Boise, ID-based Pediatric Dermatologist Dr. Elizabeth (Lisa) Swanson’s warmth and sensitivity shine through when she discusses her patients, especially those with special needs such as kids with autism spectrum disorder and Down syndrome.
Dr. Swanson recently gave a talk on Compassionate Dermatology and Managing Special Needs Patients at the 2025 Diversity on Dermatology meeting in Louisville, KY. She sat down with The Dermatology Digest to share some of the main takeaways from her presentation to help colleagues better understand and care for these patients.
TDD: What are some special needs pediatric dermatology populations that require compassionate care?
Elizabeth Swanson, MD: “The first group is patients on the autism spectrum. The second group is patients with Down syndrome. The third group is kids that have been affected by trauma in their life, and the fourth group is kids that are affected by language differences.”
TDD: Fully 1 in 36 children in the U.S. have autism. How do you approach kids with autism spectrum disorder in your practice?
Dr. Swanson: “When you’re treating patients on the spectrum, they are very sensitive to sound and touch. In a busy office, the sound can often be too much. You want to make sure you can try to accommodate these patients and get them back to an exam room as quickly as possible. If that’s not possible, suggest the family wait in their car in the parking lot until their appointment. You want to make sure that the music’s not too loud. You also want to make sure that you warn them if you’re planning on touching them. They like and expect clear communication about what will happen during the visit. You never want to surprise them and suddenly try to touch their arm or look closely at their face. You want to let them know what you’ll do before you do it, and you want the environment to feel comfortable for them.”
TDD: What skin conditions occur more frequently in children with autism spectrum disorder?
Dr. Swanson: “Autism spectrum disorder is incredibly common in patients with atopic dermatitis (AD). Patients with AD have higher rates of attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, learning disabilities, and autism spectrum disorder, and for years and years we wondered why. There was an article in the pediatric dermatology literature by Silverberg et al. that posited the hypothesis that it has to do with the effect of excess Interluekin-4 (IL-4) on the developing brain. Now that we have a therapy that targets IL-4, we could potentially thwart, prevent, and mitigate some of this. I can also anecdotally report that the patients I’ve treated with autism spectrum disorder that have AD who go on dupilumab (Dupixent, Sanofi & Regeneron) show a pretty profound improvement in some of their behavioral issues. This is just anecdotal, but I have seen a noticeable change and heard from countless parents that it does seem to help with some of those behavioral issues for patients with autism spectrum disorder.”
TDD: How may tactile sensitivities affect therapeutic choices in these patients?
Dr. Swanson: “Patients on the autism spectrum don’t really like the way almost any topical medicine feels on their skin. There are a couple of topical medicines that I find particularly well suited for patients with autism spectrum disorder with tactile sensitivities. They included topical ruxolitinib (Opzelura, Incyte) and topical roflumilast foam (Zoryve, Arcutis). These products are very rarely associated with any burning and stinging. They have a very nice feel on the skin. They’re not too goopy, so patients with tactile sensitivities tend to do very well with them. If you’re dealing with a patient on the spectrum, it can be easier to propose a systemic therapy option as opposed to topical management because the topicals are so hard to tolerate or simply so hard to work into the routine of the day for patients, that, being on a systemic therapy, whether it be an injection every few weeks, or a pill every day, often that can be an easier approach for patients and their parents. Thinking about these things as you approach the patient who’s on the spectrum and has these tactile sensitivities as you come up with and discuss a treatment plan is important so that everybody feels heard, understood, appreciated, valued, and that you give them the absolute best care individualized for them.”
What skin conditions occur more frequently in children with Down syndrome?
Dr. Swanson: “The two most common are eczematous dermatoses and folliculitis. Folliculitis is actually not an uncommon problem to see, and it can be a very frustrating problem because it looks like folliculitis. Still, it often also has features of acne or hidradenitis suppurativa, and it can be very recalcitrant to treatment. We do not know why. With folliculitis, there was a recent article that talked about common skin conditions in the Down syndrome patient population, and folliculitis numbers, but they didn’t posit any hypotheses as to why it was happening. I think perhaps if we understood better why it’s happening we would have better answers for treatment, so hopefully one day we’ll get there.”
