Dermatology Times 2025 Year in Review: Pediatrics with Peter Lio, MD

In a recent discussion with Dermatology Times, Peter Lio, MD, clinical assistant professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a board member of the National Eczema Association, outlined what he described as a transformative period for pediatric dermatology, particularly within the atopic dermatitis (AD) treatment landscape. His comments highlighted both the breadth of recent approvals and the complexity clinicians now face when integrating these therapies into practice.

Lio emphasized that one of the most significant advances has been the expansion of age indications for nonsteroidal topical therapies. Several agents, including tapinarof, ruxolitinib, and roflumilast, are now approved for use down to age 2 years. Crisaborole, approved down to 3 months of age, remains an important option for younger infants. According to Lio, this shift addresses a longstanding gap in pediatric care, as younger children represent a large proportion of patients affected by AD but historically had limited access to newer therapies.

Beyond topical treatments, the biologic landscape for AD has also expanded. Four biologic agents—dupilumab, tralokinumab, lebrikizumab, and the more recently introduced nemolizumab—are now available, with indications extending to adolescents aged 12 years and older. Lio noted that while younger children still face access limitations, adolescents now benefit from multiple targeted options, reflecting a broader trend toward precision medicine in dermatology.

The discussion also addressed systemic therapies, including the availability of 2 oral Janus kinase (JAK) inhibitors. While these agents add to the therapeutic arsenal, Lio acknowledged that the growing number of options creates challenges for clinicians attempting to determine optimal sequencing, safety considerations, and long-term management strategies.

Looking ahead, Lio described a robust development pipeline, citing estimates of more than 100 investigational agents for AD. Among the most notable emerging therapies is an oral STAT6 degrader currently in early-phase development. By targeting a key signaling component downstream of IL-4 and IL-13, this approach may offer efficacy comparable to biologics in an oral formulation. He drew parallels to developments in psoriasis, such as oral IL-23–targeting agents, suggesting a broader shift toward biologic-like oral therapies.

Lio also highlighted innovations beyond AD, including the availability of berdazimer gel as a home-based treatment option for molluscum contagiosum. Additionally, he expressed optimism about therapies aimed at modulating the skin microbiome, particularly those targeting Staphylococcus aureus, which has been implicated in AD pathogenesis. These approaches aim to restore microbial balance without broadly suppressing immune function.

Overall, the discussion underscored both optimism and caution. While the expanding pipeline represents unprecedented opportunity to improve pediatric dermatologic care, Lio emphasized the need for ongoing evaluation of safety, efficacy, and real-world applicability as clinicians navigate an increasingly complex therapeutic environment.