Lawrence Eichenfield, MD

Systemic treatment options for pediatric 

 are expanding rapidly below age 12, where dupilumab has long stood as the only biologic approved in most of the world. In a phase 3 open-label extension study, 79.3% of children aged 6 months to 5 years reached at least a 75% improvement in disease severity after 1 year of treatment.¹ Another 58.6% reached a 90% improvement, with investigators reporting a favorable long-term safety profile in this younger age group.¹

Newer agents targeting the interleukin (IL)-13 and IL-31 pathways are now generating pediatric data of their own. Lebrikizumab met its primary and key secondary endpoints in the phase 3 ADorable-1 trial, with 63% of children aged 6 months to 17 years achieving a 75% reduction in Eczema Area and Severity Index (EASI) score.² Nemolizumab has separately shown clinically meaningful reductions in lesions and itch through week 16, sustained to 1 year, in an open-label study of children aged 2 - 11 years.³

These results raise practical questions for clinicians managing young children with limited topical options. As differently targeted biologics reach younger age groups, dosing intervals, injection frequency, and effects on comorbidity development will help determine how each agent fits alongside dupilumab in practice.

Lawrence Eichenfield, MD, is chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and vice chair of the department of dermatology at the University of California, San Diego. He reviewed this expanding pipeline during a recent 2026 Maui Derm conference session on atopic dermatitis. In the following interview, Eichenfield discusses which advances he sees as most impactful and where unmet needs remain for the youngest patients:

: Which of these agents do you feel has the most potential to be impactful, whether from new data or recent approvals?

What's most impactful is that we now have a choice of non-steroids. Families come in so concerned about topical steroid use that they're often underutilizing it; there's so much penetration of the idea of steroid addiction, even though it's very uncommon with judicious topical steroid use.

The real takeaway is having an option, depending on choices, access, and the clinical situation, and now we have a broader ability to get those options across different ages. I'm especially excited to have a potentially useful drug under age 2, since there are so few options in that group, which I think is really important in the topical space.

: What are the remaining unmet needs in the topical space for children under 2?

 We have very few topical corticosteroids approved under age 2, but we use them with limitations, in a non-continuous manner, generally at lower strengths. Our first nonsteroidals, historically tacrolimus and pimecrolimus, never got approval for younger ages in the U.S. There's a fair amount of studies, especially with pimecrolimus, so sometimes they're covered and sometimes they're not from an access standpoint, but they also just haven't been well studied.

People still get concerned about the boxed warning even though we're reassuring about that. Topical crisaborole has been approved and is a very safe product, though it can cause stinging and burning. So we're trying to bring a new agent into this younger age group that shows safety in a broad population, with tolerance meaning not a lot of stinging and burning, or essentially none, and very few side effects in the PDE4 class, which is where roflumilast sits. I think that could be very useful, especially in long-term disease control models, as we're learning that if we can control disease earlier, whether with topicals or systemics, we may decrease the whole impact of the disease on a child and the family over time.

: Are there any other treatments on the horizon for pediatric patients, whether new drugs or new data?

 The systemic space is really heating up. We have extended experience and data sets on dupilumab in younger children, with multi-year data showing decreased development of comorbidities in patients treated with the drug. From an approval standpoint, around the world dupilumab is essentially the only biologic approved under age 12, though in some parts of the world patients may have access to an oral JAK inhibitor.

Part of what I reviewed was new data presented in the last few months: nemolizumab had data not just in the adolescents included in its core study, but in open-label studies in 2- to 11-year-olds, used alongside topical agents, showing some nice efficacy. Lebrikizumab has also completed placebo-controlled trials in children as young as 6 months up to 17 years of age, including a cohort of 6-month- to 2-year-olds, showing very good utility in that population.

It could be very interesting over time to see how a differently directed agent, a specific IL-13 or IL-31 agent, will be used in younger children the way we've used dupilumab, and whether there are advantages or disadvantages in terms of impact on developing comorbidities or frequency of injections. These are issues we haven't dealt with yet, especially in younger kids with pediatric atopic dermatitis, but within the next year or two that's going to be what we're figuring out in practice.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

Paller AS, Siegfried EC, Simpson EL, et al. Dupilumab safety and efficacy up to 1 year in children aged 6 months to 5 years with atopic dermatitis: results from a phase 3 open-label extension study. Am J Clin Dermatol. 2024;25(4):655-668. doi:10.1007/s40257-024-00859-y.

Eli Lilly and Company. Lilly's EBGLYSS (lebrikizumab-lbkz) is the first and only selective IL-13 inhibitor to deliver positive Phase 3 outcomes in patients aged six months to 18 years with moderate-to-severe atopic dermatitis. Published March 16, 2026. Accessed August 11, 2026. 

https://investor.lilly.com/news-releases/news-release-details/lillys-ebglyss-lebrikizumab-lbkz-first-and-only-selective-il-13

Galderma. AAD 2026: Late-breaking nemolizumab data demonstrate clinically meaningful benefits for children aged 2 to 11 with moderate-to-severe atopic dermatitis. Published March 28, 2026. Accessed August 11, 2026. 

https://www.galderma.com/news/aad-2026-late-breaking-data-atopic-dermatitis

Articles

Systemic therapy for pediatric atopic dermatitis is broadening rapidly in patients younger than 12 years, with dupilumab supported by 1-year open-label extension data showing high EASI-75 and EASI-90 response rates and reassuring safety in ages 6 months to 5 years. Emerging pediatric programs for pathway-selective biologics include IL-13 inhibition with lebrikizumab and IL-31 blockade with nemolizumab, both demonstrating meaningful efficacy signals. Practical differentiation will likely hinge on access, injection burden, dosing intervals, and potential effects on comorbidity trajectories.

In this discussion, Eichenfield discusses which advances in eczema he sees as most impactful and where unmet needs remain for pediatric patients.

Q&A: Where the Pediatric Atopic Dermatitis Systemic Pipeline Stands

The American Academy of Dermatology (AAD) issued its first pediatric-specific 

 guidelines in 2026, covering primary prevention and comorbidity awareness for children with the disease.¹ The prevention guideline gives moisturizers a conditional recommendation to reduce eczema occurrence in children aged 6 months to 3 years, while water softeners and dust mite avoidance showed no preventive benefit.¹

Eosinophilic esophagitis carries the only high-certainty comorbidity link to pediatric atopic dermatitis, with moderate-certainty evidence connecting the disease to allergic rhinitis, asthma, food allergy, urticaria, and ADHD.¹ Pediatric access to non-steroidal topicals has also widened. Tapinarof cream 1% gained 

 approval for children as young as 2 years in December 2024, adding an aryl hydrocarbon receptor agonist to the pediatric toolkit.²

Roflumilast cream 0.05% followed in October 2025 for children aged 2 to 5 years, with the phase 3 INTEGUMENT-PED trial showing 25.4% of treated children reaching treatment success at week 4 versus 10.7% on vehicle.³

These approvals carry real clinical weight because many families arrive concerned about topical steroid use and end up undertreating their child's eczema as a result. A broader menu of nonsteroidal options, spanning several drug classes and now reaching a wider pediatric age range, gives clinicians more flexibility to match therapy to a family's needs.

Lawrence Eichenfield, MD, is chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and vice chair of the department of dermatology at the University of California, San Diego. He reviewed these updates during a Maui Derm session titled ‘Atopic Dermatitis and Itch Update 2026.’ In the following Q&A interview segment, Eichenfield discusses why the pediatric guidelines and expanding topical options matter for clinicians:

: Why was this session on atopic dermatitis and itch important to highlight for clinicians?

There is an incredible amount happening in atopic dermatitis along the spectrum of ages we treat, and the therapeutic agents we're using are changing. They've morphed every year, with new agents, new information, and new experiences. For this session, I divvied up the activities with my co-presenter [UNCLEAR — please review], and my job was to review pediatric atopic dermatitis and the new changes in topical medications, then look from a pediatric perspective at the changes happening in systemic medicine. There's really just a ton of new information.

What were the key pediatric-focused topics from the session you feel are most important for clinicians?

 The American Academy of Dermatology never had specific pediatric atopic dermatitis guidelines, and now we do. That information was put out in two different papers, and they're really important for people to know about. The first one, which a lot of people might not be aware of because it's not as much a direct therapy paper, was a paper on prevention of atopic dermatitis and consideration of comorbidities, and it raised several issues we face with patients.

I structured some of the answers in this evidence-based guideline around questions patients might have. For instance, can you prevent atopic dermatitis with the use of moisturizers? That's been a highly controversial topic over the years, because we have some studies showing the ability to decrease rates of development of atopic dermatitis and others that don't. We discussed there's some conditional evidence that moisturizer may help prevent atopic dermatitis, and I went through some very interesting recent studies showing benefits of moisturizer to prevent atopic dermatitis, though maybe less in patients who already have a family history of the disease.

One big study was by Eric Simpson, and another out of Ireland showed a higher ability to decrease atopic dermatitis when moisturizers were started very early. Still, it's a conditional recommendation, and the basis of evidence isn't that strong. We also discussed other prevention strategies that didn't pan out: water softeners don't prevent atopic dermatitis, and neither does dust mite avoidance.

Then I went through the comorbidity listing, which is really important from an eczema standpoint. Allergic comorbidities are highly associated with eczema. Certain autoimmune diseases, including alopecia areata or [UNCLEAR — please review], are considered comorbidities of atopic dermatitis, and there's also data on bone health, though the evidence is actually uncertain from a pediatric standpoint.

Then I moved on to new therapies. We've had an extension of approval of non-steroids in pediatrics over the past year or two, including several within just a few months. Topical ruxolitinib has been approved down to 2 years of age; we need a little more data, but with a maximal 20% body surface area rule, it can be really helpful in our practices and has very good safety data. Topical tapinarof is also approved down to 2 years of age, with some very high efficacy data. Topical roflumilast has been developed in different concentrations: it was approved for ages 6 and up in a 0.15% cream, and now for 2- to 5-year-olds in a .05% cream.

We also reviewed infant data presented for the first time a few months ago at the American Academy of Dermatology meeting. The drug isn't yet approved in that age group, but in a study of children 3 months to 2 years old, it showed really good data on utility. In a novel approach, the researchers also looked at scalp disease, which I really like, and showed nice improvement in global scalp dermatitis in patients who had it.

Lastly, I briefly touched on delgocitinib, which has been approved for chronic hand eczema in adults; studies have been done in teens, and we believe we're going to see changes in the topical world for that age group within the next few months.

Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the primary prevention of atopic dermatitis and awareness of comorbid conditions in pediatric atopic dermatitis. J Am Acad Dermatol. 2026;95(1):124.e1-124.e19. 

Organon. FDA approves VTAMA (tapinarof) cream, 1% for the treatment of atopic dermatitis in adults and children 2 years of age and older. Published December 16, 2024. Accessed August 11, 2026. 

https://www.organon.com/news/fda-approves-vtama-tapinarof-cream-1-for-the-treatment-of-atopic-dermatitis-in-adults-and-children-2-years-of-age-and-older/

Arcutis Biotherapeutics. FDA approves Arcutis' ZORYVE (roflumilast) cream 0.05% for the treatment of atopic dermatitis in children ages 2 to 5. Published October 6, 2025. Accessed August 11, 2026. 

https://www.arcutis.com/fda-approves-arcutis-zoryve-roflumilast-cream-0-05-for-the-treatment-of-atopic-dermatitis-in-children-ages-2-to-5/

First pediatric-specific AAD atopic dermatitis guidance (2026) addresses primary prevention and comorbidity surveillance. Moisturizers receive a conditional recommendation for reducing incident eczema in children 6 months–3 years, whereas water softeners and dust mite avoidance show no preventive benefit. Eosinophilic esophagitis is the lone high-certainty comorbidity; allergic rhinitis, asthma, food allergy, urticaria, and ADHD have moderate-certainty associations. Pediatric nonsteroidal topical options have expanded with tapinarof, roflumilast (INTEGUMENT-PED: 25.4% vs 10.7% week-4 success), and ruxolitinib, supporting individualized care amid steroid hesitancy concerns.

This Q&A highlights recent data and FDA approvals described in the pediatric atopic dermatitis space by Lawrence Eichenfield, MD.

Q&A: First Pediatric Eczema Guidelines and New Topical Options Down to Age 2

Nonsteroidal topicals ruxolitinib and tapinarof creams are now approved down to age 2, expanding treatment options for young children with atopic dermatitis.

Roflumilast cream is showing promising early data in infants as young as 3 months, including improvement in scalp involvement, though it remains unapproved in that age group.

Dupilumab remains the only biologic approved under age 12, but emerging data on nemolizumab and lebrikizumab suggest more systemic options may become available for younger patients

, Lawrence Eichenfield, MD, chief of pediatric and adolescent 

 at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics at the University of California, San Diego, touched on recent approvals and emerging data in the 

, treatments for pediatric atopic dermatitis were highlighted alongside new insights in the field, continuing Eichenfield’s discussion of his 2026 Maui Derm Conference session, ‘Atopic Dermatitis and Itch Update 2026.’ 

New Nonsteroidal Options Expand for Pediatric Atopic Dermatitis

What New Topical Treatments Are Available for Pediatric Atopic Dermatitis?

Eichenfield highlighted several nonsteroidal topical therapies recently extended to younger patients, including ruxolitinib cream, now approved down to age 2 with a maximum 20% body surface area limitation, and tapinarof cream, also approved down to age 2 with strong efficacy data.

He noted that roflumilast cream is approved in a 0.15% concentration for patients 6 and older and a .05% concentration for children ages 2 - 5, with newly presented infant data in patients as young as 3 months showing promising results, including improvement in scalp involvement, though it remains unapproved in that age group.

He said the most significant development is not any single agent but the expanding availability of nonsteroidal options overall, given how often families express concern, often unfounded, about topical steroid use. Eichenfield also noted a continued need for new topical agents with strong safety and tolerability in children younger than 2, an age group historically underserved by nonsteroidal treatments.

Which Systemic Therapies Are Emerging for Pediatric Atopic Dermatitis?

Eichenfield said the systemic treatment landscape for pediatric atopic dermatitis is expanding as well. Dupilumab remains the only biologic approved for children under 12, with multiyear data suggesting it may reduce development of comorbidities.

He pointed to new data on nemolizumab in patients ages 2 - 11 and completed placebo-controlled trials of lebrikizumab spanning ages 6 months to 17 years, both showing favorable outcomes in younger populations. Eichenfield said these findings raise questions about how differently targeted agents may compare with dupilumab in younger children, particularly regarding comorbidity prevention and dosing frequency, an area he expects to become clearer within the next year or two.

Disclosures: Eichenfield previously reported receiving personal fees from Pfizer Inc; grant funding from AbbVie, Arcutis Biotherapeutics, Bausch + Lomb, Castle Biosciences, Dermavant Sciences Inc, Galderma SA, Pfizer Inc, Regeneron, and Sanofi SA and consulting for ASLAN Pharmaceuticals, AbbVie, Almirall, SA, Arcutis Biotherapeutics, Arena Pharmaceuticals Inc, Dermavant Sciences Inc, Galderma SA, Incyte Corporation, LEO Pharma A/S, Eli Lilly and Company, Ortho Dermatologics, Pfizer Inc, Regeneron Pharmaceuticals Inc, Sanofi SA, and UCB; and serving on the board of directors of Forté Pharma.

Silverberg J, Chovatiya R, Eichenfield L. Atopic Dermatitis and Pruritus: Current Concepts and Therapeutics for 2026. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

Lio P. New AAD Pediatric Guidelines and Tips for Kids in Dermatology, With Peter Lio, MD. HCPLive. June 22, 2026. Accessed August 10, 2026. 

https://www.hcplive.com/view/upcoming-aad-pediatric-guidelines-tips-kids-dermatology-peter-lio-md

Videos

In this interview, Lawrence Eichenfield, MD, reviews new data on topical and systemic treatments such as tapinarof and ruxolitinib in atopic dermatitis.

The American Academy of Dermatology released its first pediatric-specific atopic dermatitis guidelines, addressing prevention and comorbidities.

Evidence on whether moisturizers prevent atopic dermatitis remains conditional, with reduced benefit seen in infants with a family history of the disease.

Strategies like water softeners and dust mite avoidance have not been shown to prevent atopic dermatitis, while allergic conditions and alopecia areata remain notable comorbidities.

Lawrence Eichenfield, MD, chief of pediatric and adolescent 

 at Rady Children's Hospital-San Diego and professor of dermatology and pediatrics at the University of California, San Diego, discussed key takeaways from his 2026 Maui Derm conference session, ‘Atopic Dermatitis and Itch Update 2026.’

In his session, he highlighted the American Academy of Dermatology (AAD)'s first pediatric-specific 

 guidelines and what they mean for clinical practice. This interview with 

 covers some of the most notable takeaways from this session.

Recent AAD Guidelines Address Pediatric Atopic Dermatitis Prevention

Eichenfield explained that the session addressed rapidly evolving treatment options across the age spectrum of patients with atopic dermatitis, including changes in both topical and systemic therapies. His portion of the presentation focused on pediatric atopic dermatitis, covering updates to topical treatment as well as emerging systemic options relevant to younger patients, reflecting how quickly the therapeutic landscape continues to shift year over year.

What Do the New Pediatric Atopic Dermatitis Guidelines Say About Prevention?

A central highlight was the American Academy of Dermatology's release of its first pediatric atopic dermatitis guidelines, published across two papers. One paper addressed disease prevention and associated comorbidities. Eichenfield noted that evidence remains mixed on whether moisturizers can help prevent atopic dermatitis, resulting in a conditional recommendation.

He referenced a large study led by Eric Simpson, MD, MCR, along with a separate study conducted in Ireland, both suggesting that early moisturizer use may reduce atopic dermatitis risk, though the benefit appeared less pronounced among infants with a family history of the disease. Eichenfield added that other proposed prevention strategies, including water softener use and dust mite avoidance, have not been shown to be effective in reducing atopic dermatitis risk.

Which Comorbidities Are Linked to Atopic Dermatitis?

Eichenfield also reviewed comorbidities associated with atopic dermatitis outlined in the new guidelines. He noted a strong association between atopic dermatitis and allergic conditions, as well as certain autoimmune diseases, including alopecia areata.

He said the evidence connecting atopic dermatitis to bone health remains uncertain in the pediatric population, signaling an area that may warrant further research as pediatric atopic dermatitis guidelines continue to evolve.

Lawrence Eichenfield, MD, breaks down new AAD pediatric atopic dermatitis guidelines, covering prevention strategies and linked comorbidities.