Brittany Craiglow, MD, discusses highlights from her lecture on Systemic Therapies in Pediatric Dermatology at the 2021 Elevate-Derm Conference.
In this video
Dr. Craiglow explains that having a safe, on-label, reliably effective option for atopic dermatitis has been "completely life-changing" — not just for her patients, but for how she thinks about the disease. She admits she used to wait too long to treat because the older systemic medicines carried bigger risks, effectively requiring severe disease before escalating. Now she reaches for dupilumab readily in chronic, poorly controlled patients rather than staying stuck at topical calcineurin inhibitors.
She contrasts pediatric psoriasis with the adult presentation: it's far less common than atopic dermatitis, with a median onset around 7 to 10 and a frequent family history. About 80% of kids have scalp involvement, facial involvement is more common, and the plaques tend to be finer or more psoriasiform rather than the thick, white, micaceous scale seen in adults. On giving shots, she leans on honesty and comfort — acknowledging kids don't like needles, giving them a sense of control, and using topical anesthetics, ethyl chloride, and vibration, with a shout-out to Mr. Buzzy for both pediatric and adult patients.
- Dupilumab's strong safety profile lets her escalate earlier — when a patient is chronic and not well controlled on topicals — instead of waiting for severe disease.
- Pediatric psoriasis is less common than atopic dermatitis, with a median onset of 7 to 10 and a frequent family history.
- Roughly 80% of pediatric psoriasis patients have scalp involvement, facial involvement is more common, and plaques are finer or more psoriasiform than adults' thick micaceous scale.
- For injections, acknowledge the child's fear, give them a sense of control, and reassure them there's a reason for the treatment.
- Use topical anesthetics, ethyl chloride, and vibration devices like Mr. Buzzy to make shots more tolerable — helpful for adults, too.
