Intralesional injections deliver small aliquots of medication concentrated to a particular area of skin. For examples, medications such as corticosteroid, candida antigen, and botulinum toxin are frequently used in a pediatric dermatology practice. The recommended dose for IL Kenalog injections of the scalp for alopecia areata is 5–10 mg/mL (max 20 mg per session) and eyebrows 2.5–4 mg/mL [2]. Keloids and hypertrophic scars typically require higher doses of 20–40 mg/mL with injections spaced at 4- to 6-week intervals. The recommended total dose for Candida injections to treat recalcitrant warts is 0.3 mL. Botulinum toxin type A is 50 U per body part (total 200 U). Consideration for the pediatric population includes the associated pain of having serial and often multiple injections at a time. It is recommended to apply a topical anesthetic or other numbing technique prior to injections.

Many pediatric dermatologic minor procedures can be carried out in the office setting. Set-up is the key. This includes having informed consent and all parent/child questions addressed beforehand. Everyone in the room should be positioned, parents seated, and the procedural work area clear. The child should have used the restroom if needed and be positioned facing a TV screen or supportive parent. It is imperative to have the surgical tray with needles and other sharp instrumentation out of the view of the child. Safety equipment should be on and available for everyone in the room prior to the start of the procedure.

Full patient cooperation may not always be possible in the office setting. Therefore, sedation in children may be required at times to successfully perform more complex surgical and laser cases safely. For example, a nail matrix biopsy, due to the painful nature and long procedure time, is best accomplished in a controlled setting using general anesthesia, where better results can be achieved. There is increasing support in the literature on the safe use of general anesthesia in healthy children undergoing elective dermatologic surgery along with an experienced pediatric-trained anesthesiologist [19]. Many dermatologic surgeries and laser procedures can be accomplished within 1 h, and therefore shorter-acting anesthetics can be employed.