Navigating Available Topical Treatment Options for Pediatric Atopic Dermatitis

Topical therapy remains a foundational component in the management of atopic dermatitis, especially in pediatric populations. Although systemic treatments have expanded, most patients—regardless of disease severity—continue to rely on topicals for both flare control and maintenance. The basis of care begins with gentle skin care to repair the compromised skin barrier and reduce environmental triggers. From there, managing inflammation requires a tailored approach that accounts for the chronic and heterogeneous nature of eczema. Topical corticosteroids remain widely used for acute flares, but due to risks such as skin atrophy and ocular complications, they are generally not recommended for long-term use in sensitive areas or across large body surfaces.

Newer nonsteroidal options have helped address many concerns associated with long-term steroid use. Calcineurin inhibitors such as tacrolimus and pimecrolimus, as well as phosphodiesterase-4 (PDE4) inhibitors such as crisaborole and roflumilast, offer alternatives that can be used chronically and across all body regions, including delicate areas such as the face and groin. These agents have proven efficacy and improved tolerability, with some—such as roflumilast—offering longer flare-free intervals and faster itch reduction. The topical JAK inhibitor ruxolitinib has also emerged as a potent option with steroid-comparable efficacy, though it carries systemic safety considerations and usage limitations (eg, < 20% body surface area), given concerns about systemic absorption.

Safety discussions are essential, particularly as topical phobia—especially around steroids—is widespread. Although black box warnings on agents such as calcineurin inhibitors and topical JAK inhibitors may raise concern, extensive long-term data have not shown significant risk when used as directed. Patient education and shared decision-making are key to adherence. Providing families with clear explanations of mechanism, realistic expectations, and guidance on safe application helps demystify treatment and empowers long-term disease control. Ultimately, individualized regimens that prioritize both efficacy and safety offer the best outcomes for patients with pediatric eczema.