From reactive care to preventive treatment
The latest research signals a shift toward earlier therapeutic intervention in pediatric dermatology.
P008 – Showdowns in Pediatric Dermatology: Current Controversies From the Pediatric Dermatology Research Alliance
8:45-10:45 a.m. | Saturday, July 18
Rendezvous Trianon
A growing body of research in pediatric dermatology is challenging longstanding treatment approaches, with experts increasingly advocating for earlier intervention to prevent long-term complications in common childhood skin conditions.
At the center of this shift are three highly debated conditions — infantile hemangiomas, atopic dermatitis, and acne — where advances in treatment and evolving clinical evidence are prompting physicians to reconsider traditional “wait-and-see” strategies.
These disputes will take center stage at the July 18 session, P008 – Showdowns in Pediatric Dermatology: Current Controversies From the Pediatric Dermatology Research Alliance. Session directors Dawn Eichenfield, MD, PhD, FAAD, and Cristy Garza-Mayers, MD, PhD FAAD, will moderate the panel, which includes Alreem Al-Nabti, MD, FAAD; Maria Buethe, MD, PhD, FAAD; Karen Chernoff, MD, FAAD; Jinia El-Feghaly, MD, FAAD; Thy N. Huynh, MD, FAAD; and Mary E. Larijani, MD, FAAD.
“These topics highlight a broader shift in pediatric dermatology from reactive treatment toward earlier intervention and disease modification,” said Dr. Eichenfield, who is assistant clinical professor of dermatology at the University of California San Diego. “The common theme across all three debates is balancing the benefits of early intervention against concerns about overtreatment.”
Why the debate?
Dawn Eichenfield, MD, PhD, FAAD
She points to a collective voice among researchers and physicians who now emphasize that early treatment may help:
- Prevent scarring and permanent skin changes
- Reduce long-term disease burden
- Improve quality of life for patients and families
“Although opinions differ, the field increasingly recognizes that delaying effective treatment can itself carry risks, including permanent physical and psychosocial consequences,” Dr. Eichenfield said.
Such thinking represents a broader trend toward precision medicine, she said, where care is tailored to the individual patient with the goal of modifying disease progression rather than simply controlling symptoms.
Hot topics
Despite growing enthusiasm for early intervention, the dermatology community remains divided over three prominent conditions, said Dr. Eichenfield. The overarching positions on each are:
Infantile hemangiomas:
- Proponents of early laser therapy argue that treating hemangiomas during their growth phase can improve cosmetic outcomes and reduce lasting skin damage.
- Skeptics maintain that many hemangiomas resolve naturally and that early procedures may expose infants to unnecessary treatment.
Atopic dermatitis:
- New therapies, including biologics and JAK inhibitors, are transforming care. Supporters say early systemic treatment may alter the course of the disease and reduce its long-term burden.
- Critics raise concerns about cost, long-term safety, and overtreatment, especially when some patients respond well to topical therapies.
Acne:
- Some dermatologists advocate for using isotretinoin earlier to prevent scarring and emotional distress.
- Others caution that isotretinoin requires close monitoring and carries risks, arguing it should remain reserved for more severe cases.
The evidence
According to Dr. Eichenfield, navigating these complex decisions requires using a multilayered approach to evaluating research and patient care. She recommends:
- Prioritizing high-quality studies such as randomized controlled trials and systematic reviews
- Focusing on patient-centered outcomes, including quality of life
- Weighing the risks of treatment and the risks of delaying care
- Incorporating clinical experience and real-world data
- Considering individual factors such as age, disease severity, and family preferences
Dr. Eichenfield said this approach encourages shared decision-making between physicians and families, rather than a one-size-fits-all treatment model.
“The most thoughtful physicians integrate evidence-based medicine with clinical judgment and shared decision-making,” she said. “The goal is not necessarily to treat every patient earlier, but rather to identify which patients are most likely to benefit from early intervention and which can be managed conservatively.”
A more personalized future
Dr. Eichenfield said the future of pediatric dermatology will likely focus on:
- Identifying which patients benefit most from early treatment
- Refining timing of interventions
- Studying long-term outcomes like scarring and psychosocial impact
More importantly, she added, emerging research underscores that there may not always be a single “correct” answer.
“Ongoing debates reflect an evolving field where evidence is still developing and interpretations differ among experts,” Dr. Eichenfield said. “These debates also emphasize the importance of longitudinal outcomes — particularly prevention of scarring, disfigurement, psychosocial burden, and cumulative disease impact — which may ultimately prove more meaningful than short-term measures of disease activity.”
As newer therapies become available, Dr. Eichenfield said research will put more weight on evaluating the optimal timing of intervention and determining whether early treatment can truly modify disease course.
