Elevate-Derm West Conference 2024 Clinical Insights Day 4
- In:
Clinical Practice
Day 4: Sunday, November 10, 2024
Dermatologic Care of New Mothers: Jenny Murase, MD
Diagnostic criteria for Raynaud's Phenomenon of the nipple must include at least two of the following three criteria: 1. Observed or self-reported color change of the nipple (white, blue, or red), especially with cold exposure. 2. Cold sensitivity or color changes of the hands or feet with cold exposure 3. Failed therapy with oral antifungals
Lactation safety classification system: L1=safest, L2=safer, L3=moderately safe, L4=possibly hazardous, L5=contraindicated.
When prescribing antihistamines to a lactating patient, it is preferable to prescribe non-sedating antihistamines; loratadine is the first line.
Breastfed infants showed decreased incidence and severity of some types of allergies and may have reduced risk of asthma as an adult. Maternal dietary antigen avoidance during pregnancy has no protective effect on developing atopic dermatitis in the first 18 months of life.
IgG transfer into breast milk is significant only in the first four days postpartum.
Pearls in Pediatric Care: Lisa Swanson, MD
Pediatric patients with atopic dermatitis have an increased risk of food allergies, but food is rarely causing atopic dermatitis. Elimination diets are not recommended.
Pediatric patients with atopic dermatitis are at increased risk of asthma, allergies, and eosinophilic esophagitis.
Sunflower seed oil has been shown to help with atopic dermatitis, but it is difficult to find a good preparation for the oil.
Polypodium leucotomos is very helpful for sun-sensitive conditions like polymorphic light eruption, dermatomyositis, cutaneous lupus, etc. The capsules are large, but they can be opened and sprinkled in food or juice for pediatric patients.
Consider ordering a fecal calprotectin test on pediatric psoriasis patients to rule out irritable bowel disease if starting IL-17 medication.
Fulfilling Great Expectations: Safe Medical Management of Skin Disease in Pregnancy: Jenny Murase, MD
Family planning should be addressed in all women of reproductive potential. Fifty percent of pregnancies in the United States are not planned with a healthcare professional.
Acyclovir is the treatment of choice for herpes in pregnant patients. Expectant mothers should start prophylactic treatment for herpes simplex virus at 36 weeks gestation if planning a vaginal delivery.
During pregnancy, lupus patients follow the classic rule of thirds: one-third will worsen, one-third will stay the same, and one-third will improve.
Fetal skin shares the same desmoglein-3 profile as adult oral mucosa. Therefore, neonatal pemphigus is more likely to occur if the mother has oral disease.
Biologics for psoriasis have mounting safety data supporting the use of anti-TNF biologics in pregnancy and breastfeeding.