Panelists discuss how atopic dermatitis presents differently across pediatric age groups. Infants show lesions on cheeks and extensor surfaces, whereas older children develop more typical flexural patterns. They also discuss how the condition significantly impacts the quality of life for patients and caregivers through sleep disruption, school performance issues, and ongoing parental stress.
Panelists discuss how the current topical standard of care has evolved from traditional topical steroids developed in the 1960s to include newer nonsteroidal options like ruxolitinib (Janus kinase [JAK] inhibitor), roflumilast (phosphodiesterase-4 [PDE4] inhibitor), and tapinarof (aryl hydrocarbon receptor agonist), with steroids now serving as bridge treatments rather than long-term maintenance therapy.
Panelists discuss how extensive body surface area involvement in pediatric patients affects topical prescribing decisions, with high coverage areas often requiring systemic therapy consideration. They also discuss how location-specific factors like sensitive areas (face, groin) influence the choice toward nonsteroidal agents over topical steroids.
Panelists discuss how they incorporate both steroids and nonsteroidals from the initial visit by limiting steroid use to 1 to 2 weeks followed by long-term nonsteroidal maintenance, while noting the need for more vehicle formulations and lower age indications to better serve younger patients with limited treatment options.
Panelists discuss how ruxolitinib cream demonstrated impressive efficacy in the TRU83 trial, with over 50% of patients achieving near-complete clearance at 8 weeks using the 1.5% formulation, while acknowledging that the Janus kinase (JAK) inhibitor’s broad mechanism makes its effectiveness unsurprising despite concerns about the boxed warning.
Panelists discuss how tapinarof showed strong efficacy in the Adoring trials, with 45% to 46% Investigator’s Global Assessment (IGA) success and 55% to 60% Eczema Area and Severity Index (EASI-75) achievement at 8 weeks. However, they question real-world adherence to daily application over such extended periods and note folliculitis as a notable adverse effect occurring in over 5% of patients.
Panelists discuss how roflumilast demonstrated 25% Investigator’s Global Assessment (IGA) success at 4 weeks in the Integument PED trial with impressive long-term results showing 73% Eczema Area and Severity Index (EASI-75) achievement at 56 weeks, while highlighting its excellent tolerability profile with no black box warning, no folliculitis, and minimal stinging compared with previous phosphodiesterase-4 inhibitors.
Panelists discuss how twice-daily dosing represents the biggest adherence challenge and how simplifying regimens from multiple location-specific medications to single versatile treatments significantly improves adherence, with once-daily formulations being much more manageable for busy families.
Panelists discuss how they determine when to escalate to systemic therapies by focusing on patient-reported outcomes rather than clinical appearance alone, asking about flare frequency and typical vs bad days, while emphasizing the importance of continuing topicals alongside systemics with potential for future de-escalation.
Panelists discuss how comprehensive caregiver education forms the foundation of successful treatment, involving dispelling internet misinformation, demonstrating proper application techniques like fingertip units, addressing steroid fears, and establishing realistic expectations about long-term management rather than seeking quick cures.
Panelists discuss how future therapies should aim to provide faster symptom relief than the current 4- to 8-week timeframe, offer longer-lasting depot effects requiring less frequent application, and accelerate the regulatory process for extending safe adult medications to younger pediatric populations.
Panelists discuss how dermatologists should expand their therapeutic scope beyond traditional steroids and calcineurin inhibitors to embrace newer nonsteroidal options, while emphasizing that treating pediatric atopic dermatitis requires the same principles as adult care and encouraging broader provider participation, including pediatricians, to address access challenges.
