Specialty: Dermatology
Title: Clinical Assistant Professor, Department of Medicine, Albert Einstein College of Medicine
Hospital: Montefiore New Rochelle Hospital
Back in the 1970s, when she was fresh out of med school, Dr. Karen Mackler was set to start a career as a pediatrician. Then the Cornell-trained physician attended the pediatric dermatology clinic at the Albert Einstein College of Medicine, where she found her true calling. “I really enjoyed dermatology. I did a second residency in dermatology, then began practicing,” she says. “The fun of dermatology is never knowing what condition a patient will have when they walk into the office. Often, the diagnosis is clear, but occasionally there are real puzzles, which are gratifying to unravel, using history, biopsy, and research into the literature.”
Mackler treats both adults and adolescents and says that there is a difference between adult and pediatric dermatology.
How does adult dermatology differ from pediatric dermatology?
There are differences in the types of conditions adult and pediatric patients suffer. In the teenage years, acne is the most common diagnosis. In the pediatric group, I see more atopic dermatitis [a common chronic, itchy skin condition] and viral rashes. In addition, with pediatric patients, we often prescribe numbing agents for minor procedures.
Any new worrisome trends?
One condition that I’ve noticed is more prevalent in recent years is alopecia areata (hair loss) in almost every age group. I see far more cases now than I did 10 years ago. We don’t know why there has been an increase, but there are several ways to treat alopecia areata, including both topical and intralesional steroids.
There also seemed to be an increase in childhood melanoma before 2000, but, with increased public awareness and an increase in the use of sunscreens, as well as more indoor activities, the number of reported melanomas in children has recently been decreasing. Tanning beds should be avoided.
When should a patient seek immediate medical treatment?
Any non-healing sore is suspect and should be evaluated, and any unusual-looking nevus in a child should be examined.
How has pediatric dermatology changed over the course of your career?
Dermatology is changing rapidly in the treatment of diseases such as psoriasis and eczema, which are related to inflammatory processes. With new medicines called biologic agents, we are able to clear people to an extent never possible before.
