Texas Children’s Hospital DermatologyDepartment’s Treatment Guidelines:Review and UpdatesAUDREY CHAN MD

ASSISTANT PROFESSOR

DEPARTMENT OF DERMATOLOGY

TEXAS CHILDREN’S HOSPITAL

BAYLOR COLLEGE OF MEDICINE

Rationale for the Referral System:The Numbers

~10,000 board certified dermatologists in US 2017

20 Board Certified Pediatric Dermatologists in Texas

9 Board Certified Pediatric Dermatologists in Houston

The Numbers at TCH

Demand Supply

Approximately 50 new referrals(internal and external) per day.

4 full-time, 2 part-timedermatologists

~1000 new patient requests permonth.

<600 new patient appointmentsper month

Prioritizing acuity

Urgent/Emergent(<1 week): severe pain, impending permanent functionalimpairment or scarring

High Priority (2-6 weeks): severely symptomatic DESPITE guidelines

Priority (<3 months): severely symptomatic WITHOUT GL, psychological distress

Routine(<6 months): everything else…

Triage based on information provided

TCH DERMATOLOGY GUIDELINES

Update: Acne Guidelines

Update: Atopic Dermatitis Guidelines

Update: Impetigo Guidelines

Update: Hypertrophic Scars/KeloidGuidelines

Update: Keratosis Pilaris Guidelines

Update: Molluscum Guidelines

Update: Nevi/Moles Guidelines

Update: Nickel Contact Dermatitis Guidelines

Update: Onychomycosis Guidelines

Update: Psoriasis Guidelines

Consider calling on-call dermatologistfor expedited appointment

Update: Scabies Guidelines

Update: Seborrheic Dermatitis Guidelines

Update: Tinea Capitis Guidelines

Update: Tinea Versicolor

Update: Vascular Birthmark Guidelines

Urgent/Emergent: Ulcerated hemangiomas

Urgent/Emergent: Eyelid hemangiomacompromising vision

Urgent/Emergent: Large segmental facialhemangioma (S3) with airway compromise

Update: Vitiligo Guidelines

Update: Wart Guidelines

NEW TREATMENT GUIDELINES

New: Diaper Dermatitis Guidelines

New: Hidradenitis Suppurativa Guidelines