The treatment landscape for pediatric atopic dermatitis (AD) has dramatically transformed in the past decade, marking a significant shift in how this condition is managed. Once primarily reliant on topical steroids and broad immunosuppressants, the approach now incorporates targeted therapies that directly address the underlying inflammation. The approval of dupilumab (Dupixent) in 2017 was a pivotal moment, introducing the first biologic therapy for moderate to severe AD and enhancing expectations regarding efficacy, safety, and quality of life improvements.
These advancements have paved the way for an array of innovative treatments, including tralokinumab (Adbry), lebrikizumab, and systemic Janus kinase (JAK) inhibitors such as upadacitinib (Rinvoq) and abrocitinib (Cibinqo). This new generation of therapies has notably improved disease control for both adult and adolescent populations, redefining long-term management strategies for AD.
As the focus has evolved towards systemic treatments, significant attention is now being directed at topical innovations, particularly in pediatric care. The introduction of nonsteroidal agents like roflumilast (Zoryve), ruxolitinib (Opzelura), and the recently approved tapinarof (Vtama) has expanded treatment options for children as young as two. These therapies provide effective, steroid-free anti-inflammatory alternatives that serve as a bridge between topical and systemic treatments.
Shifting Paradigms in Pediatric Dermatology
During a recent clinical forum held by HCPLive in Denver, Colorado, a panel of dermatologists, including Adelaide Hebert, MD, from the University of Texas Health Houston, and Emily Becker, MD, from the University of Texas Health San Antonio, discussed how these developments are reshaping real-world care for children with AD. The conversation revolved around evolving treatment philosophies, the integration of new nonsteroidal topicals, and the critical need for education and advocacy to overcome access barriers.
The panelists underscored a vital shift towards early, proactive interventions aimed at preventing chronic inflammation. They highlighted the importance of improving not only skin health but also overall well-being, emphasizing that adequate sleep is crucial for children’s growth and development. One panelist remarked, “Sleep is the big thing for the parents… The kids are itchy and up at night. The parents don’t sleep, the kids don’t sleep.”
Access to these innovative therapies is hindered by systemic barriers, including high costs, insurance limitations, and a lack of extensive pediatric data. Despite robust safety profiles for these newer agents, challenges remain in ensuring that families can benefit from them. Panelists reiterated that improving quality of life, reducing itch, and minimizing sleep disruption continue to be central goals in managing atopic dermatitis.
Advancing Patient-Centered Care
The dialogue also touched upon how pediatric dermatology is transitioning towards nonsteroidal topical treatments, with agents like tapinarof receiving particular attention. One panelist noted, “What’s nice about that when you’re in a busy practice… is that I don’t have to know whether it’s mild, moderate, or severe. We can rest assured because tapinarof is used across all severity types.”
Despite the costs associated with these treatments, the potential benefits are significant. Another panelist stated, “[Tapinarof] is probably one of the most effective products that’s out there. It’s expensive, but if you get it covered, the eczema melts away.”
As the field of pediatric dermatology evolves, the emphasis is on delivering tailored, family-centered care. By 2025, the success of dermatology will not only be measured by clinical outcomes but also by how effectively clinicians can provide safer, more individualized treatment options for their youngest patients. The ongoing commitment to education and advocacy remains crucial for advancing understanding and accessibility in atopic dermatitis care, ensuring a brighter future for children affected by this challenging condition.
