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The rate of pediatric hospitalization for cutaneous pathology has been increasing in recent years, often requiring the expertise of consulting pediatric dermatologists; however, the infrastructure of inpatient pediatric dermatology consultative services remains poorly characterized. We sought to assess the structure, consult volume, physician compensation, and utilization of teledermatology in pediatric dermatology inpatient services to better understand the current care model. Our survey of 118 pediatric dermatologists revealed that 89% of respondents see between 1 and 10 new consults per week, 39% perform all inpatient consults including evening and weekends without assistance from other providers, 71% do not have protected time during the week to provide inpatient consultations, and only 10% receive financial compensation via stipend. By highlighting both the high demand for pediatric consultative dermatology as well as the significant burden placed on these providers by existing practice models, we hope to encourage a reappraisal of the current infrastructure of pediatric inpatient dermatology to increase structural and financial support for this vital service. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the current management of tinea capitis in the United States, specifically focusing on patients aged 0–2 months, 2 months to 2 years, and 2 years to 18 years. An online survey, distributed through the Pediatric Dermatology Research Alliance and the Society of Pediatric Dermatology, revealed the following preferences: fluconazole for those under 2 months, griseofulvin for those aged 2 months to 2 years, and terbinafine for those aged 2 years and older. There exists inter‐provider variation in tinea capitis treatment regimens within the pediatric dermatology community. [ABSTRACT FROM AUTHOR]

Background: Dermatologists and other providers play essential roles in managing the dermatologic care of pediatric patients. This study aims to identify patterns and elucidate factors associated with receiving dermatologic care in the United States. Methods: The National Ambulatory Medical Care Survey (NAMCS) was used to identify pediatric patients with dermatologic diagnoses from 2009 to 2015. Clinical and demographic information were evaluated, and visit diagnoses were stratified based on provider type (dermatologists vs. non‐dermatologists). Multivariate logistic regression analysis was used to identify key predictors of outpatient dermatology care for pediatric patients. National estimates of diagnoses were procured using weights provided within the NAMCS database to project disease incidence. Results: A total of 85,217,557 pediatric patients (survey‐weighted) were observed during the study period. Of the sampled patients, 29.3% were evaluated by dermatologists, while 70.7% were seen by non‐dermatology providers. Atopic dermatitis was the most common diagnosis encountered by dermatologists in ages 0–3 years, while unspecified contact dermatitis was the most common diagnosis reported by non‐dermatologists in all age groups. On multivariable logistic regression, ≥1 year of age, Caucasian race, private insurance versus Medicaid, residence in a metropolitan area, referral from another provider, and longer appointment wait time were associated with an increased likelihood of being evaluated by a dermatologist compared to a non‐dermatologist. Conclusions: Non‐dermatologists are responsible for the majority of pediatric dermatologic care. For pediatric patients, health disparities by race, insurance status, and rurality present significant challenges to being evaluated by a dermatologist. [ABSTRACT FROM AUTHOR]

Patients with atopic dermatitis (AD) have low treatment satisfaction. In this study, we evaluated the humanistic burden, treatment satisfaction, and treatment expectations in patients with AD in the United States. Adults with AD recruited through the National Eczema Association and clinical sites completed a web-based survey comprising the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD), Dermatology Life Quality Index; Work Productivity and Activity Impairment Questionnaire-Atopic Dermatitis; Treatment Satisfaction Questionnaire for Medication (TSQM); and answered questions on healthcare provider (HCP) visits, treatment history, and treatment goals. Descriptive analyses were performed to compare participants by severity. Among 186 participants (mean [standard deviation] age 39.7 [15.3] years, 79.6% female), 26.9%, 44.6%, and 26.3% of the participants had mild, moderate, or severe AD, respectively, based on PO-SCORAD. Greater disease severity was associated with a greater impact on work and daily life, decreased TSQM scores, and increased HCP visits. Corticosteroid topical cream or ointment (53.8%) and oral antihistamines (31.2%) were most commonly used for the treatment of AD. Participants reported declining/stopping/changing AD treatment due to the potential for side effects or lack of efficacy. 'Leading normal lives' (28.0%) and 'being itch-free' (33.9%) were important treatment goals. Individuals with AD, especially severe disease, face a considerable humanistic burden even while using treatment. [ABSTRACT FROM AUTHOR]

There are little published data on the transition of care in EB. We conducted a survey study recruiting EB patients from the Dystrophic EB Research Association (debra) website and centers caring for high numbers of EB patients in the United States and internationally from Sept 17, 2019 to Nov 3, 2021. The majority of participants had not discussed the transition of care with their healthcare providers, nor the healthcare needs to be required as an adult. Ongoing pediatric subspecialty care was reported by 12% of adults, most commonly in pediatric dermatology. Identified barriers to transition included the perceived lack of adult providers' knowledge about EB patient healthcare needs. The results suggest the need for transition guidelines, early discussions with families about transition, and practical information for the adult providers accepting care. [ABSTRACT FROM AUTHOR]

Atopic Dermatitis (AD) is a chronic, inflammatory skin condition that imposes an enormous personal and economic burden in the United States. Due to the ubiquity of the use of electronic medical records (EMR) in the United States, utilizing such data is critically important to studying common dermatologic diseases, such as AD. Our goal was to create a simple-to-use algorithm applied to EMR data to accurately identify AD patients thereby making it possible to efficiently use EMR data to ascertain and then study individuals with AD. Our results suggest that the algorithm that is most likely to accurately identify AD patients from the EMR based on PPV utilizes ICD-10 code for L20.89, L20.9, or L20.84 in conjunction with a diagnosis code for asthma or allergic rhinitis, treatment code, and dermatology consult code. This approach yields a PPV of 95.00% in our training cohort and 100.00% in our validation cohort. Therefore, future studies can use this algorithm to better assure that a subject has AD for studies of the pathogenesis and/or potential treatment targets of AD. [ABSTRACT FROM AUTHOR]

Background/Objectives: The COVID‐19 pandemic necessitated rapid implementation of telemedicine at medical centers across the United States. As telemedicine is expected to persist beyond the pandemic in subspecialties like pediatric dermatology, there is growing concern that socioeconomic factors may contribute to inequitable telemedicine access. This study aims to identify factors associated with disparities in telemedicine use among pediatric dermatology patients during the pandemic. Methods: In this single‐center cross‐sectional study, patients less than 18 years old who completed a visit with a pediatric dermatologist via a video telemedicine call or in‐person office visit during the specified time periods were included. Univariate and multivariable analyses were performed to compare demographic factors for (1) patients who had a telemedicine visit versus office visit during June 1, 2020, to January 22, 2021, and (2) patients who had either visit type during June 1, 2020, to January 22, 2021, versus June 1, 2019, to January 2020. Results: The independent factors associated with lower odds of telemedicine include identifying as Black/African American, having a non‐English preferred language, and having public insurance, whereas the independent factors reducing overall access to pediatric dermatology care during the pandemic include identifying as Hispanic/Latino and having public insurance. Conclusions: Differential telemedicine use in vulnerable communities may be attributed to disparities in technology access and digital literacy and should be addressed at a structural level. If such disparities are identified and adequately remedied, telemedicine can serve as an important tool for expanding access in the field of pediatric dermatology. [ABSTRACT FROM AUTHOR]

Background/Objectives: Up to 30% of pediatric primary care visits include a cutaneous complaint, yet the pediatric dermatology workforce has historically been too small to provide adequate specialized care. This study assesses the geographic distribution of pediatric dermatologists to determine physician‐to‐patient ratios, analyzes urban–rural disparities, and determines post‐fellowship migration patterns. Methods: Board‐certified pediatric dermatologists were identified using the Society for Pediatric Dermatology's public database, and their demographics and credentials were subsequently verified by an online search. Analysis included physician density per 100 000 children for each state and region, along with geographic distribution for rural and urban areas, based on the United States Census Bureau's definitions. The distances between practice locations and the American Board of Dermatology‐approved Pediatric Dermatology fellowship training sites were reviewed. Results: An estimated 336 board‐certified pediatric dermatologists currently work in the United States with 76.8% being women and 71.1% practicing within 50 miles of the nearest fellowship program. 96.4% are located in urban areas and 3.6% in rural areas with an average ratio of 0.54 and 0.09 per 100 000 children, respectively. The average ratio of pediatric dermatologists in the United States was 0.46 per 100 000 children. On average (standard deviation), there are 6.6 (8.8) pediatric dermatologists per state but with 7 states having zero. Conclusions: The demand for pediatric dermatologists continues to outpace the current physician availability with a disparity between urban and rural areas. Further awareness and emphasis on training and recruitment of additional pediatric dermatologists are essential to addressing this important issue. [ABSTRACT FROM AUTHOR]

Background/Objective: Current knowledge about usage of effective, but non‐first‐line topical acne medications in the United States is limited. We aimed to investigate utilization patterns and temporal trends for such acne medications in the US ambulatory care. Methods: Pediatric (≤18 years old) and adult (>18 years old) data from the 2012 to 2016 (inclusive) cycles of the US National Ambulatory Medical Care Survey were extracted. Utilization patterns of six non‐first‐line topical acne medications (ie, azelaic acid, salicylic acid, glycolic acid, sulfur, resorcinol, and zinc) were compared and followed over time. Results: Data from 218 410 US office–based sampled visits during 2012‐2016 were included in the analysis. Across all acne visits (n = 1542), salicylic acid (1.58%), azelaic acid (1.22%), and glycolic acid (0.52%) were the most frequently used agents, while zinc and resorcinol were not used. Sulfur (0.52%) and salicylic acid (0.33%) were the only medications used in preadolescents, and none of these medications were used in the neonatal or infantile group. Temporal trends for using at least one of these medications were insignificant among both pediatric and adult age groups (P =.825 and.136, respectively). Conclusions: Salicylic acid and azelaic acid are the most frequently used of the studied second‐line medications to treat acne, although the use of these and the other non‐first‐line topical medications overall is uncommon, especially among younger groups of US pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Cutaneous histopathologic diagnoses in children often differ from those in adults. Depending on practice setting, these specimens may be evaluated by dermatopathologists or pediatric pathologists. We sought to determine whether comfort level with pediatric dermatopathology is associated with prior training, pediatric dermatopathology exposure during fellowship, career duration, or specimen subtype. Methods: We surveyed dermatopathologists and pediatric pathologists practicing in the United States. Training and practice variables were evaluated by multivariable regression for association with comfort level. Results: Of the 156 respondents, 72% were dermatopathologists (response rate 11.6%) and 28% were pediatric pathologists (response rate 9.3%). Dermatopathologists reported higher comfort overall (P <.001); this was also true for inflammatory dermatoses and melanocytic neoplasms (P <.001). Thirty‐four percent and 75% of dermatopathologists and pediatric pathologists, respectively, reported lower comfort with pediatric skin specimens than their usual cases. Pediatric pathologists were 28% more likely to refer these cases to colleagues. Among dermatopathologists, dermatology‐trained were more comfortable than pathology‐trained colleagues interpreting inflammatory dermatoses (P <.001). Conclusions: Pathologists' comfort with pediatric dermatopathology varied significantly based upon prior training, career duration, and specimen subtype. These results suggest opportunities for improving education in this domain. [ABSTRACT FROM AUTHOR]

Background/Objectives: Efficacy and safety data of scabies treatments in infants are limited. Although topical permethrin is used in the treatment of scabies in adults, it is not approved for use in infants younger than 2 months of age in many parts of the world. This study aimed to describe treatment practices in the management of scabies in infants younger than 2 months. Methods: An online survey was developed and distributed to physicians worldwide through the Society of Pediatric Dermatology and the Pediatric Dermatology Research Alliance. Data collected included demographics, medication availability, experience using medications, deterrents to medication use, medication administration preferences, perceived and experienced medication side effects, and preferred treatment agent in this population. Results: In total, 57 physicians from seven countries responded. The majority of respondents were board‐certified in pediatric dermatology (48/57, 84.2%) and resided in the United States (44/57, 77.2%). Respondents had experience using permethrin (47/57, 82.5%) and precipitated sulfur (35/57, 61.4%) most frequently. Most (38/57, 66.7%) preferred permethrin as their treatment of choice. Among those who did not use permethrin, potential side effects (8/10, 80%) were most frequently reported as a deterrent from its use. However, only 4.3% (22/47) of those who used permethrin reported side effects, including itching, erythema, and xerosis. Conclusions: Permethrin is frequently used in the treatment of infants younger than 2 months with scabies. Furthermore, our results demonstrate that permethrin is the preferred treatment agent among sampled dermatologists for infants younger than 2 months. Few side effects were reported, and none were serious. [ABSTRACT FROM AUTHOR]

Background: Dermatologic conditions comprise a significant number of emergency department visits in the pediatric population in the United States. Understanding key predictors of emergency department utilization for dermatologic conditions is important to reduce inappropriate use. Methods: A total of 44 554 sampled patient emergency department visits, consisting of patients less than 18 years of age, were collected from the National Hospital Ambulatory Medical Care Survey between 2009 to 2015. ICD‐9 codes were used to define dermatologic conditions versus non‐dermatologic conditions with univariate and multivariate analyses used to identify factors significantly correlated with dermatologic emergency department utilization. Results: A total of 13 681 691 pediatric dermatologic emergency department visits (weighted) were evaluated over the seven‐year period, representing 6.4% of total pediatric emergency department visits. The most common dermatologic diagnosis was cellulitis (25.6% of visits). The majority of patients were five years old or younger (54.4%). Patients with primary dermatologic conditions were more likely to be triaged as non‐urgent (16.7%) or semi‐urgent (45.8%) than patients without dermatologic conditions. Only 2.1% of patients with dermatologic conditions required further observation or admission. On further regression modeling, age ≤ 5, semi‐urgent or non‐urgent acuity, Medicaid insurance, and residence in the Northeastern or Midwestern United States were significantly associated with presentation to the emergency department with a dermatologic condition when compared to non‐dermatologic condition. Conclusions: Dermatologic conditions continue to comprise a significant number of ED visits in the pediatric population. Increased ED utilization by vulnerable pediatric populations highlights the need to better direct or provide access to outpatient dermatologic care. [ABSTRACT FROM AUTHOR]

Skin complaints are common among pediatric patients, yet as of 2020, fewer than 400 board‐certified pediatric dermatologists currently practice in the United States. Pediatric teledermatology may address barriers to dermatologic care in children, assisting with distant geographic locations and long wait times. A review of the literature was conducted to synthesize important features of teledermatology for pediatric dermatologists. We summarize types of telemedicine platforms, common dermatologic conditions seen by pediatric teledermatologists, diagnostic accuracy and concordance, and guidelines from the American Academy of Dermatology and the American Telemedicine Association regarding teledermatology. This report highlights the utility of pediatric telemedicine in both the outpatient and inpatient dermatology setting to increase access to high‐quality dermatologic care. [ABSTRACT FROM AUTHOR]

Background/Objective: The h‐index is a measure of research achievement. Individuals with similar h‐indices should be equivalent in terms of scientific impact. However, this value is inherently biased toward fields with higher visibility and readership. To utilize the power of h‐indices in predicting future research success and as a benchmark for academic advancement, niche fields like pediatric dermatology must be examined independently. Methods: Publicly available data were examined. A list of current pediatric dermatologists were obtained from the Society for Pediatric Dermatology's member directory. The following demographic information was obtained: fellowship certification year, PhD status, prior pediatric residency training, state/region, practice setting, academic appointment, number of publications, and h‐index. Descriptive and analytic statistics were calculated. Results: A total of 317 pediatric dermatologists were included. Practice setting distribution was as follows: 54.3% academic, 32.5% non‐academic, and 13.3% combined. H‐index differed significantly based on pediatric dermatology certification year (P <.001), increasing as time from certification increased. Those in academics had higher h‐indices than those in both non‐academic and combined practice settings (P <.001 and.007, respectively). Professors (25.0) had higher h‐indices than associate professors (11.0), who had higher h‐indices than assistant professors (4.4) (P <.001). Conclusions: H‐index increased with increasing academic rank and was highest among those working in academics. For pediatric dermatologists considering application for promotion, the h‐index for each level can serve as a useful benchmark to guide decision‐making. [ABSTRACT FROM AUTHOR]

Although ethnic diversity is rising in the United States, educational resources continue to lag behind, as evidenced by prior studies highlighting limited skin of color representation in dermatology resources. The objective of this study was to evaluate the representation of skin tones in three dermatology journals commonly used in resident education and journal clubs. Overall, 5.6% (Journal of the American Academy of Dermatology), 4.1% (JAMA Dermatology), and 8.3% (Pediatric Dermatology) of images in the journals were depicted on "Dark" skin (Fitzpatrick V‐VI). Disparities in skin of color representation exist in three dermatology journals used in medical education in the United States. [ABSTRACT FROM AUTHOR]

Languages other than English represent an ever‐growing component of the tapestry of the United States. Studies have shown that language barriers can impact access to care and quality of care, particularly in specialty clinics. Given the additional challenges faced by language interpretation in pediatric settings, the field of pediatric dermatology is uniquely positioned to contribute meaningfully to improving care for families with limited English proficiency. [ABSTRACT FROM AUTHOR]

A better understanding of what skin conditions are most commonly diagnosed in different pediatric racial and ethnic groups in outpatient dermatology clinics could help guide the development of pediatric dermatology educational initiatives for primary care providers and general dermatologists who have limited access to pediatric dermatologists. Using a nationally representative dataset, we evaluated the most common diagnoses in patients younger than 15 years of age (children) and 15‐24 years of age (youth) who present to outpatient dermatology clinics, stratified by race and ethnicity. While acne and dermatitis were among the top ten most common diagnoses in all racial and ethnic groups studied, Black children were also commonly diagnosed with dermatophytosis and impetigo, and Black and Hispanic children were often diagnosed with seborrheic dermatitis; pigmentary disorders were among the top three most common diagnoses in Black, Asian, and Hispanic youth. Training more physicians how to evaluate and treat common skin conditions in children and youth of diverse racial and ethnic backgrounds may improve access to care for skin disease in the United States. [ABSTRACT FROM AUTHOR]

Abstract: Background/Objectives: It is known that inpatient care accounts for a significant portion of health care expenditures, but the national burden of inpatient pediatric dermatology is poorly characterized. We sought to assess risk factors, conditions, and financial costs associated with pediatric hospitalizations for skin disease. Methods: We performed a cross‐sectional study of pediatric dermatology hospitalizations using the 2012 Kids’ Inpatient Database, which samples 80% of non‐birth‐related pediatric admissions from 44 states to generate national estimates. The demographic characteristics of children admitted for dermatologic and nondermatologic conditions were compared, and the financial costs of these admissions were analyzed. Results: In 2012, there were 74 229 (95% confidence interval (CI) = 68 620‐79 978) pediatric dermatology hospitalizations, accounting for 4.2% of all pediatric admissions and $379.8 million (95% CI = $341.3‐418.4 million) in health care costs. Bacterial infections (n = 59 115, 95% CI = 54 669‐63 561), viral diseases (n = 3812, 95% CI = 3457‐4167), and noncancerous skin growths (n = 2931, 95% CI = 2318‐3545) were the most common conditions requiring hospitalization. The highest mean cost per hospitalization was for admissions for cutaneous lymphomas ($58 294, 95% CI = $31 694‐84 893), congenital skin abnormalities ($24 186, 95% CI = $16 645‐31 728), and ulcers ($17 064, 95% CI = $14 683‐19 446). Pediatric dermatology hospitalizations were most strongly associated with living in a low‐income community (odds ratio (OR) = 1.22, 95% CI = 1.16‐1.29) and the South (OR = 1.32, 95% CI = 1.19‐1.46) and being uninsured (OR = 1.35, 95% CI = 1.26‐1.45) or having Medicaid insurance (OR = 1.17, 95% CI = 1.13‐1.22). Conclusion: Skin disease is a common cause of hospitalizations in children, and there are disparities in these admissions that could reflect inadequate access to outpatient pediatric dermatologists. [ABSTRACT FROM AUTHOR]

Studies have suggested there is a shortage of pediatric dermatologists in the United States, but the workforce has not been well defined. The Society for Pediatric Dermatology (SPD) Workforce Committee sought to characterize the US pediatric dermatology workforce with a nine‐question survey, sent to all 484 US SPD members in December 2016. The response rate was 30%. Most pediatric dermatologists were practicing in major metropolitan markets, seeing an average of 80 patients a week with an average 6‐week wait time. These findings indicate that geographic maldistribution and long wait times for new patient appointments remain substantial hurdles for adequate access to subspecialty pediatric dermatology care. [ABSTRACT FROM AUTHOR]

Background Pediatric dermatology has always played an important role in children's healthcare, but there has been a shortage of pediatric dermatologists nationwide for more than a decade, and few metrics of productivity and practice patterns exist. This study sought to provide insight into these and other factors of the pediatric dermatology workforce. Methods Electronic surveys were distributed to all 226 U.S. board-certified pediatric dermatologists. Results A total of 108/226 (48%) of the electronic surveys were returned. Sixty percent of respondents were employed full- or part-time in academic environments and 81% were salaried. Respondents reported that children constituted 79.5% of their practice, and the average respondent spent 3.8 days/week treating 92.6 patients, considerably lower than the 136.3 patients/week that the average general dermatologist sees. The academic practice environment was associated with children constituting a larger proportion of the practice (p < 0.001), fewer patients seen per week (85.9, p < 0.001), and longer median new patient wait times (60 vs 15 days) than in other practice environments. Private practitioners saw significantly more patients per week than those in academic environments (112.7, p = 0.005). Male and female practitioners reported approximately equal patient care days per week, similar wait times, and similar proportions of children in their practices. Conclusions This assessment revealed productivity and practice pattern differences between the various pediatric dermatology practice environments and between pediatric and general dermatology. This study provides important information for workforce planning and care availability assessments and baseline information for future studies. [ABSTRACT FROM AUTHOR]

As dermatologists, we are unique in our ability to diagnose and treat diseases that present in the skin. This includes special expertise in the core disciplines of medical dermatology, pediatric dermatology, dermatologic surgery, and dermatopathology. Just as individual dermatologists strive to remain on the forefront of advances in our field, dermatology residency programs have an obligation to ensure that residents demonstrate competence in all facets of our field, and in the United States the American Board of Dermatology is moving toward a modular examination format to help assure the public that their dermatologist is truly an expert in all aspects of diagnosis and treatment of skin disease. This contribution focuses on key advances in our field, how our societies help us to remain on the cutting edge of science, and how dermatology training has kept pace. [ABSTRACT FROM AUTHOR]

In this article, the author offers information on the concern related to long‐standing workforce shortage in pediatric dermatology in the U.S. It suggests that initiatives such as improving education of primary care providers around common skin conditions, increasing opportunities for remote mentorship and promoting training of advanced practice providers to overcome from these problems.