In this video blog, Lisa Swanson, MD , briefly discusses highlights from her lecture, Text Messages to a Pediatric Dermatologist , given on November 9, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

Built from the actual text messages she receives from dermatologists, PAs, and pediatricians, Dr. Swanson's talk walks through the everyday pediatric cases that stump providers. For facial-predominant eczema in babies and toddlers — historically "stubborn to treatment" despite topical steroids, TCIs, and antibiotics — she credits the Aron regimen, a super-dilute compounded mix of betamethasone valerate, mupirocin, and a moisturizing base (Vanicream or Plastibase) developed by Dr. Aron in the UK. She calls it flexible enough that "there's no wrong way to Aron regimen," usable up to five times a day for flares or nightly for maintenance, and cautions against having families mix the components at home because they don't blend evenly.

For peri-oral dermatitis she starts with a topical calcineurin inhibitor (usually pimecrolimus cream), setting expectations that it can take a month and works about two-thirds of the time, and has grown "gun shy" about oral antibiotics after an amoxicillin reaction — now reaching for topical ruxolitinib, roflumilast, or older options like clindamycin, metronidazole, and gentamicin ophthalmic ointment. On telling HSV from impetigo, she urges providers to "train your brain" to consider both, and when unsure, swab for bacterial culture and HSV PCR while treating for both.

  • Facial-predominant eczema in kids under three to four responds well to the Aron regimen — a super-dilute compound of betamethasone valerate, mupirocin, and Vanicream or Plastibase; write out the recipe so steroid-fearful parents can see how little steroid it contains.
  • Don't have families mix the Aron components at home — compounded powder bases blend far more evenly and give better results than squeezing separate tubes together.
  • For peri-oral dermatitis, start with a topical calcineurin inhibitor (pimecrolimus cream twice daily), warn it can take a month, and expect about two-thirds efficacy; topical ruxolitinib works fast when it works.
  • When a remedy list is long, no single option is perfect — be prepared to try several, and lean on topicals longer before resorting to oral antibiotics.
  • HSV and impetigo can look identical; when unsure, swab for bacterial culture and HSV PCR and treat for both — rapid spreading favors impetigo, recurrence favors HSV.