DENVER — Navigating challenging clinical conversations requires respecting the viewpoints and experiences of patients and their families while nudging them toward shared goals and appropriate strategies, said an expert who spoke at the Society for Pediatric Dermatology 2026 pre-AAD meeting. However, he added, the prevalence of unproven skincare ingredients, social media-driven diagnoses, and overzealous parents can test dermatologists’ ability to conduct such conversations in a way that puts everyone on the same side.

Patient counseling is sometimes messy, but treatment success requires that clinicians show flexibility in meeting families wherever they are in terms of knowledge, beliefs, and past experience, Grant Plost, MD, said at the meeting. Plost is an assistant professor of dermatology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado.

‘Clean and Natural’

For children with eczema, Plost said, a common scenario involves parents who take their preference for natural treatments too far. “They reach into their bag and pull out a jar of beef tallow,” he said. “You don’t want to give anything away. But inside, you’re feeling dread and not sure what’s going to happen with the rest of the visit.”

“Small studies have suggested that moisturizing with rendered animal fat may improve barrier function and prevent development of atopic dermatitis. Side effects of topical tallow application can include skin and eye irritation, and research is limited,” Plost noted, “so in terms of safety and effectiveness, there’s a lot of uncertainty.” Additionally, research shows that skincare products marketed as “clean” and “natural” may include harmful ingredients, including allergens.

Validation of Caregiver Perspectives

To facilitate shared decision-making, Plost recommended acknowledging parents’ perspectives and feelings as real and understandable. “You don’t ever have to agree with them. You might say, ‘It must be hard to watch your child struggle with eczema for so many years. It makes sense that you believe you finally found something that helps.’ And hopefully the parent feels heard and respected.”

Open-Mindedness

If the product in question is harmless, Plost said, “it may be okay to include parental preferences in the treatment plan, even if it deviates from your typical approach.” After the child’s eczema clears on topical prescriptions, he said, one can recommend regular moisturization with topical ceramide-containing products or perhaps tallow. Making such a “peace offering” can boost parental buy-in and treatment adherence, he said.

In a case that Plost shared, parents complained that their child was suffering from topical steroid withdrawal syndrome, and that their prior dermatologist was unfamiliar with the concept. Topical steroid withdrawal syndrome is a controversial diagnosis, Plost said, as consensus regarding characteristics and diagnostic criteria is lacking. Although a recent review found published pediatric cases rare, topical steroid withdrawal syndrome remains a popular social media topic, according to a study published in 2024.

In such cases, Plost said, parents commonly produce copious records of their child’s treatment history, which can include multiple photos. “Smartphone photos pose challenges, such as poor lighting,” he added.

As a clinician, he said, “You have to look at every photograph; read every comment.” Failing to act interested quickly loses the family’s trust, he explained. “It’s okay to say, ‘I understand you have not had a good experience with topical steroids, and they haven’t worked for your child. Let’s try something different.’” Such phrasing, Plost said, throws neither the prior dermatologist nor topical steroids under the bus.

It is also important, he said, to assure parents that you will not prescribe anything that makes them uncomfortable. When discussing nonsteroidal topical treatments, Plost said, “You may enter the realm of warning labels. And sometimes those are nonstarters for families who fear topical steroids. It’s not as simple as prescribing a topical calcineurin inhibitor. You’re opening the door for their feedback. And that curiosity and lack of judgment show respect for their perspective.”

Dawn Eichenfield, MD, PhD, who attended the presentation, told Medscape Dermatology that she found it highly relevant to everyday pediatric dermatology practice. She is an assistant professor of dermatology at the University of California, San Diego, and a dermatologist at Rady Children’s Hospital in San Diego.

The presentation’s most useful aspect, Eichenfield said, was the emphasis on communication strategies for engaging families who have strong beliefs about treatments, concerns about topical corticosteroids, or information obtained from social media and online sources.

“Dr Plost highlighted the importance of validating families’ experiences without necessarily endorsing unsupported diagnoses or therapies,” she said, adding that this strategy allows clinicians to maintain trust while still providing evidence-based recommendations.

“This approach is particularly valuable for pediatric dermatologists, who frequently manage chronic conditions such as atopic dermatitis and must partner closely with parents to achieve treatment adherence and long-term disease control,” she added. Overall, Eichenfield said, the presentation provided an important reminder that successful outcomes often depend equally on building a therapeutic alliance with parents and selecting the appropriate treatment for a child.

Plost and Eichenfield reported having no relevant financial relationships.

John Jesitus is a Denver-based freelance medical writer and editor.