Every day, a child with a dermatologic condition will enter the pediatrician’s office, or the emergency room. The challenge we’re faced with is that pediatricians have variable training in dermatology, and there is a tremendous shortage of pediatric dermatologists worldwide. Confounding this problem is the fact that in dermatology, there are very few diagnostic laboratory tests. Diagnosis, treatment, and management are based heavily on clinical assessment and clinical judgment. Parents often ask, “How do you know just by looking?” and some critics have likened dermatology to “witchcraft.”
The practice of dermatology may seem simple, or easy at first glance, but actually dermatology is quite difficult to do well. Moreover, dermatology is very difficult to learn. Try as we might, dermatology cannot be entirely self-taught. As a pediatric resident (many moons ago), I was very interested in dermatology and whenever a child came in with a rash or a birthmark, I read and looked up everything I could get my hands on. It was often a frustrating endeavor, because, even if I was pretty sure of the diagnosis, there was often no way for me to confirm it by myself. Although much can be learned through reading and perusing atlases, one cannot master dermatology without clinical training. One must see many patients, with many follow-up visits over time, with a seasoned dermatologist’s guidance, in order to train one’s eye.
So, perhaps ironically, I was asked to serve as guest editor of an issue aiming to educate readers about difficult dermatologic entities. This issue of Pediatric Annals cannot be a comprehensive tome, but hopefully it will serve as a collection of readable and practical articles. I asked the authors to organize, clarify, and summarize the crux of six dermatologic conditions that can be urgent, or even life-threatening, to infants and children. They have also generously supplied beautiful clinical photographs to share what their eyes see. I believe that these articles will help show you the clues to look for, the issues to be aware of, and the language with which to discuss issues with your friendly local dermatologist. I hope that the pages that follow will help provide a dermatologic foundation and stimulate your interest in dermatology. I hope that if you are very keen on learning dermatology, like I was, you will seek out a pediatric dermatologist to continue the dialogue, and maybe even see some rashes and birthmarks together, even just for a few hours, to better learn this fascinating craft.
I would like to thank my colleagues Dr. Nina Livingston, Dr. Melinda Jen, Dr. James Treat, Dr. Richard Antaya, Dr. Deanne Robinson, Dr. Brandon Newell, Dr. Kimberly Horii, Dr. David Berk, and Dr. Susan Bayliss for sharing their experience and wisdom in the following pages. I hope you enjoy this issue as much as we enjoyed writing and photographing for you.