A 15-year-old boy with atopic dermatitis since age 4 presents with persistent disease involving his neck and arms. His atopic dermatitis has worsened since starting high school, and he has become increasingly self-conscious about the visible involvement.

He has previously used hydrocortisone, triamcinolone, mometasone, and tacrolimus, but continues to experience recurrent flares despite treatment.

Although his disease burden may warrant treatment escalation, he is hesitant to begin an injectable therapy and would prefer to explore another topical option first.

After discussing his options, the patient remains hesitant to start an injectable and chooses to try 1 more topical therapy before considering dupilumab.

He is started on tapinarof cream once daily.

The decision raises another question: With several newer nonsteroidal topical options available, how do you decide which one is the best fit for an adolescent patient?

After discussing treatment options, the patient and his family elected to try 1 more topical therapy before considering dupilumab. He was started on once-daily tapinarof cream.

The case prompted discussion among clinicians about how newer nonsteroidal topicals—including tapinarof, ruxolitinib, and roflumilast—fit into treatment sequencing and when persistent disease, quality-of-life effects, and patient preferences should prompt escalation to systemic therapy.