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Adding a
Subspecialty with Ease: Pediatric Dermatology
Excerpted from Skin and Aging
ISSN: 1096-0120, Vol 12, Issue 05_2004, May 2004, Pages 68 - 70
By Arun P. Venkatl, M.D., M.B.A., and Fred E. Ghali, M.D.
Read complete article
Pediatric patients are an interesting patient population to work with
because they tend to get over a variety of illnesses more easily, often
cannot fully understand their disease process, need special techniques
during the history and physical exam, and require a strong doctor and
parent relationship in order to facilitate healing. These special needs
often attract certain physicians and create unique subspecialties, such
as pediatric dermatology.
A variety of conditions are commonly treated, including but not limited
to alopecia, atopic dermatitis, bacterial and fungal infections,
birthmarks of multiple types, molluscum and warts, genodermatoses,
vitiligo, and much more.
What Kind of Training is Required? Presently, you can
choose from three options. One is an intern year in
pediatrics, followed by a dermatology residency and a 1-year pediatric
dermatology fellowship. Second is a general intern year in
a preliminary medicine, surgery or transitional program, followed by a
dermatology residency and 2 years of a pediatric dermatology fellowship.
Third, those who have had at least 5 years
experience and expertise in pediatric dermatology are eligible to sit for
the annual pediatric dermatology-certifying exam between 2004-2009,
after which this path will no longer be an option.
Clinic
Operations
An increasingly large demand for pediatric dermatologists exists in both
academic and private practice settings. A large majority typically
practice in the academic/university hospital setting. This is in direct
contrast to the field of adult dermatology, where only 10% to 20% of the
dermatologists practice in the academic/university setting.
The Right Tools
Certain
clinical tools are helpful in a pediatric dermatology clinic. Useful
supplies include cantharadin extract (for warts and molluscum), liquid
nitrogen (for warts and molluscum), squaric acid (for warts and
alopecia), and topical anesthetics (pre-op for minor procedures).
Secondly, access to the use of a pulsed dye laser is useful for treating
port-wine stains and other vascular lesions of the skin. The costs
associated with this laser, as well as the possible need for general
anesthesia, often limit its use to a hospital or outpatient surgical
facility. Another important tool
is a phototherapy unit, which is often used in the treatment of atopic
dermatitis, pityriasis lichenoides, psoriasis and vitiligo. The most
useful and safest mode of therapy is the narrowband UVB phototherapy
unit, which may cost around $10,000 depending upon the amount of bulbs
contained in the unit.
Reimbursement Issues
Due to a high number of referrals from the general pediatricians, the
patient encounter codes may be weighted more toward consultation visits,
which can be especially true in the academic/university setting. Common
procedural codes in pediatric dermatology include the following:
17000 (common warts)
17100-17111 (flat warts and molluscum)
17106-17108 (destruction of vascular proliferative lesions such as port
wine stains, hemangiomas or pyogenic granulomas)
96910 (phototherapy).
Choosing this Area
of Practice
There is a high demand for pediatric dermatologists and it should not be
difficult to seek employment in either the academic or private practice
setting. This is an exciting time to be a part of this specialty as the
field is currently evolving. As previously mentioned, it is now an
official subspecialty of dermatology with the American Board of
Dermatology.
Perioral dermatitis. Photo courtesy of Dr. Ghali.
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