Creative Treatment Options for Dermatology Practice, with Elizabeth Swanson, MD

Credit: Tim Smith

At the 2024 Fall Clinical Dermatology Conference in Las Vegas, Nevada, a talk was given on unique treatment options for dermatologic conditions such as hemangiomas, guttate psoriasis, and pyogenic granulomas. The talk was titled ‘Heard About It, Did It, Now it's Part of My Practice.'

Elizabeth Swanson, MD, pediatric dermatologist at St Luke’s Children’s Hospital, spoke about several options she has implemented in her pediatric dermatology practice that she recommends others consider. Swanson delved into the rationale behind the decisions and their use for various types of conditions.

Swanson first touched upon the general feeling among patients in dermatology practices and the struggles many face with insurance.

“Reimbursements are going down,” Swanson explained. “The number of patients we need to see every day is going up. The money that patients are having to spend on their own health care is going up, which means the general anger level of people is going up.”

With this situation in mind, Swanson noted that the dermatology ‘toolbox’ of options for management of different conditions is improving and has seen great strides made in recent years.

“I thought I'd start with hemangiomas, because that's how I started in life,” Swanson said, pointing to her slideshow photos. “This is me. I had 3 hemangiomas, the 2 you can see, and 1 on the top of my head. My mom tells me I was born to be a pediatric dermatologist because of my 3 hemangiomas…They grow for the first 9 - 12 months of life, they plateau, and then they slowly go away. Some hemangiomas can just be let be, but other hemangiomas you need to treat. Propranolol is still super great.”

Propranolol, Swanson noted in her presentation, is known for its safety for pediatric patients. Later, Swanson talked about conditions such as guttate psoriasis, for which she typically, which she noted is first treated with topical medicines though she then went into using ixekizumab for guttate psoriasis.

Swanson specifically highlighted an 8-year-old patient whom she had treated with ixekizumab for his guttate psoriasis. The patient saw significant results in only a couple of months.

“Next 1 is creative treatments for pyogenic granulomas, and we see these all the time,” Swanson explained. “We could shave this off but we’ll all be crying in the end…So do we have any other options? Well, for a while, I've been using topical timolol for pyogenic granuloma, supplied at just 1 drop twice a day. It works very well. You'd want to follow up to make sure it's working.”

At 1 month, Swanson commented that dermatologists can expect that if they see improvement, the treatment is on the right track. If shaving off a pyogenic granuloma, Swanson recommended using OB-GYN Q-tips. She noted that they are useful when clinicians shave off granulomas to capture the bleeding.

“Lastly, spesolimab for generalized pustular psoriasis,” Swanson said, pointing to another patient example. “Anna has generalized pustular psoriasis, and we started her on cyclosporine initially, acitretin, I tried methotrexate, I tried ustekinumab, I tried ixekizumab, I tried guselkumab, I tried all of these things. And I couldn't get her off cyclosporine.”

Swanson believed that what her patient truly needed was spesolimab, which she noted was a problem as it had been approved for patients aged 12 years and up. Despite the uphill battle she acknowledged with the patient’s insurance, Swanson found that the treatment led to positive results.

For additional information on related talks from Fall Clinical Dermatology, view our latest conference coverage here.

The quotes used in this description were edited for the purposes of clarity.