Skin Health For The Kiddos, What Parents Need To know

If you are a parent, you know that if your child isn't sleeping, neither are you. Don't Swear About your child's skin health. In this episode of Derm-It Trotter! Don't Swear About Skincare, Dr. Shannon C. Trotter talks with Dr. Lisa Swanson, a pediatric dermatologist, about things parents should know and look out for, such as Eczema or atopic dermatitis.

The good news is pharma is making great strides with drug treatments that are safe for young children. Learn how some common skin conditions manifest in children of all ages so you know when to ask an expert for help.

Dr. Swanson Denumks several myths: one she hears all too often is a parent saying oh its just diaper rash it will go away on its own. Her tip is "NO" do not explain skin irritations away, see a professional and get that child some relief as soon as possible. 

She also shares her list of favorite products to use with your children, from laundry detergent to moisturizing lotions to hand sanitizers.  This is a great episode for parents and guardians to learn how common skin irritations manifest themselves differently depending on the child's age. Plus, hear what questions you should be asking your dermatologist about your child's skin health.   

Transcript

Pediatric Dermatology

Speaker 1 0:00

Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

Speaker 2 0:18

Welcome to the Dermot Trotter Don't Swear About Skin Care podcast. Today we're gonna dive into the world of pediatric dermatology or kids and skin and I've got a great expert on here today Dermatrotter Don't Swear About Skin Care podcast. Today we're going to dive into the world of pediatric dermatology or kids and skin and I've got a great expert on here today Dr Lisa Swanson. She's a dermatologist and pediatric dermatologist. Believe it or not. Yes, we have dermatologists that specialize only in children. She practices at Ada West Dermatology in Boise, Idaho, and is affiliated with St Luke's Children's Hospital and Treasure Valley Medical Research. She loves pediatric dermatology and enjoys talking about it at conferences, meetings and podcasts, like on today. Basically, she'll talk to anyone that will just listen to her about Pete's Derm, so I want to welcome Dr Swanson to the podcast. It's great to have you here.

Speaker 3 1:00

Oh, thank you so much for having me, shannon, I'm thrilled to do it. Like, yeah, like you said, I'll talk to anybody who will listen about pediatric dermatology.

Speaker 2 1:09

Well, we have definitely got listeners out there and especially, I think, parents and you know, and even probably adults that struggled with atopic dermatitis when they were younger, will get confused about you know. It's just really what is atopic dermatitis? They may hear eczema thrown around too, the words used synonymously. So how would you really describe that?

Speaker 3 1:29

to kind of clarify that so I would say that in clinic I do use the terms atopic dermatitis and eczema synonymously. I often will call it eczema when talking with patients and their families, simply because that's the term that they've all heard. And in my note, in my medical documentation, I call it atopic dermatitis because that's what so many other medicines are approved for, and so there is a little bit of a discrepancy there. But I think of them in most contexts as synonymous when I'm discussing them. And atopic dermatitis or eczema is a skin rash that's very itchy, that a lot of people have from the very beginning of their life. Onset is possible at any point in time, but it's incredibly common to have eczema as a baby or a toddler, and then some people are lucky enough to outgrow it, but some people do not and continue to struggle with it as adults, or even 25% of adults with AD had adult onset of their atopic dermatitis, so that is possible as well. So a lot of different paths. Atopic dermatitis is very heterogeneous.

Speaker 2 2:35

You know for the heterogeneity of it. When you talk about it I always like to tell people you know it really just shows like how diverse it can present and similar to yourself, I think, that's where I kind of use both terms the same way. So I kind of tell parents, you know, you're not wrong to call it. You know eczema it's just atopic dermatitis is kind of you know the medical drug. When you'd be a bit more specific and, like you said, to get those medications covered and you talked about obviously being common, you see it in children all the time Can you describe a little bit like how it presents sort of you know from maybe an infancy stage, like as children get older, maybe in the teenage years and then, yeah, even into adulthood, just how that varies over time?

Speaker 3 3:11

Definitely Cause? It definitely does. You know, I can see 10 patients in a day with eczema and each one of them looks different and some of it is due to differences in presentation at different ages. And so a little teeny baby with eczema, they're going to be likely to have involvement of their face, likely to have involvement of their scalp and often relatively widespread body involvement. As they become toddlers the facial predominance tends to stick around. That's a very common pattern. And then sometimes they'll even get it on their elbows and knees, which is classically thought of as more of a distribution for psoriasis.

Speaker 3 3:45

But in a toddler with eczema we can see eczema in those locations. Then as the child gets a little bit older it settles into areas that are more commonly associated with eczema. So the antecubital fossa, kind of the crease at the elbow, the popliteal fossa, the crease behind the knee Often people will continue to have facial involvement, especially on the eyelids, and that's probably in the hands too, sometimes, as patients get older, a lot of hand involvement with their atopic dermatitis. But again, you know, it's such a different condition for the different people who suffer from it. It can manifest so uniquely.

Speaker 2 4:23

And do you ever see it? You know, in the diaper area. I feel like a lot of parents come in you know they'll see a rash in the diaper. They always assume, which often can be, you know, like a yeast or a fungus or that type of thing. But do you ever see in the diaper area to kind of let parents know this can happen too.

Speaker 3 4:37

So typically, eczema is not very common in the diaper area because it's moist and that kind of protects the skin.

Speaker 3 4:43

But kids with eczema are more likely to have irritant contact dermatitis in the diaper area, and so that's frequently what we're seeing there. Of course, you need to differentiate that from a yeast diaper rash, and so you can, you know, ponder that, and there are different kind of clinical features that help you differentiate the two. Commonly, though, I tell families there are two most common causes of diaper rash irritant contact and yeast. In this situation, I think it's, you know whichever one, I think, irritant contact, and we're gonna treat it as that. But if this is not getting better pretty rapidly, please let me know, because maybe we need to reevaluate and switch gears, because anything you're using to treat irritant contact in the diaper area or yeast in the diaper area, they're all under occlusion, and so typically efficacy should be swift if you've got the right diagnosis and the right treatment plan. So I always give them the caveat of if this isn't getting better and better pretty quick, you reach out to me because let's read this, yeah.

Speaker 2 5:48

Good points. Good points Because I know that's always confusing for people when something pops up in that area as well, and I think to you know, once you talk with parents, you diagnose them eczema atopic dermatitis. One of the most common questions I always get immediately is okay, you know, I know this can ride along with maybe what we call atopy, and I'll kind of have you explain that a little bit. But do I need to send my kid for allergy testing? I feel like that's the automatic response every time. So I wanted to get an idea of how you really explain or handle that for your patients.

Speaker 3 6:14

Okay, Such a complicated issue and complicated question and something I deal with every single day, but still always kind of take a deep breath right before I kind of dive into it. So we know that patients with eczema are at increased risk to have other atopic diagnoses things like asthma, nasal allergies, food allergies, nasal polyps, eoe. So if you have eczema you're more prone to those things somewhere along the road. But it's most commonly eczema. That's the first symptom that the kids get and there's a common tendency to try to blame the eczema on a food allergy. And it's a complicated issue because we know that kids with eczema have increased risk of food allergies. But it's actually pretty rare that a food allergy is driving the eczema. Something like 98 percent of the time that's not the case and there are exceptions. You know, if a flare-up occurs within 30 minutes of eating said food, that's suspicious. If a baby has widespread eczema and also bloody diarrhea, that's suspicious for a dairy protein allergy. So you know there are exceptions but the overwhelming majority of kids it's not a food driving the eczema, even if they do indeed have an underlying food allergy.

Speaker 3 7:30

And we really try to avoid widespread food elimination diets for several reasons. Number one kids need their nutrition. Number two it's rarely helpful. And number three, we know that avoidance is actually linked to an increased risk of food allergy. The other thing that we're learning is that while for so many years people have tried to blame the eczema on food, it actually appears it's the other way around.

Speaker 3 7:58

A growing body of evidence points to the fact that the eczema is actually what's leading to the food allergy that aerosolized food particles enter through the skin's broken barrier, interact with the immunologic system and generate an abnormal immunologic response which becomes allergy. And so really the best thing you can do to try to prevent food allergies for your kiddos is treat your child's atopic dermatitis, because that's going to help mitigate the risk for that. So it's a very complicated thing with all of these atopic diagnoses and I completely understand the desire and the hope that we could kind of blame the eczema on one thing. That could just be eliminated and everything would be fine. And commonly in clinic I tell parents I wish it was a food Like do you know how much easier my life would be if all I needed to do was tell families just avoid egg and your child will be totally fine? I wish that were the case, but it's rarely. It's rarely the case, yeah.

Speaker 2 9:04

Yeah, we'd be totally out of a job if that were the issue.

Speaker 3 9:07

So right, right, yeah, yeah.

Speaker 2 9:10

I feel like that's probably one of the more common, you know, like sort of myths and you know I feel like parents too. I think it's just our human tendency, we just want to find that ultimate like singular cause or driving factor. I think it's just our human tendency, we just want to find that ultimate like singular cause or driving factor. I think it's so fascinating the way you talk about, you know, eczema really being the driving force behind those food allergies. So I always explain, you know, kind of, I think, on the way you know you do it, yeah, if we notice those trends, maybe it's worthwhile and hey, we might find a food allergy. But is it really relevant to the eczema? Really the driver, you know, probably not, like you talked about. So I think that's fascinating to kind of highlight, because parents always want that allergy referral and it is right. They're going to travel with each other and I think, to what we've seen, this is kind of the newer trend. I think that's a little better than it used to be.

Speaker 2 9:51

But the whole concept, you know, if you diagnose somebody with this, we've had the allergy conversation. Now we shift gears. How do you take care of the skin? I saw a lot of parents. They're afraid to do a bath, they're afraid to do a moisturizer. They may not understand there's some differences with moisturizers and how they repair the barrier and and as some of our colleagues even don't push the moisturizer factor, they're more on the go after the immune system side. How do you approach sort of the hygiene of the skin and how you take care of it?

Speaker 3 10:19

So I tell patients and families who are dealing with eczema I say there's two primary causes of eczema. The first is what we call skin barrier dysfunction. Our skin is our barrier and in people with eczema their barrier isn't built the same way and it makes them more vulnerable to dryness and irritation from things. The second part of eczema is that it's due to too much hypersensitive immune system in the skin. There's too much immune system involved, there's too much inflammation and that's what causes the itch and the rash. And I explain it that way because I think it kind of sets up nicely how we manage atopic dermatitis. We want to focus on the skin's barrier and that's to what you're talking about with all the sensitive skincare products and using sensitive soaps, using good moisturizers, and then we want to use typically a prescription topical therapy to help combat the inflammation part of it. When I'm seeing patients in the clinic, I actually give them my list of Dr Swanson's favorite things that has all of my favorite sensitive skincare products on it, because there's so much stuff out there, so much stuff out there, and I know that the things on my list are certainly not going to fight us in our battle to get the eczema better. They've been studied in folks with eczema, they're safe for sensitive skin, and so I feel most comfortable recommending those products. I also think sometimes it helps simply to simplify it because, again, if you're a parent of a kiddo with eczema staring at the aisle in the grocery store or in your local Walmart or Target, it's pretty overwhelming all the stuff that's out there, and you could pretty easily spend a whole bunch of money on products that are probably not going to help, are probably no better than some of the basic sensitive skincare products and might even have some ingredients in it that might worsen the eczema in the long run. And so I simply give them my favorites list and say here are the things that we know to be safe.

Speaker 3 12:20

In terms of bathing frequency, I tell people it's more about the products you're using than it is about the frequency of the baths, and so if you want to do a bath every night, I think that's great. I think it can help build a nice kind of bedtime routine for the child. But if that's too much, if you want to do it every other night, I think that's great too. Um, but if you, if that's too much, if you want to do it every other night. I think that's great too. If you're using lever 2000 and you're not moisturizing but you're only doing a shower once a week, that's not going to be good for your skin. So it's more about the products that you're using than it is about the frequency of the baths.

Speaker 2 12:55

So for those parents that are in the aisle and they're about ready to swear about skincare because they don't know what to pick, do you mind sharing a few of Dr Swanson's favorite things with us?

New Treatments for Eczema in Children

Speaker 3 13:04

Yeah, definitely, definitely so. For laundry detergent I like All Free and Clear. Comes in a white bottle with big blue letters that say All I recommend avoiding fabric softener and dryer sheets. For soap, I like either Dove Sensitive or Cetaphil. For a moisturizing cream, I like either Dove Sensitive or Cetaphil For a moisturizing cream. I like Vanicream or CeraVe. For a moisturizing ointment, I like Vaseline or Aquaphor. And I also put on my list my favorite hand sanitizer. Yeah, it's actually a Baby Ganix foaming hand sanitizer.

Speaker 2 13:35

Love that, one Love it.

Speaker 3 13:37

It's so great and it doesn't burn and sting your hands, even if you have a little bit of dryness or a little bit of eczema, and so that's on my favorite list as well.

Speaker 2 13:46

That's a good tip for the parents to washing their hands doing all the diaper changes, taking care of the eczema. They probably would benefit from that on those hands, just to help with that as well.

Speaker 3 13:55

Definitely definitely, especially for new parents, and it feels like you're changing a diaper every 10 minutes.

Speaker 2 14:01

Exactly. Well, we got some secrets there, so that's good. So if we transition a little bit away from the product realm, you know, one of the things I think you know is just talking about in general. You know treatments, do you mind going over? You know kind of topical systemics, just kind of talking about sort of your approach and then what we offer now for kiddos with eczema.

Speaker 3 14:21

I mean that's really the coolest thing about practicing dermatology right now. I've been in practice 14 years. This is definitely the best time to be a dermatologist that sees patients with eczema, because we were hard pressed for options years ago. You know we basically just had topical steroids that we tried to make work in better and more ingenious ways. You know we would do wet wraps or we would do topical steroid bursts and stuff, and so we had a world of topical steroids and we had a couple topical calcineurin inhibitors called permicrolemus and tacrolemus. Those have been around for a while and those are non-steroidal but they can sometimes burn and sting and they're a bit slower than a topical steroid and so they weren't always desirable steroid and so they weren't always desirable. But in the past seven and a half years we've had a revolution of treatments for atopic dermatitis and it's really been a joy to watch it unfold. In the topical realm we have topical roflumilast, which goes by the brand name Zoriv, and it was recently approved this summer for patients age six and up. It is a once daily non-steroid cream that can be used anywhere on the body. You can put it on your eyelids, you can put it in your armpits, you can put it anywhere, no limitation on body surface area that you can treat. And one of the coolest things about topical roflumelast is that in the studies they studied it with daily use and once success was seen, they had patients apply it twice a week for maintenance and 57% of the patients didn't need to go back up to daily use for a whole year. So that's pretty cool. That's pretty cool, and so that joined our toolbox earlier this summer and was a welcome addition. We have topical ruxolitinib, which goes by the brand name Opsalura, and it's a topical JAK inhibitor that's currently approved age 12 and up to treat atopic dermatitis, but we expect an age indication to go down to age two sometime in the relatively near future, and I'm very much looking forward to that.

Speaker 3 16:44

Topical ruxolinib is a highly effective non-steroid topical cream. It does not burn and sting when you apply it, so it's one of my favorite things for patients with tactile sensitivities that burn and sting to everything. Really remarkable efficacy, really remarkable improvement in itch, and it kicks in as fast as a steroid, and not just any steroid. It works as fast as clobetazole, which is one of our stronger steroids, in my opinion. It works as fast and as well as that, and so it will be really nice to have that approved down to the age of two, hopefully sometime soon. And then we're anticipating the approval of another topical non-steroid called Topinaroff. It goes by the brand name Vitama, currently approved in the psoriasis world but soon to be approved for patients as young as two with atopic dermatitis. It also is a non-steroid. Once a day it is naturally derived, it actually comes. It has a very interesting origin story. It comes from worm poop originally. Who discovered this? Who initially discovered this?

Speaker 2 17:54

Kids are going to think that's cool, that's just so good.

Speaker 3 17:56

Right.

Speaker 3 17:57

Right, but once a day. Non-steroid, no limitation on body surface area. You can use it on your eyelids, you can use it in your armpits. It also does not get systemically absorbed through the GI tract. And so you know a lot of young kids. They're constantly putting their hands in their mouth and their hands are a frequent area of involvement for their eczema, and so often there's concern from parents about oh geez, if I put this cream here on their hands, then they're going to put their hand in their mouth. Vitamil will be something topical, tipinerof will be something where we don't need to worry about that, and so we're anticipating approval of that very soon and can't hardly wait.

Speaker 3 18:36

In the systemic world we have had dupilumab other brand name, dupixent for the past seven and a half years, and it's been a wonderful seven and a half years. You know I think of. I've been in practice for 14 years and honestly I don't know how I did it before dupi came out. I mean, whenever I think of dupi, I think of Kelly Clarkson, because my life would suck without you. It really changed everything and it's approved down to the age of six months old. It's approved for all sorts of other atopic comorbidities like asthma and EOE. It is remarkably safe, remarkably effective. You don't need to do any labs with it. It's truly a life-changing medication and its only downside is that it is a shot, it's an injection, and it's either once a month or twice a month, depending on age and weight, but it turns the eczema into something families are thinking about once or twice a month, as opposed to every single day, multiple times a day, and that's really quite freeing. We have a new biologic that was just approved a couple months ago, called Lebra Kizumab, brand name Eblis, and it's approved age 12 and up and it starts out with every two week shots with the freedom to go to every month for maintenance, which is nice. Fewer shots sounds nice and it's similar to, but not the same as, doopie, and so we're looking forward to gaining experience with it.

Speaker 3 20:06

We also have two oral jack inhibitors. One of them is called Upadacitinib, brand name Rinvoke, the other one is called Abrositinib, brand name Sibinko, and these are once daily pills to treat atopic dermatitis and they're approved for patients 12 and up. They work rapidly. These medicines are super, super fast, especially when it comes to itch. So people who want to feel better yesterday with their eczema, and they're 12 and up. These medicines are really a goldmine. For that, they do come with a little bit more safety baggage. We do have to do some blood work. They increase the risk for certain viruses like cold-serve virus and shingles, and there's a boxed warning on all members of the JAK inhibitor class which we review with our patients and their families. So just a little bit more safety baggage to them, but really offer an incredible potential for wellness for our patients dealing with bad atopic dermatitis. And that's what we have now and we're just going to keep getting new stuff in the years to come. It's really so exciting.

Speaker 2 21:08

I agree I tease the residents that they have it easy. Now I give them a hard time about it. I told them the age of treating atopic dermatitis and psoriasis that I it's just amazing to me. You know the advantages we have and I love how you mentioned too, for the eczema is sort of affecting the family, because it really is a family disease, especially in children. Like everyone is impacted by it and the quality of life and sleep and focus and attention. So I think that's really important you highlight. And the last like minute or two we have here just wanted to ask do you have any like favorite myths that you like to bust about atopic derming, kids or eczema that we haven't gone over? That might help a parent out there.

Speaker 3 21:45

So I mean the food allergy myth. I think that's an important one to discuss, and and you know, bust, but bust gently, with exceptions, you know. I think the other thing is that it it makes me sad, slash mad, if I hear somebody say, oh, you know, eczema, it's just a rash and there's a good chance that the kids will outgrow it, maybe it doesn't need any treatment. And that makes me so sad because eczema is really really uncomfortable and the itch is really really bad and it interferes with so many aspects of life like sleep and focus and growth and all of these things. It's a trickle down situation and so it's not just a skin rash. It's so much more than that and it really deserves adequate treatment.

Speaker 3 22:41

And it's wonderful now that we have so many wonderful options that we can really improve a patient's life. And treating a kiddo with atopic dermatitis to your point is an example of trickle-down healthcare. You help that one child live better, feel better, do better. You're helping the whole family unit do the same, and so that's a really exciting part of my life in pediatric dermatology these days is I just know, with the treatments that we're going to use, that everybody in that household is going to be thriving so much more as we get the eczema under control.

Speaker 2 23:18

Couldn't have said it any better myself. Dr Swanson, I want to thank you so much for coming on and really talking with us about pediatric atopic dermatitis, or eczema as we like to kind of refer it to. You know, for our listeners out there, if they want to find you, where can they find you online?

Speaker 3 23:32

Yes, yes, yes. So easiest way would probably be my practice's website, which is wwwadawestdermatologycom, so Ada A-D-A, west, w-e-s-t, and then dermatologycom, and on there we have our social media handles and you can see my profile, and that's probably the best way.

Speaker 2 23:56

Great. Thank you again, and I love this podcast. I think a lot of parents are going to appreciate it. I hope for all of you out there too. We've left you itching for more, so look forward to the next episode of Dermottrottercom.

Speaker 1 24:10

Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.