Rein in the Inflammation: April Armstrong, MD, MPH’s Case-Based Update on AD Innovation

At this year’s Winter Clinical Miami meeting, April Armstrong, MD, MPH, dermatologist, professor, and chief of dermatology at the University of California Los Angeles (UCLA) and co-director for network resources at the UCLA Clinical and Translational Research Institute, delivered a case-based update on the latest and greatest in atopic dermatitis (AD), highlighting rapid therapeutic advances across age groups.¹ Framing her discussion around the Lunar New Year and the “Year of the Horse,” she encouraged attendees to “saddle up and rein in AD inflammation,” using this metaphor to reflect both the energy of innovation and the momentum in the field.

Expanding Options in Early Childhood

Armstrong began with a case of a 3-year-old Hispanic boy with longstanding AD, lichenification, and post-inflammatory hyperpigmentation—features commonly observed in skin of color. Historically, management in children aged 2 to 5 years relied heavily on emollients and topical corticosteroids. However, the therapeutic landscape has evolved substantially, particularly with the expansion of nonsteroidal topical options.

Within the past year, 2 key agents have gained approval for this younger age group. Roflumilast cream 0.05%—distinct from the 0.15% formulation approved for older patients—has demonstrated meaningful efficacy, with approximately one-third of pediatric patients achieving clear or almost clear skin with at least a 2-point Investigator’s Global Assessment (IGA) improvement. In addition, topical ruxolitinib cream is now approved down to age 3, expanding its prior indication from adolescents and adults to younger children. Armstrong emphasized practical considerations, including twice-daily application and limiting use to no more than 20% body surface area.

Tapinarof 1% cream, previously approved, further broadens the nonsteroidal armamentarium for mild-to-moderate disease in this population. Clinical trial data in moderate to severe AD showed robust responses, with nearly half of patients achieving clear or almost clear skin at 8 weeks. Armstrong underscored the importance of documentation for prior authorizations and advocated a proactive maintenance strategy: daily treatment until clearance, followed by twice-weekly application to previously affected areas to reduce flares, with ongoing liberal emollient use elsewhere.

Follow-up of this pediatric case demonstrated visible improvement by weeks 1 and 4 on topical therapy, reinforcing the practical effectiveness of these newer agents. Armstrong also highlighted the importance of caregiver education, noting that successful pediatric management hinges on clear communication and realistic expectations.

“I am dreaming of a day when our children with AD can happily slather on medications themselves. But parents and caregivers [are] such a big part of the conversation,” she added. “I think the whole community is very excited about the possibility of all these treatments.”

Systemic Therapy and JAK Inhibitor Safety

The second case featured a 41-year-old patient with severe, childhood-onset AD (EASI 31, IGA severe). For moderate to severe disease, biologics and Janus kinase (JAK) inhibitors represent important systemic options. Armstrong reviewed baseline evaluation and monitoring requirements, referencing available summaries to guide clinicians through laboratory and safety protocols.

A key point was herpes zoster vaccination prior to initiating JAK inhibitor therapy. The recombinant zoster vaccine should ideally be initiated before treatment, with the second dose administered between months 2 and 6. In her practice, Armstrong often schedules the second dose around month 5 and may temporarily pause JAK inhibitor therapy for about a week to facilitate vaccination.

Addressing patients’ potential long-term safety concerns, she presented extended follow-up data—up to 7 years for upadacitinib and over 6 years for abrocitinib. These analyses have not demonstrated increased rates of major adverse cardiovascular events, venous thromboembolism, or malignancy compared with background AD populations. However, herpes zoster rates are elevated, particularly at higher doses, reinforcing the importance of vaccination. The featured patient achieved marked improvement with upadacitinib, illustrating the transformative potential of targeted systemic therapy.

Targeted Treatment for Head and Neck Dermatitis

The final case focused on chronic head and neck involvement, an especially challenging AD phenotype. A patient of Armstrong’s, who was significantly burdened by facial disease, achieved sustained improvement with tralokinumab, initially dosed every 2 weeks and later spaced to every 4 weeks.

Armstrong also highlighted the importance of differential diagnosis in facial dermatitis, referencing work by Peter Lio, MD, and colleagues. Clinicians should consider alternative etiologies, including contact dermatitis and other inflammatory conditions, before attributing findings solely to AD or biologic-associated facial dermatitis. In cases suspected to be dupilumab-associated, morphology may appear more indurated, warranting careful clinical assessment.

Reference

1. Armstrong A. Latest and Greatest in Atopic Dermatitis. Presented at: 2026 Winter Clinical Miami Dermatology Conference; February 27-March 1, 2026; Aventura, FL.