Unique Considerations for Pediatric Dermatologic Laser Treatments

The use of dermatologic lasers in pediatric patients presents a multitude of unique challenges, from psychosocial issues to informed consent and pain management. Pediatric dermatologists emphasize that while lasers can effectively treat various skin conditions in children, the approach must differ significantly from that used for adults.

According to Dr. Andrew C. Krakowski, MD, network chair of Dermatology at St. Luke's University Health Network in Easton, Pennsylvania, 'performing laser surgery on kids tends to be a very different experience than working with adult patients.' He notes that while adults typically seek laser treatments to enhance their appearance, children often view such procedures with reluctance, preferring to avoid the doctor's office altogether.

Lasers have been utilized in pediatric dermatology for over three decades, with applications ranging from hair removal to the treatment of vascular anomalies and scars. Dr. Kristen M. Kelly, MD, professor and chair of Dermatology at the UCI Irvine School of Medicine, states, 'Lasers can be useful for patients of all ages, from newborns to people over 100 years old, depending on what you’re trying to treat.' However, the lack of comprehensive data on the safety and effectiveness of these treatments in children underscores the need for tailored clinical guidelines.

Research conducted by Dr. Anna Yasmine Kirkorian, MD, chief of Dermatology at Children’s National Hospital in Washington, DC, indicates that lasers are particularly effective for hair removal in the pediatric population. In a 2024 review, Kirkorian and colleagues found that 'all methods of hair removal appear to be safe and generally well tolerated in children.'

The psychosocial ramifications of scarring in children cannot be understated. Dr. Krakowski points out that disfiguring scars can lead to increased anxiety and feelings of social isolation, particularly in adolescents. A cross-sectional study published in JAMA Dermatology in 2024 involving 1,671 children highlighted that skin disorders often result in bullying and stigmatization, issues that pediatric dermatologists need to address more seriously.

Informed consent for laser procedures in children presents its own challenges. Dr. Kirkorian explains that while children cannot legally consent to medical procedures, they should be allowed to assent whenever possible. Parents play a crucial role in this process, providing consent while ensuring that the child is informed and willing to participate. 'It’s important that we do not force children to undergo procedures that are not medically necessary if they are unwilling participants,' she emphasizes.

Pain management also requires a nuanced approach. Dr. Lisa Arkin, MD, director of Pediatric Dermatology at the University of Wisconsin School of Medicine, notes that while many children can tolerate laser procedures, some may require general anesthesia, especially in cases of extensive trauma. Techniques for managing pain include topical anesthetics and distraction methods such as music or virtual reality.

Managing expectations is critical. Dermatologists must communicate thoroughly with both parents and children about the potential outcomes of procedures. Dr. Kelly advises against making absolute promises, stating, 'I never promise that I’m going to completely remove the scar, but we can dramatically improve it.'

In conclusion, while lasers offer promising treatment options for pediatric dermatological conditions, the complexities of treating children necessitate a distinct approach. From informed consent and pain management to addressing psychosocial issues, dermatologists must navigate these challenges to ensure effective and compassionate care for their young patients. As the field continues to evolve, further research and the development of clinical guidelines will be essential for optimizing outcomes in pediatric laser treatments.