Children are not just little adults
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, February 1, 2023
This teaching point was drilled into me many years ago during my medical school pediatric rotation. Caring for children with skin diseases over the years allowed me to understand how true this statement really is, but I didn’t always realize in how many ways they differ from adults. For starters, there are biological differences. We now appreciate that we cannot simply take medical treatments that have been studied in adults and downsize them, hoping that children will have the same responses — and suffer the same side effects — that adults do. For years, medical research in children lagged, in part because it was considered unethical to do research in children. Once it was recognized that this approach might inadvertently harm rather than protect children, pediatric research moved forward, but it remains challenging, and I am forever appreciative of our colleagues who go the extra mile to conduct pediatric clinical studies so we can have safe and effective treatments for kids. It takes time, but we now have FDA approval to use several of our important biologics in children. We hear from several of our valued pediatric dermatology colleagues this month in our feature on the use of biologics in children; while they celebrate the availability of these critically important medications for managing complex skin diseases in our children, they remind us that as is the case with adults, FDA approval does not guarantee access. Access to care can be particularly problematic for children, many of whom are bound by limited state Medicaid formularies. Getting these medications may take a fight, whether it be a prior authorization battle or directly working with Medicaid to get these drugs added to their formulary.
You have heard my prior pleas to get involved; perhaps fighting for pediatric access to medications might be a good reason to jump into advocacy at the state or federal level. Read our other article this month for inspirational words on the topic from one of the AADA’s top advocates, Dr. Alex Gross, as well as a call to participate from Academy President Mark Kaufmann. I challenge you not to be inspired, if only for the children. However, there are plenty of other active issues in skin and hair legislation, which we review this month in our second feature. With the political landscape always changing, I’m appreciative for our colleagues and staffers at the AAD/A who are keeping a close eye on the many topics relevant to our specialty.
Our final feature this month delves into the changing face of medical care. Digital pharmacies and direct-to-consumer (DTC) teledermatology websites are among the many changes we have seen in the past few years. Whether these arose more as a result of poor access to in-person care, or simply as an effort to address a growing demand for health care, “on-demand” is perhaps unclear, but these virtual forms of care are being utilized by a significant number of people, including some of our own patients. If you still watch any form of television, you may have seen ads for “Hims” and “Hers.” From their offerings, it appears that a substantial number of people want treatment for skin issues, hair loss, anxiety/depression, and sexual dysfunction. Is this good or bad medicine? At this point, I can only say it seems to be popular medicine. Guess we will stay tuned.
