Adelaide A. Hebert, MD

Adherence, Specialty Pharmacies, and the Future of Precision Pediatric Care

Even the most advanced treatment plan is ineffective without adherence. In the final video in this series on management of atopic dermatitis and psoriasis in pediatric patients, Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, notes that when children fail to improve despite appropriate therapy, she often suspects barriers such as treatment fatigue, cost, or confusion about application. Collaboration with Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, allows primary care clinicians to reinforce plans, assess real-world use, and communicate findings back to dermatology.

The faculty also discuss the growing role of specialty pharmacies in pediatric dermatology, particularly for biologics and newer topical agents. These services assist with prior authorizations, copay support, and medication delivery. Hebert and Atkinson view patient-driven requests prompted by direct-to-consumer advertising as opportunities for education and shared decision-making, while emphasizing that therapy choices must remain evidence-based and individualized.

In the concluding segment of this series, Hebert and Atkinson look ahead to emerging precision-medicine tools that may help match pediatric patients with optimal targeted therapies. They reiterate that most pediatric inflammatory dermatoses remain clinical diagnoses but acknowledge a role for biopsy and advanced testing in complex cases. The discussion closes by underscoring the importance of strong pediatrician–dermatologist partnerships in translating therapeutic advances into better long-term outcomes.

Videos

Examine adherence challenges, specialty pharmacy support, and emerging precision medicine approaches in pediatric atopic dermatitis and psoriasis.


Steroid Safety, Growth Concerns, and When to Escalate Pediatric Therapy

Repeated or chronic use of topical and systemic corticosteroids in children raises valid concerns about metabolic effects, mood changes, Cushingoid features, and growth suppression. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, notes that families frequently ask about the impact of steroid exposure on long-term growth and health. She advises limited-duration use, clear stop rules, and reevaluation when increasingly frequent steroid courses are required.

Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, outlines clinical scenarios in which escalation to systemic biologics or oral Janus kinase inhibitors is appropriate, particularly in adolescents with severe, refractory disease or impaired quality of life. She notes that effective control of systemic inflammation may support catch-up growth and relies on pediatric colleagues to identify concerning growth trends. Hebert also emphasizes that newer topical agents have demonstrated no adverse effects on growth or infection risk.

In this segment, Hebert and Atkinson integrate dermatology and general pediatrics perspectives on balancing rapid symptom control with long-term safety. They advocate for steroid-sparing topicals as foundational therapy, reserving systemic steroids for narrowly defined indications, and engaging families in informed decision-making when advanced systemic therapy is warranted.

Understand steroid safety concerns, growth effects, and indications for biologics and oral JAK inhibitors in pediatric skin disease.

Proactive Flare Prevention and Practical Use of Advanced Pediatric Topicals

Achieving disease control in pediatric atopic dermatitis and psoriasis requires setting realistic expectations with families regarding onset of action, degree of response, and the need for maintenance therapy. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, notes that caregivers should be counseled that even effective therapies will not normalize skin overnight and that responses vary widely. Regular follow-up in primary care between dermatology visits allows clinicians to assess adherence, access issues, and application technique.

Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, describes proactive therapy strategies, such as continuing topical agents two to three times weekly on previously affected areas to reduce flare frequency. She reviews long-term safety data for newer steroid-sparing topicals, including ruxolitinib, tapinarof, and roflumilast, noting favorable profiles without clinically meaningful systemic absorption or need for routine laboratory monitoring. Hebert also contrasts newer PDE4 inhibitors with earlier agents that were limited by irritation and tolerability.

In this segment, Hebert and Atkinson offer practical guidance on selecting advanced topical therapies in real-world practice. They emphasize documentation of prior treatments, understanding payer formularies, use of samples when available, and shared decision-making based on dosing convenience, anatomic site, and prior patient experience.

Learn how to set expectations, prevent flares, and choose among advanced topical therapies for pediatric atopic dermatitis and psoriasis.

EHR Collaboration and New Steroid-Sparing Topicals in Pediatric Dermatoses

Effective longitudinal management of complex pediatric dermatoses increasingly depends on strong collaboration between pediatricians and dermatologists. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, describes how shared electronic health records, including high-quality clinical images, support real-time updates on evolving eruptions, medication exposures, and treatment responses. Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, adds that photographic documentation can also be critical for insurance approval of advanced therapies, as payers often require visual evidence of disease severity.

Within this framework, Hebert reviews three newer targeted, steroid-free topical agents that are changing the treatment landscape for pediatric atopic dermatitis and psoriasis. These include ruxolitinib cream, a topical Janus kinase inhibitor approved for mild to moderate atopic dermatitis and vitiligo down to 2 years of age; tapinarof, an aryl hydrocarbon receptor agonist approved for atopic dermatitis and plaque psoriasis in adults with emerging pediatric experience; and roflumilast cream, a phosphodiesterase 4 inhibitor approved for pediatric atopic dermatitis and plaque psoriasis, including intertriginous disease.

In this segment, Hebert and Atkinson explain how these agents expand options for children in whom long-term steroid use is undesirable or ineffective. They highlight the benefits of expanded age indications, once-daily dosing, and suitability for sensitive areas, allowing clinicians to individualize therapy while minimizing corticosteroid-related adverse effects.

See how shared EHRs support collaborative care and review newer steroid-sparing topical therapies for pediatric atopic dermatitis and psoriasis.

Adelaide A. Hebert, MD

Articles