Pediatric Pearls: Insights from Lisa Swanson, MD, FAAD, at DERM 2025

Lisa Swanson, MD, FAAD, pediatric dermatologist at Ada West Dermatology in Boise, Idaho, delivered several impactful sessions on pediatric dermatology at this year’s DERM 2025 NP PA CME Conference in Las Vegas, Nevada. In her first talk, “Systemic Therapy for the Pediatric Acne Patient”, Swanson emphasized the importance of understanding acne across developmental stages. She clarified that while neonatal acne is benign, toddler acne in patients 18 months to 3 years is clinically significant and may cause scarring, requiring prompt treatment. Mid-childhood acne in patients ages 3 to 7 warrants an endocrine workup due to its atypical presentation. Swanson also noted that teenage acne is emerging at younger ages, with theories suggesting environmental hormone exposure via animal products is a contributing factor.

Swanson discussed several systemic treatments, including oral antibiotics, hormonal therapies like oral contraceptives and spironolactone, and isotretinoin. She encouraged attendees to feel confident initiating oral contraceptives when indicated and provided practical counseling tips. She also stressed the importance of de-stigmatizing isotretinoin and fostering open, informed conversations with patients and families about its use.

In her next session, "What’s New in the Kiddy Pool: Case-Based Review of Off-Label Pearls for Treating Children," Swanson urged clinicians not to fear off-label prescribing when based on sound evidence and clinical judgment. She specifically advocated for broader comfort with JAK inhibitors in managing alopecia areata and vitiligo, both of which carry substantial psychosocial burden. Her message was one of empowerment, encouraging providers to feel excited and confident offering effective, albeit off-label, therapies to children.

“We as medical professionals are allowed to think outside the box,” Swanson noted. “So if we've done the homework and we have learned all about these therapies, and we feel confident in our prescribing of them, we display that confidence to our patients and their families and help make lives better by offering them.”

Swanson’s final talk, "Rough Surf: Tips for Speaking with Parents," tackled one of pediatric dermatology’s greatest challenges: navigating complex dynamics with caregivers. She introduced the strategy of “gentle persistent persuasion”—revisiting treatment conversations over time to build trust and acceptance. She also cautioned against becoming defensive when parents resist medical advice, instead advocating for empathy-driven communication. Swanson highlighted the need to balance parental concerns with adolescent autonomy, encouraging compromise and collaboration in shared decision-making.