At the congress of the Spanish Academy of Dermatology and Venereology (AEDV) held recently in Valencia, the attendance at pediatric dermatology sessions was cause for great satisfaction: with rooms full to capacity, many conference participants had to be turned away. The overflowing rooms demonstrated once again the keen interest Spanish dermatologists have in pediatric dermatology.

Children are inherently difficult to manage clinically, they are subject to many skin conditions that primarily affect only the pediatric population, and they seldom require cosmetic procedures. These are just some of the reasons why pediatric dermatology has remained close to the foundations of classic clinical dermatology, the specialty most of us originally trained in. At the same time, this subspecialty is open to all the fascinating new and upcoming scientific and therapeutic developments and affords scope for the application of epidemiologic and preventive strategies.

In Spain, the very healthy levels of attendance and activity at meetings of the Spanish Pediatric Dermatology Group reflect a broad interest in pediatric dermatology. The proven academic and professional excellence of Spanish dermatologists overall is particularly evident in this field. In recent years, Spain has led all other European countries in the number of articles published in Pediatric Dermatology; in fact, it ranks only second to the United States. Spanish medical professionals make a very significant contribution to international conferences in this subspecialty, and the World Congress of Pediatric Dermatology will be held in Madrid this year, with an outstanding number of papers to be presented by Spanish authors. Some 1400 participants from all over the world are expected to attend, including 300 Spaniards. We would like to achieve higher Spanish attendance, especially considering the fact that Spain will be contributing the most speakers and course directors.

There is little doubt that Spain's high standard of excellence in pediatric dermatology owes much to the keen interest of Spanish dermatologists in this subspecialty. Only the dedication of our dermatologists can explain how quality of care and research have been maintained in a context of minimal training capacity, scant specialized pediatric care centers, and continuing cutbacks in public resources. However, I am not at all surprised by this phenomenon: for decades, pediatric dermatology training and care have depended on the inexhaustible generosity of Spain's qualified pediatric dermatologists as well as the tremendous commitment and ability of younger trainee dermatologists. There is absolute nothing in the Spanish medical residency system (MIR) or in our non-existent post-residency training system to encourage dermatologists to train in this subspecialty; yet interest and dedication continue to grow.

Unfortunately, we can expect little change in this area. The Society for Pediatric Dermatology was founded in the United States in 1975 and since then it has spearheaded and overseen US training of pediatric dermatologists. Meanwhile, 38 years have gone by and we now have our own scientific society in Europe (the European Society of Pediatric Dermatology), but we still lack an organized training system, despite growing interest and relevance. Training in pediatric dermatology is fragmented, having been left up to a few pediatric hospitals that do not observe a common set of principles. In Spain, this state of affairs is reflected in the absence of any structured approach to training; dermatologists have to struggle individually to obtain training that receives no official recognition.

In my opinion, it would be much better if pediatric dermatology in Spain did not have to depend solely on the enthusiasm of a small group of people and if the Spanish health care system accorded this subspecialty the recognition it deserves, given the outstanding level of scientific excellence achieved.