Dermatologist with a sub-specialization in pediatric dermatology discusses the delicate balance of treating kids with skin problems
By Chris Motola
Q: You’re a dermatologist with a sub-specialization in pediatric dermatology. I understand that there aren’t very many of you.
A: Yes, we treat both, adult and pediatric patients. Pediatric is a separate board certification. There are less than 15 fellowship programs for pediatric dermatology and probably 400 or less actively practicing in the U.S.
Q: What’s fundamentally different about treating children’s skin?
A: There are a lot of differences. In a general pediatrics sense, we have a saying that children aren’t just little adults. Because of their age, the management of skin conditions can be more challenging. Where most adults can take care of their skin on their own, children and particularly infants, can’t do that. So you have to deal with and educate parents on treatment options. Children can participate in the decision-making process, but ultimately the responsibility lies with their parents. That also presents a different set of challenges. Kids are often born with genetic mutations in their skin that are unique to the pediatric population. To give you an idea of how challenging it can be, there have been several studies that have looked at the caregiver burden for children who have eczema, for example. The caregiver burden for that is akin to taking care of a parent with Alzheimer’s. So the child isn’t the only one with the disease burden but the whole family. Additionally, kids with skin conditions often do worse in school than their peers and have more trouble with social engagement.
Q: Take eczema as an example. For adults it seems like more of a nuisance than debilitating unless it’s an extreme outbreak. Do children get worse flare-ups?
A: The caregiver burden is one thing, but the other is that it disturbs the child’s sleep. That makes it harder for them to do well in school. The constant itching also sets them up for skin infections whether it be bacterial, viral or fungal. So that presents a little bit of a challenge as well. And as a mentioned before, the treatment usually needs to be initiated by the parent. It is a chronic condition. Some kids are fortunate enough to outgrow it. Some kids carry it into adolescence or adulthood, which can be a challenge. With adults it’s just a lot easier to set up a plan and have them carry it out. It can be more of a challenge for parents, especially working parents.
Q: What got you interested in the sub-specialty?
A: I think having good mentors initially does that. Some people are just drawn to working with kids. I think each age presents different joys. For me the sense of humor of 5- or 6-year-olds or the dry wit of adolescents are just fun. I really enjoy that. It takes a different skill set to engage with a child or teenager and I enjoy that. Some people don’t like working with parents and children at the same time. I think every child presents a unique opportunity to watch them grow and I like participating in that. I think that’s a gift.
Q: You mentioned that children grow out of a lot of skin conditions. What’s going on there, biologically?
A: That’s the other thing that happens. When you’re dealing with a pediatric population you’re dealing with a population that’s continuing to change and grow. And so some things will present themselves in infancy and then as the immune system matures they’ll disappear. Other things, like acne, will show up later in life. It’s unusual to see it before adolescence. Those things come and go because you’re dealing with a more dynamic system. So you can provide parents with some reassurance or at least prepare them for what’s coming down the pipe and what interventions are available at each stage. Most aspects of medicine that concern children are a lot more conservative than they are with adults.
Q: When should a parent bring their child to a specialist like you?
A: I work with a lot of pediatricians in the area. In general, whenever a parent sees anything of concern on a child’s skin, the pediatrician has some concern as well and will make a referral, if needed. The good news is, in general, kids are much less likely to get skin cancers. On the other hand, they can be more vulnerable to chronic conditions that an intervention can fix or ameliorate. We’re pretty flexible in seeing kids.
Q: Shifting to adults, how should they prepare for a skin exam?
A: The first and most important thing is no cosmetics, makeup, moisturizers. Wear clothing that’s easy to change out of. Be aware of your personal and family history, if you’ve had any changes to moles. Let us know if you’ve gone tanning, if you work outside or have had multiple sunburns. We look patients over from head-to-toe, working around underwear. I also look inside the mouth. The most important thing I talk about is that the standard of care is now to use a dermatoscope, which allows us to evaluate patients more closely.
Q: Does being a dermatologist and beekeeper give you any special insight into bee stings?
A: The nice thing is that bees are usually pretty kind. It’s the wasps, yellow jackets and hornets that are the mean guys. I think the more interesting thing with beekeeping is how incredibly organized and structured a colony is. I find that just so fascinating. One female worker will, in her lifetime, generate an eighth of a teaspoon of honey. It takes almost 600 bees to make a pound of honey. Their lifespan from hatching to death is only about a month on average.
Lifelines
Name: I.A. Tangoren, M.D.
Position: Dermatologist and dermatologic surgeon. Owns and operates I. A. Tangoren M.D. P.L.L.C Dermatology ad Dermatologic Surgery in Syracuse
Treatments: He and his team provide comprehensive evaluation and care for all medical, surgical and cosmetic dermatologic conditions to patients of all ages
Hometown: Rockville, Maryland
Education: Perelman School of Medicine at the University of Pennsylvania
Affiliations: Crouse Hospital.
Organizations: American Academy of Dermatology; American Society of Pediatric Dermatology
Family: Wife, two daughters
Hobbies: Beekeeping, gardening