Lawrence F. Eichenfield, MD, and I serve together on the board of Pediatric Annals’ sister publication, Infectious Diseases in Children. Larry is a past President of the Society for Pediatric Dermatology, Editor-in-Chief of Pediatric Dermatology, President-elect of the American Acne and Rosacea Society, and also serves on the editorial boards of several journals and periodicals. He is the Director of Pediatric and Adolescent Dermatology at Rady Children’s Hospital San Diego and University of California, San Diego where he is involved in, among other areas of research, determining the causes for the spike in pediatric psoriasis.
Dr. Shulman: What drew you to becoming a pediatric dermatology specialist? Was there something in particular that intrigued you, or were you inspired by someone?
Dr. Eichenfield: I did my pediatrics training at Children’s Hospital of Philadelphia and during that experience I was exposed to both a superb pediatric dermatologist and mentor Paul J. Honig, MD. In addition, I saw a field that had a breadth of cases of rare, difficult diseases, as well as common diseases that sometimes presented in atypical ways. I was fascinated by Honig, who had the ability and experience to walk into the room, and make a diagnosis that could just change the whole course and management for that one individual. So on the one hand, I was taken by the power to make the visual diagnosis of something that was challenging and difficult, and on the other hand by the fact that there was a set of diseases that clearly had a lot of need for good research, especially for management and therapy. Once I decided to specialize in dermatology, I had to do a second residency for that, but I was fortunate enough to have extensive pediatric speciality experience during that.
Dr. Shulman: So, in addition to Dr. Honig, who else have been your inspirations?
Dr. Eichenfield: Well, my father was a pediatrician on Long Island, New York. Initially, he practiced solo, then he grew the practice. His was the old-fashioned model. He didn’t run the office out of our home, but I was raised during the age of house calls. My mom was my dad’s office manager. So, we lived “pediatrics.” I can remember them arguing at the kitchen table about antibiotic use. My mother thought my father was too judicious with his use of antibiotics, but he was ahead of his time. These kinds of conversations definitely inspired me to join in taking care of children.
Dr. Shulman: That’s sadly a bygone era, but what a great way to grow up. You recently gave a talk where you mentioned the number of pediatric psoriasis cases is on the rise.
Dr. Eichenfield: Psoriasis primarily affects adults. We don’t have data but many people think that we’re seeing a lot more psoriasis in the pediatric ages. Psoriasis in adults has now been clearly associated with significant comorbidities including early atherosclerotic heart disease, stroke, as well as hypertension and lipid abnormalities.
Dr. Shulman: So are you saying that psoriasis is a precursor to these other diseases?
Dr. Eichenfield: There are some complicating factors in the interpretation of that information because adult psoriatic patients have a tendency to be obese as well as have other issues. For example, depression, drinking, and smoking are also common in that population. Because of those questions about whether these comorbidities are partially related to the psoriasis itself as an inflammatory disease, we have begun looking at pediatric psoriasis patients. What’s interesting is that in several studies, it looks as though obesity is correlated with psoriasis in children and adolescents. In the pediatric psoriasis patients, being overweight or obese is more common than would be expected in the nonpsoriatic population, as we have seen in case controlled studies. One of the questions raised is does obesity increase the risk of psoriasis? No one knows, but that is our suspicion. We are in the process of looking for markers that are associated with higher risk for cardiovascular heart disease as well as markers of inflammation in children to see if they may give us some insight to what happens in adulthood. It appears that a subset of children may have lipid abnormalities or abnormal liver function tests. My sense is that the genetic make-up that makes someone have a greater tendency to be obese may correlate with psoriasis.
Dr. Shulman: What do you do in your free time?
Dr. Eichenfield: I like to run. I’m not built like a natural runner but I do my 4 to 6 miles on the weekend. I like to run during the week when I can but it’s hard with my schedule. I’m a terrible golfer. I go out now and then to remind myself of how bad I am. I have a broad set of other interests such as getting to New York to the theater.
Dr. Shulman: What book are you reading now?
Dr. Eichenfield: The Steve Jobs biography. I tend to read novels and non-fiction, but I wanted to read his biography because I wanted to know the story of this quirky guy with an incredible ability to innovate. I really enjoy books about people who move the world or give insight.