AAD's First Pediatric AD Guidelines Are Here — and They Reflect a Decade of Change

The American Academy of Dermatology (AAD) has published its first-ever guidelines of care dedicated specifically to pediatric atopic dermatitis (AD) — a milestone that reflects how dramatically the treatment landscape has shifted over the past decade. Published in the Journal of the American Academy of Dermatology, the guidelines address a longstanding gap: until now, management of childhood eczema has largely been extrapolated from adult data, despite meaningful differences in safety considerations, disease presentation, and caregiver-dependent adherence.¹

"Finally! We got AD guidelines for our pediatric patients!" said Lisa Swanson, MD, a dermatologist and pediatric dermatologist based in Boise, Idaho, in a statement to Dermatology Times. "These new AAD guidelines help clarify the treatment approach for our little peanuts which will help patients, clinicians, and will hopefully even improve access to these recommended therapies. The care of atopic dermatitis has changed A LOT over the past 5 to 10 years, and now we have guidelines that reflect all of those advances!"

Pediatric AD affects up to 25% of children worldwide.^1,2 Beyond its prevalence, the condition carries a significant quality of life burden — sleep disruption, chronic itch, irritability, and caregiver fatigue are all part of the clinical picture. The guidelines make clear that treatment goals should address functional outcomes, not just skin clearance.

Prevention: Keep Counseling Simple

Despite strong family interest in preventing eczema before it starts, the guidelines narrow the evidence-based options considerably. Moisturizers are the only intervention receiving even a conditional recommendation for prevention, specifically in children aged 6 months to 3 years, where early skin barrier support may reduce inflammatory cascade initiation.^1,3

Everything else — probiotics, vitamin D supplementation, dietary restriction, early allergen introduction, dust mite avoidance, water softening — lacks sufficient evidence for eczema prevention.^1,3 For APPs fielding these questions from anxious parents, the guideline simplifies the conversation: emollients yes, everything else not supported.

Treatment: A Bigger Toolkit, Used Proactively

Emollients and topical corticosteroids remain foundational — first-line for acute flares, with corticosteroids specifically noted for their efficacy, affordability, and accessibility. But one of the guidelines' clearest messages is the shift toward maintenance therapy rather than reactive, flare-only treatment.

The steroid-sparing topical options now carrying strong recommendations have expanded significantly. Calcineurin inhibitors remain important for sensitive areas and maintenance. PDE-4 inhibitors — crisaborole (Eucrisa; Pfizer) and roflumilast (Zoryve; Arcutis Biotherapeutics) — provide antipruritic and anti-inflammatory effects, with roflumilast highlighted for proactive flare prevention. Topical JAK inhibitors (ruxolitinib cream) and tapinarof cream, an aryl hydrocarbon receptor agonist, extend options from mild through severe disease — both targeting inflammation and barrier dysfunction without steroid exposure.

Systemic Therapy: Earlier and More Targeted

For moderate to severe pediatric AD, the guidelines strongly support biologics and oral JAK inhibitors — and position them earlier in the algorithm than has historically been standard. Dupilumab (Dupixent; Sanofi/Regeneron), tralokinumab (Adtralza; LEO Pharma), lebrikizumab (Ebglyss; Eli Lilly), and nemolizumab (Nemluvio; Galderma) each target key inflammatory pathways, with demonstrated improvements in itch, sleep, and disease severity. Oral JAK inhibitors — upadacitinib, abrocitinib, and baricitinib — offer rapid symptom control in appropriately selected patients.

Systemic corticosteroids, by contrast, received a strong recommendation against routine use, reserved only for short-term bridging during severe flares. PUVA phototherapy is discouraged in pediatric patients, and topical antimicrobials are not supported for non-infected AD.

A Shift Worth Knowing

Whether your practice sees a handful of pediatric eczema patients or many, these guidelines provide the clearest picture yet of where evidence-based care currently stands — and where the field is heading. The move toward proactive maintenance, earlier systemic escalation when warranted, and a broader topical toolkit reflects years of accumulating data that now has formal AAD backing.

References

1. Davis DMER, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in pediatric patients. JAAD. 2026. doi:10.1016/j.jaad.2026.02.113
2. Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci. 2019;49(4):963-984. Published 2019 Aug 8. doi:10.3906/sag-1810-105
3. American Academy of Dermatology issues first-ever pediatric atopic dermatitis guidelines, highlighting prevention strategies and effective treatments. News release. American Academy of Dermatology. April 7, 2026. Accessed April 22, 2026. https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines