Pediatric dermatology remains an underserved subspecialty due to workforce shortages, geographic disparities, and systemic barriers. This 4-year, single-center initiative implemented 15 targeted interventions, including optimization of provider roles, referral redesign, teledermatology expansion, and electronic health record-based scheduling strategies, to improve access and efficiency. The program achieved sustained improvements in fill rates, reduced no-shows, and decreased appointment lag times, enabling same-day appointments. By combining structural workflow redesign with technology-driven solutions, the initiative demonstrates a replicable model for expanding equitable access to pediatric dermatology care and may inform similar efforts in other underserved medical fields.

Pediatric dermatology has historically seen a shortage of dermatologists relative to demand, leading to limited access for patients, which is amplified in underserved communities. Telemedicine has emerged as an attractive means to supplement clinical care and a tool that may assist in overcoming many of the barriers present in pediatric dermatology. Studies have found that teledermatology increases access to care, decreases wait-times and provides cost savings for patients and health care systems, all while maintaining high patient and provider satisfaction. Despite limitations, telemedicine remains a powerful resource with the ability to expand access to pediatric dermatologists.

Pediatricians and pediatric subspecialists receive lower rates of compensation than their colleagues who care for adult patients. Systemic financial structures within the American health care system disincentivize both individual providers and larger health care systems from investing in pediatric care. The disproportionate overvaluation of procedural care over cognitive care in our Relative Value Unit designation structure encourages systems to focus their care energies on adult patients. In addition, the primary insurer of pediatric patients, Medicaid, systematically reimburses at lower rates than Medicare and commercial insurances.

Integrating medical photography into clinical practice provides substantial benefits and should be considered a standard patient care component. For patients, it enhances care quality, fosters engagement, reduces anxiety, strengthens trust, improves adherence, and increases access through telemedicine and E-visits. For clinicians, it facilitates consultations, supports care continuity, reduces invasive procedures, strengthens documentation to mitigate liability, and aids in monitoring treatment and capturing otherwise visually undetectable details. Additionally, with appropriate consent, medical images serve as valuable educational tools for both patients and health care professionals, helping to bridge gaps in knowledge and ultimately improve outcomes across the broader health care system.

Laser procedures are safe and effective for various medical conditions in the pediatric population. Laser therapies are viewed as elective or cosmetic rather than medically necessary leading to their denial. Laser therapy can be deemed experimental or investigational, due to a lack of sufficient high-quality evidence showing that the treatment is safe, effective, and necessary for a medical condition. There is also lack of specific Current Procedural Terminology codes leading to the use of unlisted procedure codes that cause an increase in denials or initiation of prior authorizations. Overall, insurance coverage of laser procedures in pediatric patients is highly inconsistent.

This article addresses the critical shortage in the pediatric dermatology workforce despite growing demand. It explores barriers including limited early exposure, mentorship, and lengthy, costly training pathways. The authors propose new models to streamline training, including alternative residency tracks and combined programs, while emphasizing the importance of mentorship, educational resources, and institutional support. They recommend actionable strategies like requiring pediatric dermatology exposure during training and increasing preliminary pediatric positions. The article calls for collaboration and innovation to expand access, improve training pathways, and ultimately increase the number of practicing pediatric dermatologists.

Anogenital complaints are prevalent among pediatric patients in both primary care and specialty care settings (ie, dermatology, urology, gynecology). Sensitive area examination is a critical diagnostic tool in pediatric patient care. Unfortunately, even experienced practitioners may lack formal training and confidence in performing anogenital exams. In this article, we provide a simple yet systematic approach to the pediatric anogenital exam, which outlines key components before, during and after the exam. We hope to empower physicians to confidently execute a pediatric anogenital exam while maintaining comfort for the patient and laying the foundation for a life-long practice of anogenital and sexual health.

There are life-threatening pediatric skin conditions in dermatology that require immediate recognition by pediatric clinicians. This article provides a review of these conditions including diagnostic pearls, beneficial testing, and therapeutic approaches. When these diseases are in the differential, a dermatologist should be consulted early to assist with diagnosis and management. There are barriers to accessing pediatric dermatologists that must be addressed to improve outcomes for patients.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease that can affect children and adolescents. It is often associated with significant medical and psychological comorbidities, leading to a substantial impact on quality of life. In this age group, HS is often underdiagnosed, resulting in delayed treatment and progression of disease. Timely recognition of HS by pediatricians and primary care providers is essential, particularly in distinguishing it from mimics like infections or folliculitis, providing appropriate treatment, and prevention of complications. Early referral to dermatology in severe or treatment-resistant cases can significantly improve patient outcomes.

Acne is an inflammatory condition that can affect quality of life. New topical treatments include tazarotene lotion, trifarotene, combined microencapsulated benzoyl peroxide and tretinoin, minocycline foam, topical dapsone, and clascoterone cream. More recent systemic options include subantimicrobial doxycycline, sarecycline, combined oral contraceptives, spironolactone, and isotretinoin-lidose.

Molluscum contagiosum (MC) and verruca vulgaris are common infectious skin conditions encountered by pediatric clinicians. There is substantial overlap between treatment options for both conditions, and the most effective regimens often use a combination of in-office and at-home treatments. There are innumerable treatments for both conditions. This article focuses on familiarizing the pediatric provider with prescription topical therapies for both conditions including cantharidin, imiquimod, and retinoids, as well as berdazimer sodium for MC and 5-fluorouracil and diphenylcyclopropenone and Squaric Acid Dibutyl Ester for viral warts. Other therapies including injections and oral medications will also be discussed.

Targeted therapies have revolutionized the treatment of atopic dermatitis (AD) by offering patients highly effective disease control with complete or near-complete resolution. The American Academy of Dermatology updated their 2014 AD treatment guidelines in 2023. Since 2014, the treatment of AD has evolved immensely with the advent of biologics and small molecule inhibitors. While the foundation of AD treatment has stayed relatively consistent (ie, gentle skin care, emollients, and topicals), new therapies have supplanted previous systemic agents given their superior efficacy and safety profiles. This article discusses the shifting landscape of AD treatment and provides insight into current clinical trials.

Periorificial dermatitis, rosacea, and idiopathic aseptic facial granuloma are all acneiform disorders that a pediatric provider may encounter in the clinic. This article updates the reader on the various clinical presentations of each disorder, the differential diagnosis, and details what is known about pathogenesis. Management options, along with treatment algorithms, are discussed.