How to Approach Dermatological Assessment in Children and Young People

The Importance of a Structured Dermatological Assessment

Children and young people frequently present with dermatological concerns in primary care, ranging from common conditions such as eczema and impetigo to more complex presentations requiring specialist input. A systematic and structured approach to dermatological assessment can improve diagnostic accuracy, guide appropriate management, and ensure timely referrals when necessary.

For healthcare providers, mastering dermatological assessment in paediatric patients is essential. Skin conditions in children often have different presentations compared to adults, and certain conditions are more prevalent in younger populations. Furthermore, variations in skin tones can influence how dermatological conditions appear, making an inclusive and detailed assessment framework crucial.

Key Steps in Paediatric Dermatological Assessment

A comprehensive dermatological assessment in children should include the following structured steps:

1. History Taking

A detailed history can provide valuable diagnostic clues. Key aspects to explore include:

• Onset and progression: When did the symptoms first appear? Has there been any progression or change?
• Associated symptoms: Is there itching, pain, fever, or systemic involvement?
• Previous episodes: Have similar symptoms occurred before?
• Family history: A history of atopic conditions (eczema, asthma, hay fever) or psoriasis may be relevant.
• Environmental and lifestyle factors: Consider allergens, recent infections, travel history, or new skincare products.

2. Visual Examination and Description

A structured approach to describing skin lesions can improve diagnostic accuracy:

• Site and distribution: Is the rash localised or generalised? Symmetrical or asymmetrical?
• Morphology: What is the primary lesion type (e.g., macule, papule, vesicle, pustule)?
• Colour and variation in different skin tones: Some conditions may present differently in darker skin.
• Scaling, crusting, or ulceration: Are there any secondary changes?
• Palpation findings: Assess for texture, warmth, and induration.

3. Differential Diagnosis Consideration

Understanding common paediatric skin conditions helps in forming a differential diagnosis. Some key conditions to differentiate include:

• Eczema vs. Psoriasis: Eczema commonly affects flexural areas, while psoriasis is more common on extensor surfaces.
• Viral vs. Bacterial Rashes: Chickenpox presents with vesicles, while impetigo features honey-coloured crusts.
• Allergic vs. Infectious Dermatitis: Contact dermatitis is well-demarcated, while viral exanthems are often more diffuse.

4. Further Investigations if Needed

While many skin conditions can be diagnosed clinically, some cases require additional tests such as:

• Skin swabs (for suspected bacterial or fungal infections)
• Patch testing (for allergic contact dermatitis)
• Blood tests (in cases of systemic involvement)

Enhancing Diagnostic Accuracy in Primary Care

1. Recognising Variations in Different Skin Tones

Traditional dermatology education has often been centred on lighter skin tones, leading to diagnostic challenges in patients with darker skin. It is crucial for healthcare providers to familiarise themselves with how common conditions present across diverse ethnic backgrounds.

2. Utilising Dermatology Resources and Clinical Guidelines

Staying updated with dermatology guidelines and using visual reference resources can support better identification and treatment of conditions. The British Association of Dermatologists and NICE guidelines offer valuable resources for primary care providers.

3. Seeking Specialist Input When Necessary

Some dermatological presentations require referral to dermatologists or paediatricians, particularly when conditions are severe, recurrent, or treatment resistant.

Expand Your Knowledge with Specialist Training

To support primary care providers in improving their dermatology skills, PDUK offers specialised training courses:

• Diverse Dermatology: Identifying and Treating Acute Skin Conditions in Children and Young People – This course enhances diagnostic skills by covering a range of paediatric skin conditions, with a focus on recognising variations across different skin tones.

Click here to learn more and book your place.

• Childhood Eczema: Diagnosis, Treatment, and Support – A dedicated course for healthcare providers managing paediatric eczema, covering best practices in diagnosis, treatment plans, and parental support strategies.

Click here to enrol today.

Conclusion

A structured approach to dermatological assessment in children and young people is essential for accurate diagnosis and effective treatment. By focusing on thorough history-taking, systematic examination, and staying up to date with dermatological education, primary care providers can significantly improve patient outcomes. Investing in professional development through targeted training courses will further enhance diagnostic confidence and treatment success.

References

British Association of Dermatologists (BAD) (n.d.) ‘Clinical Guidelines’, BAD Guidelines and Standards. Available at: https://www.bad.org.uk/guidelines-and-standards/clinical-guidelines/ (Accessed: 3 April 2025).​bad.org.uk

Primary Care Dermatology Society (PCDS) (n.d.) ‘Atopic eczema’, PCDS Clinical Guidance. Available at: https://www.pcds.org.uk/clinical-guidance/atopic-eczema (Accessed: 3 April 2025).​PCDS