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Atopic Dermatitis Provider Toolkit

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Dermatology Hot Topics

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A 3-year-old boy is seen for unilateral swelling on the left side of the face, in front of and behind the left ear. Findings on examination of ears, oral cavity, and teeth are normal. He is afebrile (temp, 37°C [98.6°F]), cooperative, and in no distress. He is otherwise healthy. Past medical history includes 1 MMR vaccination.

The child is bright and alert and has no fever. The swelling is on the left side of the face only. Find other clues to a diagnosis in the accompanying video.  

3-Year-Old Boy With Unilateral Facial Swelling 

A 27-year-old woman intermittently experiences painful oral lesions such as this one on her upper lip. She denies a history of genital lesions or ophthalmologic problems and is otherwise in superb health.

A 27-year-old woman intermittently experiences painful oral lesions such as this one on her upper lip. Your impression?

Oral Lesions

Pain is often severe in patients with adhesive capsulitis, or frozen shoulder, and motion is restricted. Distinguishing between frozen shoulder and osteoarthritis may be difficult. Internal rotation of the shoulder is measured by the highest vertebral level that the tip of the thumb may reach with the arm behind the back.

The patient’s reach with his thumb helps distinguish between frozen shoulder and osteoarthritis. How high is enough to tell?

Clinical Topics

Thumbs Up or Down on Shoulder Pain?

A new KFF–Washington Post survey released today finds most parents remain confident in long-standing childhood vaccines like measles, mumps, rubella (MMR) and polio and even support mandates for school entry, but skepticism remains widespread when it comes to seasonal flu and COVID-19 vaccines.

 say MMR vaccines are important for children in their community, and 

 express confidence in the safety of the shots.

 view flu shots as important for kids, and fewer than half (

) say the same about COVID-19 vaccines. Confidence in safety is 

The survey comes as Health and Human Services Secretary Robert F. Kennedy Jr. questions the CDC’s vaccine schedule and promotes policy changes that have generated both confusion and concern among parents.

The majority of parents responding also support school mandates, with

agreeing that schools should require MMR and polio vaccines for school attendance, with allowances for medical and religious exemptions. This consensus cuts across party lines. Still, 

 of parents say they have sought an vaccine exemption for a child to attend school or daycare.

Rationale for Skipping, Delaying Vaccines

While most parents keep children up to date, 

 say they have skipped or delayed at least one childhood vaccine (other than against flu or COVID). That number rises to:

The most common reasons for the hesitation include concerns about side effects, doubts about vaccine safety, and feeling that not all recommended vaccines are necessary. Nearly

of those who delayed cited not wanting multiple shots at once. About 

 also said their child’s health care provider supported their decision. Approximately

said they had changed or had tried to change clinicians based on the professional's view on vaccines. 

Age did make a difference in perceptions of vaccine safety with younger parents (younger than age 35) more concerned than older groups. The survey also found that Black parents were less confident in the safety of flu, MMR, and polio vaccines than White and Hispanic parents. 

The survey asked about specific false claims circulating about vaccines and measles. While relatively few (9%) said they believe the false claim that the MMR vaccine causes autism, nearly half (48%) responded that they don't know enough to say one way or the other. Parents of children diagnosed with autism appeared more likely (16%) to believe the false claim that vaccines are the cause than other parents. 

Four in ten parents say children are healthier if vaccines are spaced out, reflecting concerns promoted by federal officials who question current guidelines and have suggested there may be changes made to the childhood vaccination schedule.

 of parents of children ages 9 and older say their child has received or will likely receive the vaccine against human papillomavirus (HPV) vaccine. Sentiment on this matter reflected the current political divide: 

 of Democratic parents say their child has or will get the shot.

Moral or religious concerns and worries about long-term safety were the most common reasons cited by parents who oppose the vaccine for a child.

The poll findings underscore the shaky confidence in federal oversight. Only 

 of parents say they have “a lot” of confidence in the CDC or FDA to ensure vaccine safety and effectiveness. 

) say the CDC recommends too many vaccines. 

Despite the near daily headlines and media coverage about policy changes and federal health agency upheaval, parent's awareness of the drastic shifts that could affect their children's future immunizations is quite limited.

 of those surveyed said they have heard little or nothing about them. 

The survey underscores a split landscape among American parents. As strong as the consensus is around core childhood vaccines, the uncertainty about and mistrust of newer and seasonal immunizations persists. At the same time, confidence in federal health agencies is low, and confusion fueled by misinformation remains widespread.

New KFF-Washington Post survey explores parents' trust in,  and confusion about, childhood vaccines as the Trump administration revamps federal policies. News release. KFF. September 15, 2025. Accessed September 16, 2025. https://www.kff.org/public-opinion/new-kff-washington-post-survey-explores-parents-trust-in-and-confusion-about-childhood-vaccines-as-the-trump-administration-revamps-federal-policies/

Most parents support childhood vaccines such as MMR and polio, but skepticism about seasonal and newer shots persists, along with distrust of federal agencies.  

Most Parents Trust Standard Childhood Vaccines, but Many Question Flu and COVID-19 Shots: KFF-Washington Post Survey 

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Scaly Plaque on the Nose

Some vaccinations for adults are recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) for all adults, regardless of health, lifestyle, or occupational factors. Others are highly recommended for specific populations that may be at greater risk for a vaccine-preventable disease. A simple mnemonic from 

guides clinicians to consider factors related to health, age, lifestyle, and occupation, or HALO, when making an initial decision about vaccination for a specific adult. A definitive decision, the organization says, should be based on the more detailed information published in the complete vaccine recommendations of the ACIP.

The short slide show above summarizes the HALO factors most relevant to consider for 17 adult vaccines. 

A review of 4 factors can help primary care clinicians with an initial decision about adult vaccination: health, age, lifestyle, and occupation (HALO).

Grace Halsey

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