Sarah Hallowell, MSN, CRNP, BSN, RN, and Catherine Griffin, MSN, APRN, CPNP-AC/PC
Ms. Hallowell is with Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Ms. Griffin is with MUSC Children’s Health, Charleston, South Carolina.
Funding: Arcutis Corner is supported by Arcutis Biotherapeutics.
Disclosures: The authors have no disclosures to report.
Introduction
Pediatric dermatology is entering an exciting era, and nurse practitioners and physician assistants have never been better positioned to shape it. Some of us work in dedicated children’s clinics, hospitals, or academic institutions, while others evaluate pediatric patients alongside adult patients in general practice. Across these settings, advanced practice providers (APPs) are bridging the gap between clinical expertise, growing wait times, and the needs of families caring for a child with a skin condition.
In pediatric dermatology, what happens beyond the prescription is just as important as what we prescribe. A nervous child might arrive with an overwhelmed parent. A family might be trying to absorb a treatment plan alongside school schedules, work demands, siblings, and other commitments at home. In these moments, our role extends well beyond a diagnosis and prescription. We also build trust, make treatment plans feel manageable, and create long-lasting partnerships with families.
Earning Trust
Trust is at the heart of every pediatric dermatology visit for both the child and the caregiver. The child needs to feel safe in our care, while the caregiver needs to trust that we understand their child’s individual experience with skin disease and feel confident in the treatment plan.
Trust begins immediately in the first few moments of the visit through simple gestures like a friendly introduction, sitting at a child’s eye level, speaking directly to them when appropriate, and explaining what you are going to do before you do it. The language we use can specifically help set the tone for the exam. The exam might start by saying “We are going to look at your skin today.” This setting of expectations can help reduce a child’s anxiety about what will happen next. Engaging the child in the visit by asking “Can you show me where you are itchy?” can feel less intimidating while also giving them a sense of control through participation.
Caregiver trust is built initially through listening. Many caregivers experience a long journey before finally reaching your pediatric dermatology clinic. Families want to know that the provider has done their research on their child’s unique history. Reviewing their individual case and being prepared before entering the room instills trust that the provider is tailoring care specifically for their child. From there, confidence in the plan comes from being realistic about what we are asking them to manage at home. Whenever possible, simplify the regimen and be specific. When the plan is more involved, acknowledging the complexity and potential burden can go a long way. For example, “I know wet wraps are tedious, but this is short term. Let’s schedule a follow up in just a few weeks and hopefully we can simplify our plan then.” Similarly, if there is a possibility of needing systemic therapy, talking with families about biologics early on can help families anticipate future conversations and begin considering the options. Simple acknowledgements and anticipatory guidance provide parents with empathy and reassurance that their provider is already thinking one step ahead of the care plan developed at the initial visit.
Making Care Plans Manageable
We can create an ideal treatment plan that becomes impracticable the moment a family leaves the office if it is too complicated to follow. Simple and precise plans are often the ones children and caregivers are most likely to carry out. We can achieve adherence by limiting the number of prescriptions and providing specificity. This might look like “Let’s keep the plan simple with one medication for sensitive areas and another for the body” or “This is a single treatment that can be used anywhere.” Rather than telling a family to “use a thick, bland emollient,” tell them specific moisturizers with which you have had success.
This becomes even more important with chronic disease. Families should be instructed on how to maintain the skin when doing well and the changes to make during a flare. Some families might benefit from receiving direction on how to identify a flare. For example, “When the skin is rough and red, that means the skin is flared and topical medication is needed.” Before the family leaves, ask, “Does this feel manageable?” That question can uncover barriers you might not otherwise have known and gives you the opportunity to adjust the plan together. Ultimately, families should leave with clear, written instructions and feel confident knowing exactly what to do when they get home.
Creating Partnerships
One of the most rewarding parts of pediatric dermatology is watching patients grow up. The infant with eczema becomes the toddler who cannot sit still, then the school-aged child embarrassed by a visible rash, and eventually the teenager who is ready to take more ownership of their care. While their skin disease might change along the way, their goals and priorities might also change. A regimen that worked well when a parent was applying medication to an infant might be far less practical for a teenager balancing school, a job, extracurricular activities, and friends. We, as APPs, are uniquely positioned to provide continuity across each of these stages and can gradually give children an age-appropriate role in their care.
Setting expectations is just as important as identifying goals of care. For chronic conditions that wax and wane, conversations should focus on meaningful improvement rather than promising a complete cure. Questions such as, “What is the most important thing you want us to make better?” or “Does your skin ever keep you from doing anything fun?” can reveal patient-specific goals and functional impact of their skin disease.
All treatment options should be presented openly with their risks, benefits, and alternatives, and a treatment plan should be jointly agreed upon, fostering the partnership. This patient-centered approach gives caregivers and children a voice and involvement that builds their confidence and sense of ownership in their care.
Asking for Help
Pediatric dermatology is broad, and even experienced clinicians will encounter cases where another perspective can make the difference. Good clinical judgement comes with knowing when to ask another dermatologist to take a look, reach out to a colleague with expertise, or consider a biopsy, additional workup, or referral. Collaborative practice not only strengthens the care we provide but also creates opportunities to learn from one another and grow professionally, which contributes to a more positive and fulfilling work environment.
Promoting Longevity
A career focused on children lasts only when the work itself remains sustainable. Intentional scheduling can help by balancing new and return patients, strategically placing virtual visits, avoiding late-day overbooking when possible, and building additional time into the schedule for more complex cases.
Similarly, the electronic record can either consume the day or, when optimized, can promote efficiency. Development of preset smart phrases, order sets, patient instructions, and note templates can decrease time spent on documentation and allow for more attention to be given to the child and family during the visit.
Clinic staff and professional relationships are also vital to longevity. Training staff on provider preferences such as all new patients in gowns, pregnancy tests for female patients on isotretinoin, and preprocedural application of topical anesthetic for warts creates a shared mental model and efficiency. The idea of a shared mental model also applies to patient messages and refill protocols. By training staff on disease processes, treatments, and provider preferences, staff are better educated to further investigate patient messages and refill requests to avoid automatic forwarding and provider disruptions.
Finally, the quieter work of noticing a job well done and celebrating one another matters in the workplace. Celebrating professional weeks, career achievements, personal milestones, birthdays, and even scheduling gatherings outside of work help to promote workplace positivity, a feeling of value, and job satisfaction allowing a pediatric practice to endure.
APPs in Pediatric Dermatology Research
Perhaps one of the most exciting areas of growth is clinical research, where more APPs are stepping into investigator roles. Research has traditionally relied on physicians to serve as principal investigators, but as studies become more complex, demanding, and costly to conduct, APPs are increasingly well positioned to help fill that gap. Our close, sustained relationships with patients also give us a valuable perspective on what matters in day-to-day care, whether leading a study as principal investigator or contributing as a key member of the research team.
For APPs looking to grow into these roles, the path often starts with smaller opportunities to get involved. A first step might be a poster, case report, research project, or presentation. Support for professional development can help make these opportunities possible; therefore, it is important to advocate for funding for continuing education through your institution or practice. Most importantly, do not wait until you feel like an expert to raise your hand. These experiences build a greater clinical expertise while giving APPs a voice in the research shaping our field and an opportunity to ensure that the questions we study and the outcomes we measure reflect what matters most to the patients and families we care for.
Find Your Niche and Continue Learning
There is no single path to becoming an excellent pediatric dermatology NP or PA. Some clinicians will build their careers entirely around children, while others will develop pediatric expertise within a broader dermatology practice. Some clinicians might find a niche within the field. As pediatric dermatology continues to evolve, NPs and PAs should also advance their practice alongside the field through mentorships, conferences, literature, conversation, and continued learning.
From the 2nd Annual RAPIDS Immuno-Dermatology Conference: From Approval to Adoption—Translating Innovation Into Clinical Practice