Division of Pediatric Dermatology

The Saint Louis University Division of Pediatric Dermatology is a nationally recognized center of expertise, providing tertiary medical, surgical and investigative dermatology services for children with all forms of skin disease.

Dr. Siegfried is one of 3 pediatric dermatologists in a major metropolitan area, and the only one in a 300-mile radius accessible to all children, regardless of ability to pay. The major focus of her career has been caring for thousands of children and adolescents with inflammatory skin diseases in the clinic, emergency room and hospital, through investigator-initiated clinical research and industry-funded clinical trials. As an experienced pediatric subspecialist, she has focused her efforts on improving the unmet need for safe and effective treatment for children with psoriasis and eczemas. She served as the first dermatologist participating in the NICHD/FDA sponsored Best Pharmaceuticals for Children Act (BPCA) Prioritization Process, participated in the BPCA process and served as chair of the 2012 Dermatology Committee. She was an invited member of the March 9, 2015 Dermatologic and Ophthalmic Drugs Advisory Committee (DODAC) focusing on pediatric development of systemic products for the treatment of atopic dermatitis, and serves on both the AAD Atopic Dermatitis Expert Resource Group and the Scientific Advisory Board of the National Eczema Association (NEA). She lead an effort to develop a consensus-driven guidance document to facilitate patient-centered protocol design for pediatric clinical trials of new treatments for atopic dermatitis, which was supported by the Pediatric Dermatology Research Alliance (PeDRA) with seed funding from the NEA, and industry-supported grants. Increased interest in new drugs and biologic agents has yielded increasingly expensive treatments, with safety and efficacy data based on placebo controls. Dr. Siegfried has focused additional efforts on supporting the safety and efficacy of time-honored, cost-effective options.

Pediatric Dermatology Training

In addition to a busy clinical service, the division provides lectures and didactic training for dermatology and pediatrics residents, medical students, allied health students from Saint Louis University and other collaborating institutions, as well as CGCMC clinical staff.

Elaine Siegfried, M.D., has been an active mentor for medical students and dermatology residents, supervising several student and dermatology resident research projects. Dr. Siegfried is also a frequently invited speaker and appointed member of multiple national organizations and working groups.

Dr. Siegfried also serves as principal investigator for clinical trials utilizing the infrastructure of the Department of Dermatology Clinical Trials Unit. She lead a national multi-specialty effort in collaboration with the FDA Division of Dermatology and Dental Products to create a draft guidance document for the industry to help standardize and optimize new drug clinical trials protocols for atopic dermatitis in pediatric patients.

Staff and Facilities

The members of the division include one full-time physician, a mid-level provider, two full-time RNs and an administrative assistant. Remote dermatology consultation is available seven days per week, 24 hours per day via the Cardinal Glennon Access Line, direct phone consultation and web-based requests. This system addresses more than 100 of these requests per month.

In-person consultation is provided for the emergency department, inpatient services and hospitalized dermatology patients at SSM Health Cardinal Glennon Children’s Hospital.

Ambulatory patients are seen at SSM Health Cardinal Glennon Children’s Hospital and two off-site other locations.

Service Overview

Pediatric dermatology encompasses large group of diverse diagnoses, possibly the largest of any subspecialty. The Dermatology Division in the Department of Pediatrics provides care for children with a range of congenital and acquired skin disease, including:

Acne
Dermato-oncology
Acquired Bullous Disorders
Epidermolysis Bullosa
Alopecias
Genodermatoses
Connective Tissue Diseases (lupus, morphea, dermatomyositis
Hemangiomas
Cellular infiltrates (mastocytosis, lymphocytic and neutrophilic spectrum)
Hyperhidrosis

Ichthyoses
Hypersensitivity Reactions (Erythema multiforme, Stevens-Johnson, Toxic Epidermal necrolysis)
Inflammatory Skin Diseases (psoriasis, eczemas, overlap)
Skin infections (Tinea, Candidiasis, HSV, molluscipox, verruca vulgaris)
Neonatal Skin Disease/complications (incl Collodion and Harlequin Ichthyosis)
Urticaria
Nail Disease
Vascular Malformations
Vitiligo

Research

Multicenter Collaboration

PeDRA: The TREatment of severe Atopic dermatitis in children Taskforce (TREAT) U.S. and Canada Survey
PeDRA: Retrospective review of systemic therapy for atopic dermatitis in children
SUNY Downstate/Yale: Management of harlequin ichthyosis: consensus opinion (submitted for publication)
UT-Houston: Infantile hemangiomas: analysis of untreated lesions to establish early systemic treatment criteria, presented at the American Academy of Dermatology annual meeting, Washington DC, March 2016
UCSD: Pediatric psoriasis disease and treatment: effects on concomitant NAFLD
International Psoriasis Council: Retrospective Chart Review of Systemic Treatments in Pediatric Psoriasis: An International Multicenter Study

Research and Grants

Active Industry Sponsored Clinical Trials

Phase 2, An Open-Label 5 year Extension Study to Evaluate the Safety of Etanercept in Pediatric Subjects with Plaque Psoriasis, Principal Investigator, Sponsor: Amgen
A Multicenter, Randomized, Double-Blind, Vehicle-Controlled Study of the Safety and Efficacy of AN2728 Topical Ointment, 2% in Children, Adolescents, and Adults (Ages 2 Years and Older) With Atopic Dermatitis, Sponsor: Anacor
A Multicenter, Randomized, Double-Blind, Phase 3 Study of the Safety, Efficacy, Systemic Exposure, and Pharmacodynamics of Calcipotriene Foam, 0.005%, Versus Vehicle Foam in Pediatric Subjects (Ages 2 to 11 Years) with Plaque Psoriasis (Site initiation 9/29/15), Sponsor: GSK-Stiefel
A Randomized, Double-Blind, Placebo-Controlled Study To Investigate The Efficacy and Safety Of Dupilumab Monotherapy In Patients 12 to 18 Years Of Age, With Moderate-To-Severe Atopic Dermatitis, Sponsor: Regeneron Pharmaceuticals
An Open-Label Phase 4 Safety and Efficacy Trial of ACZONE (Dapsone) Gel, 7.5% in 9 to 11 Year-Old Patients With Acne Vulgaris, Sponsor: Allergan, Inc.
A Phase 3 Open-label Study to Assess the Efficacy, Safety, and Pharmacokinetics of Subcutaneously Administered Ustekinumab in the Treatment of Moderate to Severe Chronic Plaque Psoriasis in Pediatric Subjects 6 to <12 Years of Age, Sponsor: Janssen Pharmaceutical
A Single Center, Investigator-Initiated Retrospective Review of Daily Subcutaneous Interferon-Gamma for Severe Inflammatory Skin Disease Complicated by Recurrent Eczema Herpeticum, Sponsor: Vidara

SLU Medical Student/Resident Collaboration

Kurta A, Dai D, Armbrecht A, Siegfried EC. Prescribing Propranolol for Hemangioma of Infancy: Assessment of Dosing Errors. Presented at the Annual Meeting of the Society for Pediatric Dermatology, July 14-17 2016
Gruber P, Siegfried EC. Congenital Ichthyosis and Musculoskeletal Dysplasia. Presented at the Missouri Dermatologic Society Annual Meeting, Sept. 24, 2016
Crider C, Siegfried EC, Hurley Y. Incontinentia Pigmentii, Finally Recognized. Presented at the Annual City Wide Dermatology Conference, April 13, 2017
Varade R, Siegfried EC. Tuberous Sclerosis A Family Matter? Presented at the Annual City Wide Dermatology Conference, April 13, 2017
Clark, Siegfried EC. Atypical Conradi-Hünermann-Happle Syndrome. Presented at the Annual City Wide Dermatology Conference, April 13, 2017
Simonetta C, Siegfried EC. Iceberg Hemangioma with PHACE Arterial Anomalies. Presented at the Annual City Wide Dermatology Conference, April 13, 2017
Dhanda, M, Siegfried EC. Cost-Effective, Custom-Designed Wet Wrap Garments for Pediatric Patients: Experience at a Children’s Hospital. Rising Star Presentation Award, Hawaii Derm Feb. 2017

SLU Graduate/Faculty Collaboration

Schneider C PhD candidate: Parent-child interactional factors affecting medical adherence in children with atopic dermatitis
Chaudhry S Asst. Prof Derm: Pediatric dermatology no-show rates: impact of insurance type and scheduling policy
Frisch S Private Dermatologist: Immune function in children with severe inflammatory skin disease: A retrospective analysis
Morrison L Prof. Micro: Herpes simplex virus detection in atopic children with suspected eczema herpeticum, and trial of topical treatment with ciclopirox olamine

Multicenter Collaboration

PeDRA: The TREatment of severe Atopic dermatitis in children Taskforce (TREAT) U.S. and Canada Survey
PeDRA: Retrospective review of systemic therapy for atopic dermatitis in children
SUNY Downstate/Yale: Management of harlequin ichthyosis: consensus opinion
UT-Houston: Infantile hemangiomas: analysis of untreated lesions to establish early systemic treatment criteria
UCSD: Pediatric psoriasis disease and treatment: Effects on Concomitant NAFLD
International Psoriasis Council: Retrospective Chart Review of Systemic Treatments in Pediatric Psoriasis: An International Multicenter Study

Extramural Collaborative Efforts

Evaluation of Phenotypic and Genetic Properties in Male Subjects Affected By X-linked Hypohidrotic Ectodermal Dysplasia (XLHED): Intrafamilial Variation and Assessment of Skin Properties (NFED, University of Colorado via ICTS)
Systemic Therapies for Pediatric Atopic Dermatitis and Systemic Therapies for Pediatric Psoriasis (via PeDRA - Pediatric Dermatology Research Alliance - an independent multicenter consortium of clinical investigators)
Protocol Guidance for New Therapeutic Agents for Atopic Dermatitis in Children (via PeDRA; R-13 and WUSTL ICTS grants submitted)

Publications

Improved Management of Harlequin Ichthyosis With Advances in Neonatal Intensive Care. Glick JB, Craiglow BG, Choate KA, Kato H, Fleming RE, Siegfried E, Glick SA. Pediatrics. 2017 Jan;139(1). pii: e20161003. doi: 10.1542/peds.2016-1003. Epub 2016 Dec 20. PMID: 27999114
Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey. Totri CR, Eichenfield LF, Logan K, Proudfoot L, Schmitt J, Lara-Corrales I, Sugarman J, Tom W, Siegfried E, Cordoro K, Paller AS, Flohr C. J Am Acad Dermatol. 2017 Feb;76(2):281-285. doi: 10.1016/j.jaad.2016.09.021. Epub 2016 Nov 14. PMID: 27855965
Glick JB, Craiglow BG, Choate KA, Kato H, Fleming RE, Siegfried E, Glick SA. Improved Management of Harlequin Ichthyosis With Advances in Neonatal Intensive Care. Pediatrics. 2017 Jan;139(1). pii: e20161003. doi: 10.1542/peds.2016-1003. Epub 2016 Dec 20. PMID: 27999114
Siegfried EC, Jaworski JC, Eichenfield LF, Hebert AA, Paller AS. Optimizing Clinical Trials for Atopic Dermatitis in Children. J Invest Dermatol. 2017 Jun;137(6):1363-1364. doi: 10.1016/j.jid.2017.01.025. Epub 2017 Feb 9. PMID: 28189536
Kurta AO, Dai D, Armbrecht ES, Siegfried EC. Prescribing propranolol for infantile hemangioma: Assessment of dosing errors. J Am Acad Dermatol. 2017 May;76(5):999-1000. doi: 10.1016/j.jaad.2016.12.001. No abstract available. PMID: 28411779
Dhanda, M, Siegfried EC. Cost-Effective, Custom-Designed Wet Wrap Garments for Children: Experience at Cardinal Glennon Children’s Hospital. The Journal of Cutaneous Medicine. www.jofskin.org/index.php/skin/article/download/4/pdf
Serving as associate editor for the 5th edition of the Textbook of Pediatric Dermatology, Mosby

Abstracts

Chu MB, Siegfried EC, Wild AP, Reis M, Frieden IJ, Drolet B. “Iceberg” hemangioma: a segmental scalp lesion marking extensive multifocal extracutaneous involvement. Presented at the Annual Meeting of the Society for Investigative Dermatology, April 2016
Prindaville B, Horii KA, Siegfried EC, Brandling-Bennett H. Pediatric Dermatology Workforce in the United States. Presented at the World Congress for Pediatric Dermatology, July 5-9, 2017
Paller AS, Siegfried EC, Pariser DM, Rice, et al. Five-Year Open-Label Extension Study of Safety and Efficacy of Etanercept in Children and Adolescents With Moderate to Severe Plaque Psoriasis. Presented at the Annual Meeting of the American Academy of Dermatology, Washington DC; March 4-8, 2016
Darji K, Siegfried EC. Vitamin D deficiency and atopic dermatitis: consider disease, race, and body mass. Presented at the Annual Meeting of the Society for Investigative Dermatology Hebert AA, Siegfried EC, Baselga E, Chen L, Dang B. Infantile Hemangiomas: Analysis of Untreated Lesions to Establish Criteria for Early Systemic Treatment. Presented at the Annual Meeting of the American Academy of Dermatology, Washington DC; March 4-8, 2016
Paller AS, Bronckers M, Seyger M, Kiguradze T, West T, Day J, Groenewoud M, PeDRA Psoriasis Investigator Group (W. Tom, M. Tollefson, I. Lara-Corrales, N. Celano, R.A. Vleugels, E. Siegfried, M. Hogeling, L. Belazarian, A. Winkler, K. Holland, and K. Cordoro) and the European Working Group on Pediatric Psoriasis. Systemic Agents in Pediatric Psoriasis: International Study of Characteristics, Comorbidities, and Adverse Events. Presented at the Annual Meeting of the Society for Pediatric Dermatology, July 2016 •

Editorials

http://dermatologytimes.modernmedicine.com/dermatology-times/news/fake-medical-news (June 17, 2017)
http://dermatologytimes.modernmedicine.com/dermatology-times/news/so-many-medications-so-little-access (March 1, 2017)
http://dermatologytimes.modernmedicine.com/dermatology-times/news/there-ought-be-word (October 10, 2016)