Pediatric dermatology; Curriculum; Fellowship; Pakistan

Globally, pediatric dermatology emerged as a distinct specialty in the 1970s, particularly in North America and Europe, through structured fellowship programs, whereas it remained part of general dermatology training in Pakistan for decades. Formal dermatology units were scarce even in the 2000s, and pediatric dermatology was not established as a separate subspecialty at that time, as pointed out by an audit at Hamdard University Hospital in 2006, which described it as “hitherto nonexistent” [1].

Nearly 40% of the Pakistani population is under 18 years of age, making it one of the largest pediatric populations worldwide, with approximately 112 million children. Skin diseases constitute a large proportion of hospital visits among children. Multiple hospital audits have reported infections as the most common skin diseases in children. Shahzeen et al. reported infestations and infections (62%) and noninfective dermatoses (32%), whereas Habib et al. reported infections (42%), infestations (22%), and eczema (13%) as common skin diseases in children [2,3]. The literature supports the need for pediatric dermatology as a structured subspecialty, with a standardized curriculum and fellowship pathway.

Specialty training in Pakistan remains largely within general dermatology [i.e., Fellowship of the College of Physicians and Surgeons (FCPS), Doctor of Medicine (MD), Membership of the College of Physicians and Surgeons (MCPS), and Diploma in Dermatology (Dip Derm)], with exposure to pediatric dermatology through outpatient clinical experience rather than through a standardized pediatric dermatology fellowship program. Tertiary hospitals provide the main training opportunities and are key centers for fellowship development [4,5]. Advocacy for pediatric dermatology clinics, highlighting the inadequate workforce to meet the dermatological needs of children, has been used to frame policy and training discussions [6,7].

Pediatric dermatology in Pakistan has evolved through three phases of development. The foundation phase (1990s–2000s) began with the establishment of the first pediatric dermatology unit in Pakistan at the Institute of Child Health, Lahore, in 1996 by Prof. Farhana Muzaffar. She developed a unit that catered to the needs of children suffering from skin diseases on an outpatient basis. In addition, services such as phototherapy, cryotherapy, and electrocautery were available in the department [8]. During this period, the subspecialty was not formally recognized.

The second phase (2010–2021) involved advocacy and the gradual recognition of pediatric dermatology as a subspecialty. The development of pediatric dermatology during this period was driven by local audits, advocacy for pediatric dermatology clinics, and senior dermatologists’ opinions highlighting gaps in training and urging the establishment of level IV training in dermatology-related subspecialties, including dermatosurgery, dermatopathology, aesthetic dermatology, and pediatric dermatology [6,7]. A key driving force behind the emergence of pediatric dermatology as a second fellowship in Pakistan was Dr. Yasmeena Khan, who has been a strong advocate for formal fellowship training in pediatric dermatology across Pakistan and has persistently campaigned for the creation of posts for pediatric dermatologists in children’s hospitals nationwide [9]. Although several children’s hospitals exist in the country, only a few currently have dedicated pediatric dermatology departments.

The third phase (2022 onward) marked accreditation and curriculum development. These advocacy efforts culminated in the formal recognition of pediatric dermatology as a Level IV specialty by the College of Physicians and Surgeons Pakistan (CPSP). A second fellowship in pediatric dermatology was subsequently initiated, with five dermatology departments accredited for training. The first department to be recognized was the Dermatology Unit-I, Allama Iqbal Medical College, Lahore, in 2022 [10].

Following formal recognition, the CPSP introduced a structured Level IV fellowship training program in pediatric dermatology, offered to dermatologists and pediatricians holding FCPS or MD degrees. It is a two-year program that includes clinical and procedural training based on a structured curriculum approved by CPSP. Assessment is conducted through maintenance of digital logbooks, workplace-based evaluations, research work, and an exit examination. However, the implementation of the program varies across institutions because of differences in faculty availability and infrastructure among training centers.

Currently, five dermatology departments across Pakistan are accredited by the CPSP to provide level IV fellowship training in pediatric dermatology. These include Dermatology Unit-I, Allama Iqbal Medical College/Jinnah Hospital, Lahore; Dermatology Unit-I, Faisalabad Medical University and its affiliated hospitals, Faisalabad; Dermatology Unit-I, P.N.S. Shifa, Karachi; Dermatology Unit-I, SIMS/Services Hospital, Lahore; and Dermatology Unit-I, Lady Reading Hospital/Medical Teaching Institute, Peshawar [10].

In comparison with international training models such as the United States, where the duration of fellowship is one year and training is conducted within dedicated children’s hospitals with multidisciplinary collaboration [11,12]. Pakistan’s model differs in terms of the duration of training (two years), the scarcity of trained faculty, and the limited number of training centers, which are located mainly in tertiary care hospitals. In the United Kingdom, a one-year post-CCT fellowship in pediatric dermatology is recognized [13].

Strengths of this program include formal recognition by the CPSP, a growing number of accredited hospitals, and a structured training curriculum. Furthermore, the first dedicated pediatric dermatology journal of Pakistan, titled the Pakistan Journal of Pediatric Dermatology, and the first pediatric dermatology society have been established. However, the program also faces several limitations, including resource constraints, a limited faculty pool, demographic disparities, and a low number of public sector posts for trained specialists.

To address these challenges, the expansion of CPSP Level IV fellowship programs across multiple centers in Pakistan is recommended. Creating posts for pediatric dermatologists in children’s hospitals and teaching hospitals would improve access to specialized care and reduce the outpatient burden on tertiary care hospitals. In addition, promoting multidisciplinary clinics for complex dermatological diseases and encouraging collaborative research will further strengthen the subspecialty and contribute to national capacity development.

Overall, pediatric dermatology in Pakistan has transitioned from limited recognition to a formally recognized level IV subspecialty. With the pioneering efforts of early leaders, continued investment by government institutions and professional bodies will be essential. Ongoing curriculum refinement, faculty development, workforce planning, and institutional support are necessary to address the growing burden of pediatric dermatologic diseases. Strengthening this subspecialty also provides Pakistan with an opportunity to improve pediatric healthcare nationally and contribute meaningfully to the global pediatric dermatology community.

The author herself wrote and revised the manuscript.

This research received no specific grant from the public, commercial, or not-for-profit funding agencies.

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The author declares no conflicts of interest.

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