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Dermatology

We are a referral-based clinic providing comprehensive care for children and youth with challenging skin, hair and nail disorders.
Our program

The Dermatology Clinic at BC Children’s Hospital diagnoses and treats common and complex skin conditions, caring for more than 3,000 children each year. 

In addition, we are a centre for both teaching and research – trainee medical staff enhance the quality of care, and research conducted here helps improve patient health outcomes. 

You need a referral from a physician or nurse practitioner to attend this clinic.

Diagnosis and care

Our most frequently seen conditions are eczema (atopic dermatitis), acne, birthmarks, psoriasis, hair loss, vitiligo, molluscum and warts. As a tertiary care centre we also experts at treating rare and complex conditions including epidermolysis bullosa, dermatomyositis, cutaneous lupus erythematosus, morphea, ichthyosis, and rare genetic skin diseases.

The clinic consists primarily of outpatient consultations. We also provide inpatient consultations for hospitalized children, and province-wide teleconsultations. 

Common dermatological conditions include:

Whiteheads, blackheads, papules and pustules on the face, neck, shoulders, back, or chest which may become inflamed. Acne can run in families.

Acne is caused by oil and dead skin cells clogging pores, and is frequent in the teenage years when hormonal changes make the skin oilier. (“Baby acne” is not really acne; it develops on a newborn’s face, particularly on the cheeks, nose and forehead within the first two to four weeks after birth, and usually clears up by itself.)

Skin care includes avoiding oily skin products in favour of those marked non-comedogenic, which do not clog pores, using a gentle soap or acne wash for face washing, and avoiding scrubbing or picking pimples. Prescription topical gels and creams can help acne that does not improve with over-the-counter medications. Oral medications are helpful for more severe acne.

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Birthmarks are coloured marks on the skin which are present at birth or appear shortly afterwards. They may appear as if they are on the skin surface, raised above or positioned below. 

Many types of birthmarks exist. These include:
  • Infantile hemangioma
  • Congenital hemangioma
  • Congenital melanocytic nevus
  • Port wine stains
  • Nevus Sebaceous 
  • Epidermal nevus 
  • Dermal melanocytosis 
Many are harmless and do not require treatment. Some will fade with time but others are permanent. If required, laser or surgical excision can be used to treat those that won’t go away on their own.

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An itchy skin problem that’s common in children but can occur at any age. It cannot be spread from person to person, but may run in families. It is closely linked to asthma, hay fever and food allergies. Some children grow out of eczema, but for many people it comes and goes through life. 

Causes are not entirely clear, but there seems to be an interaction between genetic and environmental factors. A defect in skin barrier function leaves the skin susceptible to dryness and contact irritation, particularly by soap and perfume. Eczema often begins with dry, itchy skin – scratching makes the skin inflamed and prone to infection.

Skincare including bathing, avoiding irritants and frequent moisturization is important. Treatment is usually by topical medicines, which calm the immune reaction. Oral medications or phototherapy may be prescribed. Early medical intervention can prevent symptoms worsening and might even help prevent asthma or food allergies from developing.

More:
HealthLinkBC
DermNetNZ
A viral infection that causes an outbreak of blisters on the mouth and feet and sometimes also on the legs and buttocks. Possibly painful, usually lasting a week or so. (Hand-foot-mouth is not connected with foot-and-mouth disease affecting farm animals.)

Hand-foot-mouth disease is a mild, contagious viral condition that’s common in young children. It begins with a fever, which is often followed by a sore throat before blisters break out. 

A minor illness, symptoms are usually relieved with home care – rest and cold fluids – but contact a doctor if a sore throat or mouth sores prevent your child from drinking, or if symptoms are worsening after a few days.  Many children will temporarily lose their fingernails or toenails a few months after having hand-foot-and mouth.

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A bright red “strawberry” birthmark caused by extra blood vessels in the skin, most commonly seen on the face, scalp, chest or back. Sometimes present at birth, but more often appearing in the first few weeks, growing rapidly at first but then stabilizing and going away on their own.

Most hemangiomas do not require medical attention as they usually regress without treatment by about age five. Some, however, cause problems, with complications including ulceration and bleeding  or relating to the location and size of the hemangioma, as they can interfere with breathing, vision or hearing.

When treatment is necessary, topical creams or oral medicines are mostly prescribed. Laser treatment or occasionally surgery may be recommended. 

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A highly infectious superficial bacterial skin condition, comprising of red sores that can ooze fluid and develop a crust. It is common in young children, being spread by contact or shared clothing, towels or toys. Scratching can spread the sores to other parts of the body.

Impetigo is typically a secondary infection, caused when bacteria enters skin that has already been irritated or injured by bites, eczema, burns or cuts. But it’s highly contagious and can be spread to healthy skin.

It is usually treated with antibiotics, with a topical cream applied to mild cases or oral medication prescribed for more severe infections. 

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Common, benign marks on skin caused by a grouping of cells that make pigment (melanocytes). Sizes and shapes vary, and they can appear anywhere on the body. A mole may be present at birth (congenital nevi), or appear later (acquired nevi) when they often relate to sun exposure. Congenital nevi are often much larger than acquired nevi.

Moles are mostly harmless and require no treatment. However, if a mole is changing rapidly, has an unusual shape or colour, or bleeds easily it should be evaluated to make sure it is not actually melanoma (skin cancer).

When moles – as opposed to melanoma – are removed it’s for cosmetic reasons or because they cause discomfort. If moles are going to be removed this should be done by surgery.

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A childhood skin infection that causes isolated clusters of firm, painless bumps. These are pearly or flesh-coloured with a dimple in the middle, ranging in size from a pinhead to a pencil eraser. Molluscum bumps last between a few weeks and several years before they go away.  

The virus mostly affects children under the age of 10, spreading through skin-to-skin contact, and can spread from one part of the body to another. It’s contagious until the bumps are gone, and can be passed on via objects such as towels. To prevent the virus spreading patients are advised not to scratch the bumps, if necessary covering them with tape or bandage. Even though the bumps are contagious, children with molluscum should not be kept home from school or prevented from participating in activities.

In most cases, no treatment is necessary, although topical creams, freezing and curettage may be helpful in speeding the resolution. 

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There are many causes for pigment change in the skin. Some conditions make the skin darker and some make it lighter. Birthmarks (see above) can have different skin colours as can some autoimmune conditions such as vitiligo (see below).

Post-inflammatory pigment change makes the skin lighter or darker after an injury or rash. It is like a “footprint” of the rash and will go away slowly. This is especially seen in patients with eczema. 

Pigment change often does not need treatment and may improve slowly with time.  However, it may be treated for cosmetic reasons, generally with topical creams.

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An inflammatory condition that leads to skin cells growing too quickly. Regular skin cells grow and flake off over a four-week cycle, but with psoriasis, new cells move to the skin surface within days, building up thick patches. 

Psoriasis is not contagious. In some cases it runs in families. Mild cases may present as a small rash, and in severe cases the skin becomes itchy and tender with widespread involvement.

While there is no cure for psoriasis, patients can manage symptoms. Moisturizing, stress management and prescription medicines can help. Mild psoriasis is generally treated with topical medicines. Phototherapy, oral medications or injections used for the more serious cases.

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A fungal infection that causes an itchy rash on the skin or scalp, which can also occur in nails. It is spread by skin-to-skin contact, from infected objects such as clothing or towels, or sometimes from pets or soil.

On the body, face and groin it often appears as a red, scaly ring (hence the name ringworm).  It may resemble dandruff on the scalp or cause flaky skin between the toes (“athlete’s foot”). 

Ringworm responds well to topical antifungal creams and ointments, though scalp and nail involvement require oral medications. 

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An intensely itchy condition caused by microscopic mites that burrow into the skin. It is highly infectious, being easily spread by physical contact and often affecting several household members at the same time. 

Symptoms include a rash with tiny blisters or sores, often seen in folds in the skin, which is accompanied by intense itching that is often worse at night. In infants and young children the scalp, palms of the hands and soles of the feet are most common sites of infestation. In older children and adults the wrists, ankles and armpits are more commonly affected.

Without treatment the mites will continue to reproduce under the skin, causing more irritation and itching. It’s normally treated with non-prescription topical creams, usually Permethrin 5%. All household members must be treated; cream is applied at night and washed off in the morning. All linens and recently worn clothing must be washed (this is repeated after seven to 10 days). Frequently used items that cannot be washed, such as stuffies, should be placed in a bag and set aside for about four days.  Itching may continue for up to four weeks after treatment due to the body’s allergic reaction to the mites.

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A disorder causing the loss of skin color in patches, resulting from loss of pigment-producing cells. It can affect any part of the body, although favours exposed areas (face, neck and hands), skin folds and sites of injury.

Vitiligo is an autoimmune condition, and may run in families. It is not contagious. People with the condition need to be conscious that the white skin of vitiligo requires extra sun protection. 

Although it is usually not itchy or painful, vitiligo is often addressed for cosmetic reasons because it can be distressing to patients to have light spots. Treatments include topical creams, light therapy, oral medicines and, rarely, surgical procedures. Some people choose to cover their vitiligo and others are comfortable with the light areas being visible. 

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A small and common skin growth caused by infection with human papillomavirus virus (HPV). Usually painless, they can grow anywhere on the body but are mostly found on the hands or soles of the feet (plantar warts).

Warts are spread through touch, with a long incubation period. In children, 50 per cent of warts disappear within six months without treatment, and 90 per cent are gone in two years.

Most warts don’t require treatment, with older children and adults using topical home remedies including salicylic acid. Medical approaches include freezing or injection of Candida or Bleomycin. Surgical removal is rarely recommended. 

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Services

We provide the following services:
  • Diagnosis, treatment and follow-up care for all skin, hair and nail disorders in children.
  • Cryotherapy for warts.
  • Inpatient consultations for hospitalized children.
  • Laser treatment for port wine stains and other birthmarks.
  • Minor surgical procedures to remove skin lesions.
  • Narrow band UVB phototherapy. 
  • Skin biopsies.
  • Teleconsultation for physicians seeing patients outside of the Lower Mainland.
  • Wound care.

Speciality clinics

Outreach clinic

Many communities in BC do not have access to dermatology care. BC Children’s Hospital physicians travel to Terrace and Prince George four times each year to see patients in their own communities. 

Specialized Pediatric Outreach Consultation for Kids (SPOCK)

A component of the RICHER pediatrics program seeking to address disparities in health equity, SPOCK is particularly concerned with health care access for marginalized children in inner city communities. 

The BC Children’s Hospital dermatology department supports the RICHER program by providing monthly pediatric outreach clinics in Vancouver’s Strathcona neighbourhood, as well as telehealth support between clinics. 

Telehealth

The dermatology service at BC Children’s Hospital supports children throughout the province, although sometimes it is not feasible for a patient to come to Vancouver. In these cases our dermatologists assist physicians with phone and digital consultation.

Vascular anomalies

Monthly multidisciplinary clinics for children with vascular malformations and tumours. The health care team includes dermatologists, plastic surgeons, occupational and physical therapists, pediatricians, radiologists and ENT physicians.

Your visit
Referral for this service is open to all physicians and nurse practitioners in BC. 

Phototherapy is available to children under the care of community dermatologists as well as to those referred by community-based medical practitioners for care by BC Children’s Hospital staff dermatologists. 

Telephone and email consultations are available to assist the care of children unable to travel to Vancouver for assessment and treatment. 

Preparing for your visit

Please bring all of your medications and creams to your appointment. (Don’t just tell us, show us – it’s useful for us to know exactly what you've been using!)

Parking can be a challenge at BC Children’s Hospital, so allow extra time when coming to your appointment.  Valet parking is conveniently located in front of the entrance to Emergency, which is very close to our clinic.  The cost for the valet service is included in the regular parking fee; there is no extra valet charge.

We are a teaching institution and your child might be seen by a medical student or resident in addition to a BC Children’s Hospital dermatologist. If you have any concerns about this, let us know at check-in.

Our research

The research conducted at BC Children’s Hospital Dermatology Clinic mostly focuses on studies of new drugs developed for the treatment of eczema and psoriasis.  We have also been working to design and validate diagnostic algorithms for atopic dermatitis patients.  

New studies investigating the impact of stigma on children with skin disease will be starting soon.

Physician Sunil Kalia is investigating the use of artificial intelligence to improve diagnostic performance of automated diagnosis of vascular and pigmented lesions

More info

Preferred sources of skin disorder information:

Patient support & advocacy groups
Physician resources
Our team
Our dedicated and highly experienced health professionals work diligently to create a safe, compassionate and healing environment.

Together, we will meet your child’s medical needs and keep you informed all the way along.



Physicians

Dr. Wingfield Rehmus, MD, MPH, FAAD
Dr. Sunil Kalia, MD, MHSc, FRCPC
Dr. Joseph Lam, MD, FRCPC 
Dr. Harvey Lui, MD, FRCPC 

With special thanks and appreciation to Dr. Julie Prendiville for her excellent mentorship, leadership, and clinical care as division head from 1990-2018.

Nurse Practitioner 

Alissa Collingridge

Nursing staff

Annette Gardin

Administrative staff

Michelle Deo
Zeba Prasad
Rapinder Rakhra

Affiliates and partners

Tab Heading



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