Pediatric Skin Disease Frequencies and Dermatology Use by Race and Ethnicity in US Children’s Hospitals

Importance: Understanding which children present with skin disease and reach specialty care is essential for characterizing patterns of disease frequency and care use. Objective: To describe the frequencies of common pediatric skin diseases and patterns of dermatology use, stratified by race and ethnicity, across 8 US children's hospitals participating in the PEDSnet system. Design, Setting, and Participants: This was a multicenter cross-sectional study of 8 US children's hospitals in PEDSnet from January 2009 to July 2022. Data were analyzed from January 3 to March 26, 2024. The study cohort included children with 1 or more dermatology clinic visit or 2 or more non-dermatology clinic visits coded for atopic dermatitis (AD), acne, infantile hemangioma, psoriasis, or hidradenitis suppurativa (HS). Main Outcomes and Measures: Disease frequency per 100 000 children and proportion of children using dermatology care for each condition, stratified by race and ethnicity. Results: Of 536 776 patients, the mean (SD) age was 6.4 (6.3) years, 51.5% were female, and 0.2% were American Indian or Alaska Native, 6.4% Asian, 27.9% Black, 14.1% Hispanic, 0.3% Native Hawaiian or Other Pacific Islander, 8.4% non-Hispanic, 44.3% White, 4.3% multiple races, 5.5% unknown ethnicity, and 16.6% unknown race. Case counts were 377 970 for AD, 139 632 for acne, 54 305 for infantile hemangioma, 11 339 for psoriasis, and 5722 for HS. Electronic health record-derived frequencies varied across race and ethnicity groups. There were 10 469 (95% CI, 10 414-10 524) cases of AD per 100 000 Black children compared with 3099 (95% CI, 3083-3114) per 100 000 White children. There were 290 (95% CI, 280-300) cases of infantile hemangioma per 100 000 Black children compared with 764 (95% CI, 756-772) per 100 000 White children. Black children had a low proportion of dermatology use across all 5 conditions, yet high frequencies of AD, acne, and HS. Conclusions and Relevance: In this study, across all studied conditions, Black children had a low proportion of dermatology use at participating PEDSnet US children's hospitals, despite having high frequencies of AD, acne, and HS. Further research is required to determine whether these patterns represent appropriate specialty care use or reflect gaps in care.