About 15%-20% of primary care visits by pediatric patients are for skin-related issues,
the dermatologic literature shows.
“Primary care providers end up managing a lot of skin disease because there simply
are way more pediatricians, family medicine docs and physician extenders who work
in primary care than there are subspecialists who work in dermatology,” said Dawn
Davis, MD, FAAP, associate professor of pediatrics and dermatology at Mayo Clinic,
Rochester, Minn. “We need their help, and we’re very grateful for their care of patients.”
However, not all primary care clinicians feel equipped to diagnose and manage such
“Some people either like making visual diagnoses and feel very comfortable with their
visual acumen, and some people do not,” Dr. Davis said. “A lot of times people will
say to me something like ‘I believe I have a patient with X condition. Can I please
review the patient with you? Can you please come see the patient to reaffirm my diagnosis
and to give me some tips on how to manage this patient?’”
Dr. Davis encourages primary care providers looking to improve their visual diagnostic
skills to attend a session she is presenting titled “Dermatologic Emergencies.” The
session will be held from 8:30-9:15 am Saturday, Sept. 16 (F1036) and again from 3:00-3:45
pm Sunday, Sept. 17 (F2149).
During the session, Dr. Davis will review erythema multiforme spectrum, including
Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN); staphylococcal scalded
skin syndrome; Kawasaki disease; Kasabach-Merritt phenomenon; and acne fulminans.
For each condition, she will give demographics on who gets the condition, show photos,
talk about physical exam findings, mention if there could be complications beyond
the skin, such as systemic complications, list any associated syndromes, and discuss
“It will be a lecture format with numerous photographs because dermatologists love
photographs,” she said.
All the conditions Dr. Davis will discuss are emergencies that can land a patient
in the hospital. Yet pediatricians may wonder why Kawasaki disease is on the list.
Unlike the other conditions, which usually are managed by a dermatologist, Kawasaki
disease usually is managed by a pediatrician or pediatric infectious disease specialist,
with a dermatologist providing consultation, she said. While pediatricians know a
lot about the disease, “there’s a new understanding in the medical world that there’s
a lot of atypical Kawasaki’s disease or people who don’t necessarily meet the very
stringent criteria but truly do have Kawasaki’s disease. A lot of these patients have
subtle skin findings that can be a helpful clue to the diagnosis,” she said.
Other serious skin disorders can be confused with less serious conditions. For example,
Kasabach-Merritt phenomenon initially may be diagnosed as a hemangioma or port wine
Hopefully, Dr. Davis concluded, the talk “will increase their (attendees’) comfort
level for these conditions because they are all fairly uncommon.”