9:221. 4. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics 2013;131(Suppl 3): S163–86.
Preface Pediatric Dermatology for the Primary Care Provider
Kara N. Shah, MD, PhD Editor
It is my great pleasure to highlight selected topics in Pediatric Dermatology in this issue of Pediatric Clinics of North America. Dermatologic concerns, including rashes, birthmarks, and skin infections, are very common in children and adolescents and are a frequent reason for ambulatory visits to pediatric primary care providers. In addition, referrals to Dermatology are one of the most common subspecialty referrals made by pediatric primary care providers and were the third most common subspecialty referral, behind Ophthalmology and Orthopedics, in a review of referral practices from a large network of private pediatric practices affiliated with the Children’s Hospital of Boston.1 In the United States, access to pediatric dermatologists and general dermatologists with interest and expertise in pediatric dermatology is limited. In a recent survey conducted in collaboration with the AAP Committee on Pediatric Workforce, 81.6% of primary care pediatricians reported a lack of access to pediatric dermatologists, ranking behind only subspecialty care access to child/adolescent psychiatrists and developmental-behavioral pediatricians.2 Specific barriers to subspecialty care include long wait times for subspecialty appointments and significant distance from subspecialty care. However, a recent review of data from the National Ambulatory Medical Care Survey for the years 2002 to 2006 revealed that a significant proportion of care provided to children and adolescents by subspecialists, including dermatologists, was for routine follow-up or preventative care for common conditions, suggesting that at least a proportion of this care could be provided by the primary care provider.3 Although there are multiple factors contributing to the large demand for pediatric dermatology subspecialty care, one of these factors is the paucity of pediatric dermatology education provided during pediatric residency training, in particular, to pediatric residents intending to practice primary care. Unfortunately, despite the fact that dermatologic issues are common in pediatric practice, there are no ACGME Pediatr Clin N Am 61 (2014) xv–xvi http://dx.doi.org/10.1016/j.pcl.2014.01.002 pediatric.theclinics.com 0031-3955/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xvi
Preface
requirements for education in pediatric dermatology during pediatrics residency training and limited or no access to teaching faculty in pediatric dermatology in many residency programs, and therefore, most pediatrics residents receive little or no formal training in pediatric dermatology. Educational opportunities for pediatric residents and primary care providers that contribute to increased competence in pediatric dermatology are an important component of improving the quality and efficiency of dermatologic care provided to children and adolescents. The 13 articles that comprise this issue have been selected to capture a significant proportion of the most common skin diseases that are seen in children and adolescents. They are intended to provide practical information on diagnosis and initial management that can be performed by the primary care provider and to provide a framework for allowing for more active involvement by the primary care provider with regards to ongoing management of these conditions. From atopic dermatitis to vitiligo, the pediatric primary care provider is guaranteed to see these conditions in their practice. Of note, pediatric acne, despite being a very common skin disease in children and adolescents, was not included due to the recently published guidelines entitled, “Evidence-based Recommendations for the Diagnosis and Treatment of Pediatric Acne,” which are an excellent resource for the pediatric primary care provider.4 Pediatric dermatology is a diverse and exciting field. Although given the breadth and depth of skin disease seen in children and adolescents it can be somewhat intimidating, a working knowledge of the more common skin conditions is well within the scope of care that can be provided by the primary care provider, thus ensuring that all children and adolescents receive appropriate initial evaluation and management of these disorders. Kara N. Shah, MD, PhD Director, Division of Pediatric Dermatology Cincinnati Children’s Hospital 3333 Burnet Avenue MLC 3004 Cincinnati, OH 45229, USA Pediatrics and Dermatology University of Cincinnati College of Medicine Cincinnati, OH 45229, USA E-mail address: [email protected] REFERENCES
1. Vernacchio L, Muto JM, Young G, et al. Ambulatory subspecialty visits in a large pediatric primary care network. Health Serv Res 2012;47(4):1755–69. 2. Pletcher BA, Rimsza ME, Cull WL, et al. Primary care pediatricians’ satisfaction with subspecialty care, perceived supply, and barriers to care. J Pediatr 2010; 156(6):1011–5, 1015.e1. 3. Valderas JM, Starfield B, Forrest CB, et al. Routine care provided by specialists to children and adolescents in the United States (2002-2006). BMC Health Serv Res 2009;9:221. 4. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics 2013;131(Suppl 3): S163–86.
