ITASCA, IL - The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, has released a list of common medical therapies and practices related to children’s dermatology that may be unnecessary and should be considered carefully by physicians and parents.
The AAP Section on Dermatology developed the evidence-based list after considering common issues that come up during pediatric visits.
“We encourage parents to ask questions about their child’s care, and for physicians to be responsive and thoughtful about the best treatment for specific conditions,” said Bernard Cohen, MD, FAAP, a member of the AAP Section on Dermatology. “Unnecessary treatments or testing are a waste of time, convenience and expense, and can sometimes lead to more harm than good. We offer these suggestions based on the evidence and experiences of our peers.”
The Section on Dermatology recognizes there are unique considerations and options as it concerns children. The list is available here and includes:
- Do not treat tinea capitis with topical medications only, which is insufficient to effectively treat the infection. Tinea capitis, an infection of the hair shafts of the scalp, requires a systemic treatment that includes the use of oral antifungal medications, most commonly griseofulvin and terbinafine. The available formulations and dosing are often used off-label but safe and effective if more recent guidelines are followed.
- Do not routinely order laboratory tests for associated autoimmune diseases in healthy patients with vitiligo in the absence of signs or symptoms of the diseases in question. Recognizing the risk of associated autoimmune conditions has led physicians to screen patients with vitiligo for other diseases. Yet there is no convincing evidence that extensive laboratory workups in the absence of specific clinical suspicion improves outcomes for patients. This approach may result in additional costs and harms. Thorough review of systems and physical examination are good screening tools.
- Do not routinely order laboratory tests for patients with the hair loss disorder known as alopecia areata in the absence of signs and/or symptoms of the diseases in question. Patients with alopecia areata have an increased risk of other autoimmune conditions, with thyroid disease being the most common. Thyroid function testing, including screening for thyroid autoimmune disease or hypothyroidism, is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history of thyroid disease.
- Avoid the use of combination topical steroid/antifungal medications for tinea corporis, Candida skin infections, and diaper dermatitis. Combination products contain a relatively high potency topical steroid and frequent applications may result in complications related to the topical steroid. Topical antifungal agents may be safely applied 2-4 times a day for an extended period and a separate low potency topical steroid may be used sparingly once or twice a day to suppress inflammation and pruritus for short periods of time as needed only.
- Avoid the use of systemic (oral or injected) corticosteroids in most cases of atopic dermatitis, as many short- and long-term adverse effects limit their use. Moreover, most patients treated with systemic steroids will rebound following discontinuation of the steroid. In general, atopic dermatitis can be adequately controlled with good skin care practices and topical prescription therapies. Patients with severe recalcitrant atopic dermatitis may be candidates for new safer non-steroidal biologics or other non-steroidal systemic medications.
The list, Five Things Physicians and Patients Should Question, is available through the Choosing Wisely website. Choosing Wisely® is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary.
At least 80 medical specialty societies have published more than 500 recommendations of overused tests and treatments as a result of the initiative, launched in 2012.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.