Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Maggie McKay (Host): Going to the dermatologist for the first time, there are a lot of questions to ask. But what if your child needs to see a dermatologist? My guest is Dr. Michael Barton, pediatric dermatologist at Skagit Regional Health. And today, we'll learn about pediatric dermatology, when to take your child for treatment, what to expect during the visit and more.

This is Be Well, the podcast from Skagit Regional Health. I'm Maggie McKay. Many adults have visited a dermatologist, but what if your child needs to see one? What are they most commonly treated for? And are there things to know to prevent acne, for example? Dr. Barton, thank you so much for being here. Let's get right to it. What age of patients do you see in your practice?

Dr. Michael Barton: Yeah, most board-certified pediatric dermatologists have completed four years of foundational training in seeing both adults and kids and then tack on an extra year of fellowship just seeing kids. So in academic institutions, generally a pediatric dermatologist will only see, you know, newborns up until 18 years of life before they transition to more of an adult dermatologist. In community settings like Skagit Regional Health, there tends to be a lot of overlap. And so, I'll see kids all the way into adults. First day of life to the last day of life, if necessary.

Maggie McKay (Host): What conditions do pediatric dermatologists most frequently treat?

Dr. Michael Barton: I'd say some of the more common inflammatory conditions that I see would be things like atopic dermatitis or eczema, which can affect upwards of 20% of kids. Acne is obviously very common in teenagers and sometimes before and after. And then, less common things like psoriasis or alopecia areata. Certainly, a lot of infections, viral-triggered things like warts or molluscum. Tinea capitis, which is a fungal infection on the scalp, tends to be more common in children and than a wide array of different bacterial infections. And then the final thing, we tend to see a lot of our either birthmarks or sometimes just mole checks to make sure things are looking healthy, which fortunately, barring an underlying genetic predisposition, skin cancer in kids tends to be much, much less common.

Maggie McKay (Host): That's a good thing. When should a child visit a dermatologist?

Dr. Michael Barton: I'd say most of the kids I end up seeing, or we end up seeing are under two categories. One is when, you know, skin findings just aren't quite adding up. They're not clear. Is it psoriasis? Is it eczema? Are there overlapping features? So when there's diagnostic uncertainty and there just needs to be a little bit of specialist input to kind of try to tease those things out, we can be helpful in that regard.

And then when skin conditions just aren't responding to, you know, first-line therapies or things you've been trying at home and they're either getting worse or just not responding as you'd expect, and then we can help to kind of step back and make sure we have the right diagnosis, but also explore some of those other therapies that might be more beneficial.

Maggie McKay (Host): Would their pediatrician recommend going to the dermatologist?

Dr. Michael Barton: Yeah. You know, especially if there is diagnostic uncertainty, or if they've tried some of the first line things that they're more comfortable with and it's just not responding, then we can definitely be helpful in that regard.

Maggie McKay (Host): As a parent, what symptoms or skin issues should we be looking out for?

Dr. Michael Barton: Symptoms primarily that we'll see are things that are itchy or painful, bothersome to kids, whether that's, you know, any of the things I've previously mentioned are often associated with some of those symptoms. A lot of times it's asymptomatic and not even bothersome, you know, to the children. And so if it seems kind of unusual or out of place, something that say, a mole, for example, something that looks nothing like anything else on the rest of the child's body, those can sometimes be yellow flags, not necessarily concerning, but worth potentially monitoring or having looked at.

Maggie McKay (Host): And can you offer parents some tips for caring for children's skin just in general?

Dr. Michael Barton: Yeah. You know, we've had a few previous podcasts that have explored the kind of sunscreen to use. And so I won't belabor that, but I do just want to echo, you know, this is the first time where we're getting sun exposure. And accumulative and interval exposure to the sun can really set the stage for developing skin cancers later in life. And so finding a sunscreen somewhere with an SPF of around 30 or higher is generally sufficient; something that's broad-spectrum, so it's going to protect against both UVA and UVB; and then water-resistant, so it lasts up to about 80 minutes in the water. And then reapplying kind of every few hours is needed. So that can be helpful. And I'll say, you know, there are mineral blockers and there are physical blockers and both can be used in kids. But physical blockers, like zinc oxide and titanium dioxide, don't tend to rub into the skin quite as well. And so for children with darker skin types, that can be a little bit challenging to use. And so the mineral blockers may be a little bit more cosmetically desired in that regard.

And outside of just sun protection, I get a lot of questions about kids with eczema or sensitive skin, and so it can be tough because marketing often brands things as, you know, fragrance-free, but there may be a lot of preservatives or fragrances that are used to mask those fragrances. And so generally, if something's bland and has a short ingredient list, that tends to be a little bit better tolerated in kids with more sensitive skin. So if you can find things that are hypoallergenic or will say safe for eczema-prone skin, those tend to be a little bit better tolerated.

Maggie McKay (Host): I remember when I was a teenager and went to the dermatologist, they never said anything kind of consoling or like, you know, you'll outgrow this, nothing. It was just by the book. So it can be so frustrating for teens and make them self-conscious. Can you offer any advice to teenagers experiencing acne or to parents, on what to say to them?

Dr. Michael Barton: Yeah, definitely. I start off by just saying, you know, you're not alone. This is such a common, almost for a lot of teenagers, a rite of passage. And for some fortunate few, they end up not getting acne. And some, it tends to resolve as you get into your early twenties or past your teenage years. And for others, it can persist a little longer after that, but it's definitely a common thing that we see in this age group.

I often see patients that come in and they're frustrated because they have four or five different things that they're using. And my advice is generally just to try to keep it simple. You know, if you're adding too much, it may be harsher and drying and that can actually cause irritation and sometimes do more harm than good. And so generally for mild to sometimes moderate run of the mill acne, something as simple as just one acne wash, which typically either has something like benzo peroxide around 5% is usually sufficient. The higher you go, the more irritating it can sometimes be and the risk of bleaching towels and clothing increases. But something like that just once a day can be beneficial.

The other thing is if you are getting more painful, deeper acne, or you have a family history of people that have had severe or scarring acne, seeking treatment early can be beneficial to try to get an upper hand on your acne early to prevent scarring down the road.

Maggie McKay (Host): That's a good idea. What causes acne?

Dr. Michael Barton: On a granular level, it actually gets a little bit complicated. But I usually say there's one of three things that most of our therapies are going to be targeting. And those consist of normal bacteria that live on all of our skin, hormones that can cause oil glands to release their secretions and then blockage of the pores and follicles that then trap bacteria and lead to that kind of inflammatory acne that we see.

Maggie McKay (Host): How much of a factor does hygiene play a role in when preventing acne?

Dr. Michael Barton: Hygiene can be important, but only necessarily, you know, goes so far. It doesn't cover all of those factors. You know, you can scrub as hard as you want, but you're still going to have those hormones that are contributing to acne formation. So I view hygiene more as a kind of a habit that can help you effectively treat your acne. It kind of builds that routine. And when it comes to acne, consistency is the name of the game. And so just some general tips, avoiding over washing or scrubbing, which can be a little bit more damaging and irritating. For people that tend to have more sensitive skin, there are sensitive skin products that may be better tolerated than some of the better-smelling deodorant soaps. And then for teenagers that are wearing makeup, making sure that the product says something like non-comedogenic or acne-friendly, so that it's not clogging those pores and leading to that acne formation.

Maggie McKay (Host): And hasn't every parent of a teenager with acne at one point or another said, maybe repeatedly, "Stop touching your face"?

Dr. Michael Barton: Absolutely. Yep. And there's some truth to that in regard to the picking and squeezing. If it's causing more trauma, that can increase the risk sometimes for either slower healing or scar formation down the road.

Maggie McKay (Host): Right. And does diet play a role in preventing acne?

Dr. Michael Barton: Yeah, that's an interesting question. I get that quite a bit in the clinic. And I'll start by saying there's not a ton of overwhelming evidence or data looking at diet in pediatric patients. It's interesting in certain parts of the world, like Papua New Guinea or Paraguay, acne is minimal to absent. And so there's been some interest in how diet or lifestyle in these areas can lead to such a finding.

What I can tell you is, at least in the literature, there are really two diets that I at least explore and think about. And those are diets that have what we call a high glycemic index. And so foods like processed candy bars, breads, cake, cookies, you know, all the good stuff, if they're high in glycemic index, there is some relationship with acne and acne severity. And so if you can replace those foods with lower glycemic index foods, things like undefined grains, non-starchy vegetables and fruits, that can sometimes be beneficial.

And the second one is the overconsumption of dairy and, specifically, it seems like the studies suggest low fat and skim milk is a possible contributing factor. And so it's not very often that I come across those or make a lot of strong restrictive dietary recommendations. But those two instances can sometimes play a role. And there's always a parent that says, "It's got to be the chocolate. Chocolate seems to be the primary culprit." And there was at least one study in the late '60s where they had two groups, one got chocolate bars and one got placebo chocolate-less bars. And it didn't seem like there was any statistically significant difference between those two groups. And so, I generally don't deprive people of their chocolate and just moderation in all things.

Maggie McKay (Host): I love it. That's probably a parent thing, just trying to have an excuse to get their child off chocolate maybe.

Dr. Michael Barton: Keep the chocolate for themselves. Exactly.

Maggie McKay (Host): That's true, too. Dr. Barton, thank you so much for helping us understand pediatric dermatology and what we can do to help our children. This has been so useful and so informative. We appreciate your time.

Dr. Michael Barton: Yeah, no problem. Thank you for having me.

Maggie McKay (Host): Absolutely. To learn more, please visit SkagitRegionalHealth.org. Thanks for listening to Be Well, the podcast from Skagit Regional Health. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm your host, Maggie McKay. Be well.