Lawrence Eichenfield, MD: Sharing 5 Tips for Dermatologists

During his HCPLive interview, Lawrence Eichenfield, MD, spoke at the 2023 Fall Clinical Dermatology Conference in Las Vegas about the tips he shared to his audience at his presentation ‘30 Tips in 30 Minutes.’

Eichenfield is known for his work as chief of pediatric and adolescent dermatology for Rady Children's Hospital-San Diego, as professor of dermatology and pediatrics, and as vice-chair of the department of dermatology at UC San Diego School of Medicine.

“I was responsible for 5 tips of the 30,” Eichenfield explained. “So several of them were procedural and other sorts of medical dermatology. The first one is a procedural tip. Many times we have children who come in with cysts, and you're not certain what kind of cyst it is. And there's this method where you can just take an otoscope or a flashlight and hold it up to the cyst. It translites and with the normal epidermal inclusion cyst, the light will go right through it. But if you have a pilomatrixoma, which is a calcified cyst, it becomes a solid color blue.”

He noted that, therefore, it would be called a calcified system and that can help assist clinicians in explaining to the family what the issue is, as well as a surgical approach.

“Second tip is a medical dermatology tip,” Eichenfield said. “We're in this age with new medicines for inflammatory skin diseases and, and it's good to document the severity of the disease. So when atopic dermatitis has become pretty standard, do a body surface area assessment. I just like to simplify the approach to that because I believe if you have moderate severe atopic dermatitis, it's good to do a body surface assessment.”

Eichenfield explained the typical rule, which is that 10% of body surface area is the head, neck and scalp, 20% is the arms, 30% will be the trunk, and then 40% is going to be the buttocks and legs. For babies, he explained that you borrow 10% from the legs and bring it up to their heads because the head is relatively bigger.

“Third tip relates to procedural pain control,” Eichenfield said. “So this is for doing procedures on children and we generally use liposomal lidocaine, put on 40 minutes to an hour before. For people who are doing more significant procedures are laser procedures, I just wanted them to know that the commercial cooling devices such as the Zimmer cooler unit are totally transformative. We do a lot of scar laser.”

Eichenfield explained that in prior times, dermatologists would have had to inject such patients with lidocaine, but now they can do 90% fewer injections even for a relatively painful laser procedure with the use of the cooling device.

“Next tip, also procedural, is to wrap children,” he said. “We use a ‘burrito wrap’ if we're doing procedures and for younger children, we don't want them to move. They actually do pretty well if they laugh when you put on the sheet and we had a little video, which is actually a published video at this point, in which I had a wrap up.”

Eichenfield noted that this can make procedures easier because if the younger patients are not fighting with their doctor, it's easy to do the procedure.

“And lastly, medical dermatology,” he said. “What do you do in the situation where a family has a child with pretty significant atopic dermatitis and yet they're scared about using medicine, whether it be topical steroids, non-steroids, or systemic agents. Basically, my approach is I have a set of questions that I ask. It's basically that I want to unpack the backpack of their issues with atopic dermatitis. I want to document of course their disease severity, but also sleep disturbance and itch, but also workarounds that the family might have made.”

He explained that activities that a child might not do are documented, to assess the impact of the disease on the patient. That way the family making the decision to do the appropriate therapy has a much easier time.

For more information from Eichenfield on these tips, view the full interview segment above.

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