A Rising Researcher’s Take on Underrecognized Pediatric Skin Conditions: Hira Ghani, DO

Often skin conditions in kids go undiagnosed, highlighting the importance of considering a child's caregiver when having discussions about treatment adherence, explained Hira Ghani, DO, a dermatology research fellow at Brown University.

Ghani presented her poster entitled, "Understanding Systemic Treatment Use in Pediatric Atopic Dermatitis: Clinician and Patient–Caregiver Perspectives" at the Society of Pediatric Dermatology 2025 conference in Seattle, Washington. This systematic review evaluates treatment options for pediatric segmental vitiligo (SV), a rare and often treatment-resistant form of vitiligo. Analyzing 14 studies with over 2000 patients, the review found variable repigmentation outcomes and mostly mild side effects across therapies like skin grafting, light therapy, and topical immunosuppressants. However, a lack of high-quality studies highlights the urgent need for targeted research in pediatric SV.

Transcript

In pediatric dermatology, how do you navigate treatment adherence, especially with younger patients and their families? Are there strategies or tools you find particularly helpful?

As a dermatology research fellow at Brown [University]—where I do get to spend a lot of time seeing patients during the clinic with the pediatric dermatologist, Lionel Bercovitch, MD, and the dermatology residents over there who are also interested in pursuing pediatric dermatology—I have seen that it can be tough. It can be tough in the sense that with children, you're not just dealing with them as the patients; it's their whole family, especially the parents. And adhering to the treatment could be tricky, just because children wouldn't comply.

At times, there are topical creams and ointments that need to be applied twice daily for months. For instance, when it comes to vitiligo, you have to use topical tacrolimus or pimecrolimus every day, in the morning and at night, for months. When you have a younger child who's, let's say, 5 or 6 [years old], he wouldn't be okay with it. Sometimes the ointment can burn or sting, right? Parents have to wait until they go to bed so they can apply it, and also early in the morning, before the child wakes up, before he actually finds out something is going on the face or the eyes that might cause irritation or annoy them or frustrate them.

With adults, obviously, compliance isn't really much of an issue. So, that's one thing. I feel as a parent, it's very hard for you to stay on top of things and make sure that you are applying the creams and ointments that are prescribed to your child.

What are some underrecognized or misdiagnosed skin conditions in children that you think clinicians need more awareness of?

For one, I can say vitiligo. Vitiligo may appear as hypopigmented skin patches on any part of your body. And really it may appear very similar to other skin conditions, like tinea, which you'd call a fungal infection in layman's terms.

When you see that it could look very much like a fungal skin condition or anything else, you just really wouldn't be able to call it vitiligo until you've seen it under a Wood's lamp in a dark room so you can see that the hyperpigmented patches are really depigmented patches. There is loss of pigmentation. There's no skin pigment, or melanin, in there, and that's when you know that it's actually vitiligo and not something else. That's one thing.

Any other skin conditions, like even atopic dermatitis or eczema, could be misdiagnosed or underdiagnosed in kids if they have colored skin. So with people with colored skin, many skin conditions, as you might know already, may appear differently than what you see in, like, a White individual, so that is also very tricky and challenging when it comes to diagnosis. Those are 2 skin conditions I have particularly seen in the clinic, atopic dermatitis and vitiligo, that go misdiagnosed or underdiagnosed a lot.