Less Is More: A Practical Approach to Tween Skin Care

In an era of evolving pathogens and aggressive consumer marketing, clinicians are increasingly required to balance evidence-based medicine with patient education. In a recent interview with Dermatology Times at the 2026 Masters of Pediatric Dermatology meeting, Lisa Swanson, MD, a dermatologist and pediatric dermatologist in Boise, Idaho, discussed 2 areas pediatric clinicians face in daily practice: rising antifungal resistance and the growing use of complex skin care regimens in children.

Swanson opened with a concern many clinicians are now encountering firsthand: “Resistance is everywhere, and this is a relatively new issue for us.” She noted that dermatology has long relied on oral antifungals such as terbinafine with “remarkable success,” but resistant organisms are changing that landscape. As a result, she has adjusted her diagnostic approach.

“Every time I see a patient that I think I'm dealing with a fungal infection, I always do a fungal culture,” Swanson explained, emphasizing the importance of obtaining cultures at the initial visit. Once treatment has begun, cultures may be unreliable, making that first encounter critical. Her process includes speciation and susceptibility testing, which often requires samples to be sent beyond local laboratories to one of only a few US centers equipped for fungal susceptibility testing.

This step has become particularly important given increasing terbinafine resistance. Swanson described a pragmatic approach in pediatric patients: initiating empiric griseofulvin while awaiting results, reassessing clinical response, and then using culture data to guide subsequent therapeutic decisions. “This is essential because we are noticing so much resistance to terbinafine, and we need some additional alternatives,” she said.

The conversation then shifted to pediatric skin care, an area Swanson believes has been complicated by marketing rather than medical need. She cautioned against multi-step regimens for children and adolescents, noting that they often provide little benefit. “They don't need expensive things. They don't need fancy products,” she said, adding that some products may even be harmful.

Of particular concern are anti-aging and skin-lightening products marketed to young patients. Many contain ingredients intended for mature skin and can cause irritation in children. Swanson warned that hyperpigmentation treatments may include topical steroids, hydroquinone, or even mercury, stating, “Special caution should be paid to the ones that promise to lighten your skin.”

Her recommendation remains simple and practical: a gentle cleanser, a moisturizer with SPF, and restraint. For clinicians, Swanson’s insights reinforce 2 parallel responsibilities—adapting diagnostic and treatment strategies in the face of antifungal resistance, and guiding families through an increasingly complex and sometimes risky skin care marketplace with clarity and caution.