Welcome to Pediatric Dermatology


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Welcome to Pediatric Dermatology

  1. 1. PEDIATRIC DERMATOLOGY Welcome to Pediatric Dermatology Guidelines for Res B The attending staff consists of Drs. Ilona Frieden (Director of Pediatric Dermatology), Renee Howard, Mary Williams, and Kelly Cordoro. The Fellows for the 2008 - 2009 academic year are Drs. Ki-Young Suh and Marcia Hogeling. The pediatric dermatology fellow pager is (415) 443-6221. Louise Crotwell is the pediatric dermatology nurse, and her contact number is (415) 353-7823. Resident Clinic and Conference Schedule while on Pediatric Dermatology M T W Th F Resident’s Continuity Clinic General Derm Clinic 8:00-10:00 Staff Conference 10:00-12:00 Pediatric Derm Clinic Renee Howard/ Pedi Fellow (Please check in after resident teaching) General Derm Clinic 8:00-12:00 Pediatric Derm Clinic or Vascular Anomalies Clinic Ilona Frieden or Kelly Cordoro, Attendings 1:00-5:00 Pediatric Derm Clinic Ilona Frieden Attending Fellows Academic Time 1:00-5:00 Pediatric Derm Clinic Renee Howard Kelly Cordoro Attendings 1:00-5:00 Pediatric Derm Clinic Ilona Frieden Kelly Cordoro Attendings 1:00-5:00 Fellow Continuity Clinic or Fellow Surgery Clinic Fellows Ilona Frieden or Kelly Cordoro Attending Expectations of Resident B: • At the beginning of rotation (or prior), please inform Dr. Frieden or the fellow of any anticipated absences. • Resident B should assume responsibility for the follow-up of any laboratory tests ordered, including microbiology as well as pathology from biopsies performed in the clinic. o A pediatric follow-up binder is located in the clinic and tests ordered should be logged into the binder. Revised 6-13-2008
  2. 2. PEDIATRIC DERMATOLOGY o The resident is expected to complete the follow-up, including telephone follow-up (calling in prescriptions when appropriate and informing parents/patients of biopsy results.) o Discuss follow-up or management plan with fellow prior to patient contact as needed. Please document phone contacts, prescriptions called in to pharmacy, etc. on a telephone log sheet and cross off completed follow-ups in the book. o At the end of their rotation residents are expected to continue to complete these tasks or if this is not possible, sign out pending care to subsequent Resident B and/or the Pediatric Dermatology fellow. • All new, complicated patients and those referred by dermatologists should have a letter dictated to the referring doctor or pediatrician. Parents and primary care physicians should always be sent a copy of the consultation, even if going to another provider. Please do not dictate letters during a busy clinic, as patients are waiting to be seen. These can be dictated after clinic is over. • NP visits, simple consultations, and more complex F/U notes are generally cc’ed to the PMD/referring physician by placing the note in the “To Be Faxed” box at the Derm1 reception desk after billing has been completed. Please ask the attending if you aren’t sure whether a letter should be dictated or not. Instructions for dictation are attached. Revised 6-13-2008
  3. 3. PEDIATRIC DERMATOLOGY Goals of the Rotation: First-Year Residents • Recognition, management, and differential diagnosis of common pediatric skin conditions including atopic dermatitis, psoriasis, acne, diaper dermatitis, newborn rashes, viral exanthems, molluscum contagiosum, and warts as well as other bacterial/viral infections. • Familiarity with examination of infants and young children including making children at ease with physicians, lap-examination, and speaking with children and parents about pediatric skin disease. • Recognition and management of common “birthmarks” in pediatric dermatology such as port wine stains, salmon patches, uncomplicated hemangiomas of infancy, nevus sebaceous, segmental pigmentary disorder, and congenital melanocytic nevi. • Familiarity with administration and dosing of basic pediatric dermatology therapeutics, including topical steroids/immunomodulatory agents (such as Protopic® and Elidel®), topical retinoids, systemic antibiotics, and systemic antihistamines, as well as developmental aspects of pharmacology such as when children are old enough to swallow pills and apply medications on their own. • Comfort with cryotherapy and skin biopsy technique in infants and children; observe and when possible assist in laser dermatologic procedures. • Understand methods of anesthesia, analgesia, distraction techniques, and methods of restraint for procedures in pediatric dermatology. Readings while on Pediatric Dermatology: First-Year Residents Texts (Available in the resident library as well as for check-out in the UCSF library): • Weston and Lane’s Color Textbook of Pediatric Dermatology • Hurwitz’s Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence • Eichenfield, Esterly, Frieden. Neonatal Dermatology, 2nd edition Articles (Hard copies of those not available as pdfs are in the academic office and resident binder). • Miller T, Frieden IJ. Hemangiomas: new insights and classification. Pediatr Annals 2005 Mar;34(3):179-187. (Hard copy only) • Fayad L, Hazirolan T, Bluemke D, Mitchell S. Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options. Skeletal Radiol. 2006;35(3):127-37. Epub 2006 Jan 27 • Roberts BJ, Friedlander SF. Tinea capitis:a treatment update. Pediatr Annals 2005 Mar;34(3):191-200. (Hard copy only) Revised 6-13-2008
  4. 4. PEDIATRIC DERMATOLOGY • Carder KR, Weston WL. Atypical viral exanthems: new rashes and variations on old themes. Contemporary Pediatr 2002 Feb;19(2):111-134. (Hard copy only) • Haggstrom AN, Lammer EJ, Schneider RA, Marcucio R, Frieden IJ. Patterns of infantile hemangiomas: new clues to hemangioma pathogenesis and embryonic facial development. Pediatrics. 2006 Mar;117(3):698-703. • Singalavanija S, Frieden IJ. Diaper dermatitis. Pediatr Rev 1995 Apr;16(4):142-7. • Makkar HS, Frieden IJ Congenital melanocytic nevi: an update for the pediatrician. Curr Opin Pediatr 2002 Aug;14(4):397-403. • Metry DW, Dowd CF, Barkovich AJ, Frieden IJ. The many faces of PHACE syndrome. J Pediatr. 2001 Jul;139(1):117-23. • Smolinski KN, Yan AC. How and when to treat molluscum contagiosum and warts in children. Pediatr Annals 2005 Mar;34(3):211-221. (Hard copy only) • Sterling JC, Handfield-Jones S, Hudson PM; British Association of Dermatologists. Guidelines for the management of cutaneous warts. Br J Dermatol. 2001 Jan;144(1):4-11. • Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol 2003 Dec;49(6):1088-95. • Dohil MA, Eichenfield LF. A treatment approach for atopic dermatitis. Pediatr Annals 2005 Mar;34(3):201-210. (Hard copy only) Revised 6-13-2008
  5. 5. PEDIATRIC DERMATOLOGY Goals of the Rotation: Second-Year Residents • In addition to the above… • Recognition of more complex genetic pediatric skin conditions such as tuberous sclerosis, neurofibromatosis, ichthyoses, incontinentia pigmenti, epidermolysis bullosa, ectodermal dysplasias, and NOMID. • Ability to recognize and manage less common developmental abnormalities (ie. aplasia cutis congenita and dermoid cysts.) • Ability to manage more complicated hemangiomas of infancy, including a familiarity with the indications for systemic therapy and management of complications of hemangiomas (such as ulceration.) • Ability to recognize and manage pediatric-specific vasculitides and inflammatory conditions such as Henoch-Schönlein Purpura, dermatomyositis, and Kawasaki disease. • An understanding of basic concepts of genetics: including mosaicism and chimerism, X-inactivation, and imprinting phenomena. Second Year Residents All readings above not completed during first year rotation Articles • Bruckner AL, Frieden IJ. Hemangiomas of Infancy. J Am Acad Dermatol 2003 Apr;48(4):477-93 • Frieden IJ, Haggstrom AN, Drolet BA, Mancini AJ, Friedlander SF, Boon L, Chamlin SL, Baselga E, Garzon MC, Nopper AJ, Siegel DH, Mathes EW, Goddard DS, Bischoff J, North PE, Esterly NB. Infantile hemangiomas: current knowledge, future directions. Proceedings of a research workshop on infantile hemangiomas, April 7-9, 2005, Bethesda, Maryland, USA. Pediatr Dermatol. 2005;22(5):383-406 • Berger TG, Duvic M, Van Voorhees AS, Frieden IJ; American Academy of Dermatology Association Task Force. The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol. 2006;54(5):818-23. • Buka RL, Cunningham BB. Connective tissue disease in children. Pediatr Annuals 2005 Mar;34(3):225-238. (Hard copy only) • Burns JC, Glode MP. Kawasaki syndrome. Lancet. 2004;364:533-44. • Boh EE. Neonatal lupus erythematosus. Clin Dermatol 2004;22:125-128 • Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW, Newell B, Nopper AJ, Frieden IJ. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006 Sep;118(3):882- 7. Revised 6-13-2008
  6. 6. PEDIATRIC DERMATOLOGY • Farvolden D, Sweeney SM, Wiss K. Lumps and bumps in neonates and infants. Dermatologic Therapy 2005;18: 104-116. (Hard copy only) • Lombillo VA, Sybert VP. Mosaicism in cutaneous pigmentation. Curr Opin Pediatr 2005 Aug;17(4):494-500 Revised 6-13-2008
  7. 7. PEDIATRIC DERMATOLOGY Goals of the Rotation: Third-Year Residents • In addition to the above… • Ability to recognize and manage the more complex genetic pediatric skin conditions listed above. • Ability to recognize and initiate management of pediatric neoplastic and infiltrative diseases such as Langerhans Cell Histiocytosis, mastocytosis, infantile myofibromatosis, and congenital leukemias. • Familiarity with the use, monitoring, and administration of systemic/immunomodulating medications for pediatric skin disease including oral retinoids, oral steroids, cyclosporine, anti-TNF-α agents, and mycophenolate mofetil. Third Year Residents All readings above not completed during first year rotation Texts: • Schachner and Hansen’s Pediatric Dermatology. Chapter 4. Principles of Treatment in Pediatric Dermatology (p 87-143). Articles • Drolet BA, Dohil M, Golomb MR, Wells R, Murowski L, Tamburro J, Sty J, Friedlander SF. Early stroke and cerebral vasculopathy in children with facial hemangiomas and PHACE association. Pediatrics. 2006 Mar;117(3):959-64. • Kilcline C, Shinkai K, Bree A, Modica R, Von Scheven E, Frieden IJ. Neonatal-onset multisystem inflammatory disorder: the emerging role of pyrin genes in autoinflammatory diseases. Arch Dermatol. 2005;141(2):248-53. • Lacour M, Mehta-Nikhar B, Atherton DJ, Harper JI. An appraisal of acitretin therapy in children with inherited disorders of keratinization. Br J Dermatol. 1996;134(6):1023-9 (Hard copy only) • Arbuckle HA, Morelli JG. Pigmentary disorders: update on neurofibromatosis-1 and tuberous sclerosis. Curr Opin Pediatr 2000 Aug;12(4):354-8 Other: • Dictation instructions Revised 6-13-2008