The treatment of atopic dermatitis (AD) in children is undergoing a remarkable shift, with several new therapies now approved for use in increasingly younger patients, according to a recent discussion with Peter Lio, MD, clinical assistant professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a board member of the National Eczema Association.
Lio highlighted the expansion of age indications for nonsteroidal topical treatments as a key advancement. Tapinarof, ruxolitinib, and roflumilast are now approved for children as young as 2 years old, while crisaborole remains a valuable option for infants starting at 3 months of age. This addresses a critical need, as younger children are disproportionately affected by AD but previously lacked access to these newer treatments.
The landscape of biologic therapies for AD has also broadened, with four agents—dupilumab, tralokinumab, lebrikizumab, and nemolizumab—now available for adolescents aged 12 and older. While access for younger children remains a challenge, Lio noted that this represents a move toward more precise, targeted treatments in dermatology.
Navigating a Complex Treatment Landscape
Beyond topical and biologic options, two oral Janus kinase (JAK) inhibitors have entered the therapeutic arsenal. However, Lio cautioned that the growing number of choices presents a challenge for clinicians in determining the optimal treatment sequence, ensuring patient safety, and developing long-term management plans.
Looking ahead, the development pipeline for AD treatments is robust, with over 100 investigational agents in the works. An oral STAT6 degrader, currently in early-phase development, is particularly promising. This therapy targets a key signaling pathway downstream of IL-4 and IL-13, potentially offering efficacy similar to biologics in an oral formulation. Lio drew a parallel to advancements in psoriasis treatment, such as oral IL-23 inhibitors, suggesting a broader trend toward oral therapies with biologic-like effects.
Innovations extend beyond AD, with berdazimer gel now available as a home-based treatment for molluscum contagiosum. Lio also expressed optimism about therapies that modulate the skin microbiome, specifically targeting Staphylococcus aureus, a bacterium implicated in the development of AD. These approaches aim to restore a healthy microbial balance without widespread immune suppression.
What is the best way to treat atopic dermatitis? The expanding range of treatment options for atopic dermatitis offers unprecedented opportunities to improve pediatric dermatologic care, but Lio emphasized the importance of ongoing evaluation of safety, efficacy, and real-world applicability as clinicians navigate this increasingly complex therapeutic environment.
The availability of tapinarof, ruxolitinib, and roflumilast for children as young as 2 years old marks a significant step forward in pediatric AD treatment.
Overall, the discussion underscored a blend of optimism and caution. While the expanding pipeline represents unprecedented opportunity to improve pediatric dermatologic care, Lio emphasized the need for ongoing evaluation of safety, efficacy, and real-world applicability as clinicians navigate an increasingly complex therapeutic environment.
