Pediatric dermatologic disorders have a profound impact on the quality of life of affected children and their families (Vivar & Kruse, 2018). Patients can experience considerable emotional distress and impaired school performance (Vivar & Kruse, 2018). Self-image may also be impacted because of visible differences in the skin associated with a number of skin conditions, such as port-wine stains and burn scars, creating considerable social burden. In 1993, the American Academy of Dermatology (AAD) created Camp Discovery to offer children (ages 8–16 years) with chronic skin conditions the opportunity to establish friendships and find acceptance through a fun summer camp experience. Under the supervision of dermatologists and nurses, campers come together every summer at one of the five locations across the country to participate in a weeklong program involving various activities such as canoeing, horseback riding, and arts and crafts (Dahl, 2018). Camp is provided at no cost to families, and current locations include Minnesota, Texas, Connecticut, Pennsylvania, and Washington. Eligibility for camp is determined after referral by the child’s respective dermatologist and review by the Camp Discovery medical director (AAD Association, 2022). Because of the COVID-19 pandemic, camp was transformed into a virtual experience in 2020, allowing children to reconnect with old friends and make new ones during a time of social distancing (O’Connell et al., 2021). With the success of the summer virtual camp experience, a virtual Camp Discovery Reunion was hosted by the AAD in Winter 2021. The reunion experience included a skin-model-building activity. The goal was to provide a relaxed and engaging activity where campers could learn the skin’s layers and functions, while also learning to love the skin they are in, perhaps representing the first step toward increased knowledge, self-concept, and empowerment of their disease (Vivar & Kruse, 2018). In addition, because a child’s skin disease often affects caregivers' mental health, conducting this activity may ultimately impact not only the personal happiness and knowledge of children but also that of their parents (Manzoni et al., 2013). After dermatologist referral and Camp Discovery medical director approval, permission was obtained from parents/guardians to participate. The model was constructed with arts and crafts supplies and household items. Camp counselors taught the participants about the three layers of the skin and their functions using the AAD's Skin Introduction lesson plan from their Good Skin Knowledge online curriculum (https://www.aad.org/public/parents-kids/lesson-plans). Figure 1 includes the necessary materials and step-by-step instructions on how to build the skin model. While building the model themselves, participants followed along and read each layer’s functions in the AAD's Our Skin handout, beginning from the deepest layer (subcutis) and working up to the epidermis.FIGURE 1.: Instructions on how to build a skin model. *Pipe cleaner cut into smaller pieces can be used as a substitute for matchsticks.Suggested materials include paint, glue sticks, scissors, a Styrofoam cube, pipe cleaners, cotton balls, sequins, foam sticker shapes, buttons, pom-poms, or wooden craft sticks. To delineate each of the three layers discussed, the Styrofoam cube is divided into three sections using paint or markers. Next, the model is built from the deepest layer to the most superficial layer. Participants first create the subcutis by applying cotton balls using glue to extend around the perimeter of the Styrofoam block. Next, the dermis is constructed. Pipe cleaners are inserted around the perimeter of the middle layer of the block, representing both blood vessels and nerves. Subsequently, foam sticker shapes, buttons, or pom-poms are applied to the middle layer of the block to illustrate glands housed within the dermis. The final step is the creation of the epidermis. Either colorful matchsticks or pipe cleaners (cut into roughly 2-inch pieces) are inserted into the top layer of the block, representing hair follicles emerging from the epidermis. Finally, sequins are added to illustrate moles, freckles, and scars individuals may have on their skin. Figures 2 and 3 are examples of the final skin model created by participants.FIGURE 2.: Example of a final skin model.FIGURE 3.: Group photo of participants displaying final skin models.Importantly, skin color was discussed from a scientific perspective. Camp counselors informed participants that the pigment melanin and its quantity are responsible for differences in skin shades, but we all look very similar underneath the top layer (epidermis) of our skin. Campers were encouraged to embrace the uniqueness of each individual’s skin (i.e., shade/color, moles, and scars) to promote acceptance and spread skin positivity. After the session, participants were asked via Zoom polling, “I know how to identify the three layers of the skin” and “I know what each layer of the skin does.” Sixteen participants participated in the camp session, and n = 16 (100%) of participants answered the preactivity poll, whereas n = 14 (88%) answered the postactivity poll. Answer options included “Yes,” “Kind of,” and “No.” Statistical analyses were conducted using Fisher’s exact test in R-4.0.3 (R Core Team, 2020). In addition, we asked parents and children for feedback on their experience with the activity. A summary of select responses is included (Table 1). TABLE 1 - Selected Responses on Experience With Skin Model Craft “My daughter...really enjoyed participating. She was really nervous about it at first, but I could tell once it started she had a lot of fun and she was proud of the skin model that she ended up making. A has not been able to go back to school in person since last March which makes interactive sessions like this even more special.” “...enjoyed winter camp project. It was great hands-on fun…. Thanks for making it fun.” “My daughter…liked the project! It was interactive, unique and educational and turned out cute! …got a kick out of it! I'd definitely do this with other kids.” “She thinks the project would be good for a younger audience that really likes crafts such as these. (...is in 6th grade.) ... liked the idea of learning about the skin and all the layers/parts. She thinks it would have been cool (since we're doing these projects online anyway) to have the group use an online program to work together (all have a say) in how to create a model online; each camper would contribute ideas to make a cooperative model using an online platform. Each camper could also use the online tool to add to the collaborative model. If you wanted to do a craft like this with an older group, ... thought incorporating the names of each part into the online model would be interesting so that you remember what each part means/is.” “She shared that she thinks it's a good project for younger kids because she felt like it was review of things she had already learned in school. She did say the project was a fun and easy project.” “My 10-year-old daughter, ... enjoyed the skin project and was proud of her result. I think it was an excellent learning exercise on the anatomy of our skin.” A significant number of participants reported being able to identify the three layers of the skin (presurvey = 0% [0/16], postsurvey = 50% [7/14]; p < .001) and their functions (presurvey = 13% [2/16], postsurvey = 57% [8/14]; p = .003). Pediatric dermatologic diseases are well documented to negatively impact children, often affecting self-esteem and relationships with caregivers and contributing to stigmatization. Pediatric patients with diseases like port-wine stains, atopic dermatitis, and hidradenitis suppurativa self-report decreased confidence; patients with atopic dermatitis and acne report stigmatization among peers; and childhood skin diseases are reported to contribute to parental fatigue, stressing the caregiver–child relationship (Vivar & Kruse, 2018). Pediatric dermatology camps, similar to Camp Discovery, have been documented to improve self-esteem and long-term psychological outcomes in children with skin diseases (Wu & Hogeling, 2021). On the basis of written feedback, this art project was informational in teaching campers the three skin layers. Parents affirmed the educational aspect of the activity, noting that their children thought the project was “educational” and “an excellent learning exercise on the anatomy of the skin.” One parent mentioned their child “was proud of the skin model that she ended up making.” Other responses regarding the activity stated, “Thanks for making it fun” and “I’d definitely do this with other kids,” indicating an appreciation of the activity. Limitations of this model include the monetary cost and requirement of an Internet-capable device. Although the costs of the materials were reimbursed, families were required to purchase the materials, and some mentioned difficulty obtaining supplies. As iterations of this activity continue, we hope this experience can serve as a “welcome” activity for Camp Discovery. Future variations could include using a food model or utilizing an online model-building platform to target adolescents and reduce monetary costs. Overall, we hope that this project encourages other healthcare professionals to adopt similar models toward empowering pediatric patients with chronic skin diseases and to teach children with and without skin diseases more about their skin. Katie Alexandra O’Connell School of Medicine Eastern Virginia Medical School Norfolk, VA [email protected] (ORCID: https://orcid.org/0000-0003-4999-0458)David X. Gao School of Medicine University of Illinois Peoria, ILHaya Raef School of Medicine Tufts University Boston, MAVanessa Ramos School of Medicine Eastern Virginia Medical School Norfolk, VA