Biologics, JAK Inhibitors, and Atopic March Data in Pediatric Atopic Dermatitis

Mark Lebwohl, MD, dermatologist, dean for clinical therapeutics at the Icahn School of Medicine at Mount Sinai, and chairman emeritus of the department of dermatology at Mount Sinai, recently discussed the atopic march and systemic options for pediatric atopic dermatitis. He highlighted a recent poster by Eric Simpson, MD, and colleagues comparing dupilumab (Dupixent; Sanofi and Regeneron) with systemic corticosteroids.¹ Lebwohl also reviewed approved biologics and JAK inhibitors, along with injection tolerability in children.

Atopic March Data for Dupilumab vs Systemic Corticosteroids

The poster examined progression from infant atopic dermatitis to other atopic diseases such as asthma.¹ Lebwohl described the comparison of patients treated with dupilumab versus those treated with systemic corticosteroids.

“The patients treated with dupilumab are less likely to go on to develop asthma than patients treated with systemic corticosteroids,” Lebwohl said.

He also cited data showing a reduction in average lifetime height among patients treated with topical steroids. Patients treated with dupilumab seem to grow more, either because their eczema is better controlled or because they are not using topical corticosteroids.

“There are some real breakthroughs in using these new therapies,” Lebwohl said.

Biologics and JAK Inhibitors

Lebwohl treated the first patient ever treated with dupilumab for atopic dermatitis, a little more than 10 years ago, and knew right away the drug worked. A sizable number of patients still need more than dupilumab provides. Three additional biologics are approved: lebrikizumab, tralokinumab, and nemolizumab, which blocks IL-31.

Lebwohl said the other biologics presumably would do something similar to dupilumab regarding the atopic march. Two JAK inhibitors, abrocitinib and upadacitinib, are also approved in the United States and are very effective.

“The boxed warning probably overstates the side effects of those drugs and scare patients from using the appropriate drug for them,” Lebwohl said.

He tells all patients about the boxed warnings and encourages those with truly severe disease to take a JAK inhibitor nonetheless. Patients closer to the borderline are treated with biologics. A genetic test on skin scrapings can indicate whether a patient is likely to respond to a biologic or a JAK inhibitor.

Dupilumab Use in Young Children and Injection Burden

Dupilumab is the only systemic therapy approved down to 6 months for atopic dermatitis, and Lebwohl said he uses it quite often.

“The drug appears to be very safe,” Lebwohl said. “The main side effect has been conjunctivitis.”

Older children may complain about injections, but many realize treatment has changed their lives for the better and generally tolerate them. Some patients are waiting for an oral medication. Lebwohl recalled a father who said his child is afraid of him because he gives the injection.

According to Lebwohl, a recently published pain of injection study found all atopic dermatitis drugs are not very painful. “Nemolizumab hardly hurts at all,” Lebwohl said, probably in part because of its small injection volume.

Reference

1. Simpson EL, Paller A, Eichenfield LF, et al. Modification of atopic march progression in dupilumab-treated pediatric atopic dermatitis patients in the United States: a retrospective, real-world study. Poster presented at: Fall Clinical Dermatology Conference 2026; October 8–11, 2026; Las Vegas, NV.