Pediatric Atopic Dermatitis Treatment Selection: Biologics vs Nonsteroidal Topical Therapies

The recent FDA approval of topical JAK inhibitors for children 2 years or older marks a significant advancement in pediatric atopic dermatitis treatment. Previously approved only for individuals 12 years or older, this approval is based on a well-designed clinical trial that tested both 0.75% and 1.5% dosing against placebo in children aged 2 to 11 years with mild to moderate eczema (3%-20% body surface area affected). The study findings showed that both concentrations were superior to placebo in achieving clinical improvement, with the 1.5% dose showing slightly better efficacy. Importantly, safety profiles were reassuring, with no new or severe adverse events such as lymphoma or systemic adverse events noted, paralleling the adult data. This provides dermatologists a promising, effective, and safer nonsteroidal option for managing pediatric eczema, allowing for flexible dosing strategies, such as weekend maintenance therapy, unlike topical steroids, which require stricter short-term use.

Despite these advances, practical challenges remain in prescribing these novel medications. Insurance approval processes and access barriers often complicate timely treatment initiation, leading many clinicians to rely on topical steroids, which are inexpensive and easy to obtain. Clinicians must carefully assess each patient’s age, disease severity, lifestyle, and treatment adherence potential when selecting therapies. For example, once-daily regimens may be better suited for adolescents who struggle with more complex routines. The goal is to integrate these new options thoughtfully into individualized care plans, starting with basic skin care and trigger avoidance, and then tailor topical therapies based on patient needs and feasibility.

Communication with and education of families are critical to ensuring safe and effective use of these newer treatments. Providers emphasize the importance of translating clinical data into understandable risks and benefits for parents and patients, often drawing from personal experience as parents themselves to build trust. Scheduled follow-ups help monitor adherence and safety, allowing for timely adjustments. Finally, clinicians must continuously evaluate when to escalate from topical therapies to phototherapy or systemic treatments, balancing efficacy with patient-specific factors and preferences.