Challenges With Topical Treatments in Pediatric Atopic Dermatitis

Families managing extensive atopic dermatitis coverage on their child’s body face unique treatment decisions that may require combining topical and systemic therapies for optimal results. When children have large, affected areas covering 40% to 60% of their body surface area, topical treatments alone become impractical due to safety concerns with high steroid doses and insufficient quantities of nonsteroidal medications typically covered by insurance. Health care providers must carefully evaluate the extent of involvement and specific body locations when selecting appropriate topical treatments.

Patients with atopic dermatitis affecting sensitive areas like the face, eyelids, armpits, or groin require special consideration in treatment selection due to increased absorption rates and a higher risk of adverse effects in these locations. Nonsteroidal topical medications become preferred choices for these delicate areas, as they avoid the skin-thinning effects and other complications associated with corticosteroid use on sensitive skin. The topical Janus kinase inhibitor ruxolitinib carries a body surface area limitation of less than 20%, highlighting the importance of individualized treatment planning.

Despite significant advances in topical therapy, children with atopic dermatitis still face unmet medical needs, particularly in the youngest age groups, where treatment options remain limited. Infants under 6 months who develop severe atopic dermatitis present the greatest challenge, as families and pediatricians have fewer safe, effective options available during this critical period when symptoms can be most distressing. The expansion of current nonsteroidal medications to younger age groups represents a crucial area for future development, as does the need for better predictive tools to match specific treatments to individual patients based on their underlying disease mechanisms.