pediatric dermatologist?

[Anonymous]

Can anybody recommend a pediatric dermatologist? My 3 mo. old son has a birthmark on his face that I may want to get removed but need someone who is skilled and won't leave a scar. Thanks!

[Anonymous]

I think where you want to go will depend on the type of birthmark - do you mind saying? (Our DC has a port wine stain that we are treating with lasers, so that's what I am most familiar with.) As for Drs, we first saw Dr. Silverman at Georgetown who gave the diagnosis (but they don't do laser treatment there). We then went to Dr. Cohen at Johns Hopkins (and have received most of the treatments from Dr. Puttgen there.) We have been really happy with the clinic at Johns Hopkins - highly respected professionals, and they take insurance (we have BCBS).

Do be prepared for long wait times however. I think we have waited a minimum of 3 months whenever we have scheduled an appt.

[Anonymous]

Thank you so much for the recommendation! Our son has a strawberry hemangioma on his face and a fairly sizable port wine stain on his wrist. My understanding is that the hemangioma can be surgically removed while the port wine stain can be lasered, as you mentioned. Am more concerned with his face at the moment since I understand the hemangioma can continue to grow until 9 or 10 years of age and this one is fairly close to his eye. Have the lasers been successful for you?

[Anonymous]

I would recommend Nancy Bauman at Children's. She runs a clinic for infants and kids with hemangiomas.

[Anonymous]

21:06 again -

Can't speak TOO much to the hemangioma, since my information is primarily gleaned as a side note to my research on the PWS (though I did learn a fair amount, since they are both forms of vascular birthmarks.) However, before jumping to surgery, I believe the normal course of action is to watch the growth pattern first to see if it's actually a problem. Obviously the proximity to the eye is a concern, but since the issues caused by hemangiomas are almost entirely secondary to growth, I do think a 'watch and see' attitude is appropriate. And you might also look into steroid treatment - I can't remember the details, but I seem to recall Drs having good success with that. (and of course - this is all my personal opinion and I am not a medical professional.)

As for the Laser treatments - we have actually seen quite good results. Our DC's PWS was 2 extensive patches along her left arm, with the bottom one wrapping around the wrist, and then 2 smaller marks on her chest and back. She has had 4-5 treatments so far, and we are happy with the results - the arm has faded considerably, and the marks on the chest and back have lightened to the extent it's pretty hard to tell where they were. Which is consistent with what we expected, i.e. that the marks closest to the heart respond faster / better than those on the extremities. (Our DC is quite pale however, which does make her a better responder.)

You may also already be familiar with these, but if not, there are some great online resources for information about vascular birthmarks:
(1) Vascular Birthmark Foundation - http://birthmark.org/babieswithbirthmarks.php
(2) Birthmarks.com

[Anonymous]

I second the recommendation for Dr. Bernard Cohen at Hopkins.

[Anonymous]

I would also recommend Craig DuFresne a plastic surgeon who does a lot of work with children with major facial deformaties so I know he is well qualified for your child's case. He has even been featured on Discovery Health for his work. He works out of Fairfax Hospital and Georgetown. As an FYI - I am 43 and had surgery at 6 months old for the same thing. They had to reconstruct my cheek. It turned out so well that to this day, surgeons can't tell that I ever had surgery on that cheek. I would recommend the surgeon who did my surgery; however, he has passed away.

[Anonymous]

Thanks for all the recommendations and links - very helpful and informative. I'll probably get a few opinions but right now the hemangioma on his face is small - my concern is that it will grow much larger so I'd rather just nip it in the bud now.

21:06 - I read that PWS have to be lasered forever to maintain results - is that what your derm told you?

[Anonymous]

we also loved Dr. Cohen at Hopkins. He recently removed a mole from my 3 year old and was fabulous. We also saw Dr. Puttgen at Hopkins for our initial consult and liked her a lot as well but she may currently be out on maternity leave.
Also fabulous: Hopkins takes all insurance. None of this "cash only" policy that is the norm at most DC area derms.

[Anonymous]

21:06 again - I have also read that PWS require maintenance treatments, but haven't discussed this thoroughly with the Drs. For now our concern was getting the initial treatments underway, as the treatments are actually more effective for younger patients (since the birthmark is smaller and closer to the surface I believe.) That said, if maintenance treatments are required, I don't think it will be a big issue - the treatments themselves are just a few minutes long and at least at JHU have been an easy in and out, and those treatments would be at a pretty low frequency. (You need to space treatments minimum 8-10 weeks a part, and in the beginning we were trying to get them done a lot more often.)

[Anonymous]

A Big Big second for Dr. Craig Dufresne (he also is at Sibley and INOVA Fairfax) absolutely wonderful with my son's hemangioma...you won't find a doctor whose beside manner is better esp. with a child who may be frightened and not know what to expect.

[Anonymous]

Thanks everybody! I have an appt. with Dr. Cohen at Johns Hopkins and Dr. Bauman at Children's Hospital. I'll call Dr. DuFresne on Monday - the hemangioma may be too small for the kind of work he does but it can't hurt to ask.