Pediatric dermatology: developmental and psychological issues.

Adolescence is characterized by a sensitivity to issues of attractiveness, emerging sexuality, and the challenge of parental rules and values. The latter tends to carry over into the relationship with other authority figures like the dermatologist. Noncompliance is a significant problem in treating this age group. It can be decreased by establishing an alliance with the patient concerning the goals of therapy. Although the parent may have brought in the teenager, the success of treatment depends on the patient himself or herself. The adolescent is most likely to follow through if the dermatologist presents the pros and cons of the treatment and explicitly leaves the choice of implementation to the adolescent. Parents who confidently offer to make sure the adolescent follows the treatment plan may only increase noncompliance by placing the treatment in the middle of existing parent-child struggles. For a variety of reasons, adolescents are hesitant to ask questions of the dermatologist, but this is especially true in sexually transmitted conditions. Teenagers may turn to each other and receive inaccurate information unless the physician actively invites their questions. In sexually transmitted illnesses this potentiates public health hazards, and in all dermatologic conditions it adversely affects compliance.