Topical Standard of Care in Pediatric Atopic Dermatitis

Patients with atopic dermatitis today have access to more treatment options than ever before, marking a significant advancement in topical therapy over the past several decades. Topical corticosteroids, developed in the 1960s, remain widely prescribed due to their proven effectiveness, affordability, and immediate availability without prior authorization requirements. However, modern treatment approaches have evolved beyond the traditional “use for a week or two, then stop” methodology, with dermatologists now using steroids as bridge treatments to newer nonsteroidal options for long-term management.

Children and their families can benefit from 3 revolutionary nonsteroidal topical medications that have recently received FDA approval for pediatric use. Ruxolitinib, a topical JAK1/2 inhibitor approved for ages 12 and older, demonstrates comparable effectiveness to medium-strength topical steroids like triamcinolone while offering superior long-term safety. Roflumilast, an enhanced PDE4 inhibitor available for children older than 2 years, provides excellent tolerability with its advanced cream formulation that does not cause the burning and stinging associated with earlier PDE4 inhibitors.

The newest addition to pediatric atopic dermatitis treatment, tapinarof, introduces a novel mechanism through aryl hydrocarbon receptor modulation for patients with moderate symptoms. This medication decreases inflammation and oxidative stress while potentially improving skin barrier function. Roflumilast and tapinarof offer the significant advantage of once-daily dosing, making adherence easier for busy families than traditional twice-daily treatments. This represents a game-changing improvement in practical management for children with atopic dermatitis.