Beyond Steroids: Topical Agents in Pediatric Eczema

When a child with atopic dermatitis presents with an active flare, the selection of a topical therapy involves more nuance than a simple potency ladder might suggest. The new pediatric-specific guidelines published in the Journal of the American Academy of Dermatology (AAD) provide a detailed framework for topical treatment selection, affirming the continued role of corticosteroids while cataloguing an expanded array of steroid-sparing options that have reshaped the treatment landscape.1,2

Andrew C. Krakowski, MD, of St. Luke's University Health Network, and Carla Torres-Zegarra, MD, of Children's Hospital Colorado, University of Colorado Anschutz, walk through the guideline's treatment recommendations, which include topical calcineurin inhibitors (TCIs), phosphodiesterase-4 inhibitors, and topical Janus kinase (JAK) inhibitors alongside corticosteroids. A notable feature of the guidelines is a recommendation for the proactive use of TCIs between flares to reduce recurrence—a practice Torres-Zegarra acknowledged she had not routinely employed, citing practical concerns about insurance access leading to medication shortages when flares occurred. The discussion also addresses black box warnings: for TCIs, the guideline notes that Canada has removed the lymphoma warning, with similar action potentially forthcoming in Europe; for topical JAK inhibitors, a black box warning tied primarily to systemic JAK data remains in place and must be communicated to families.

In this segment of the HCPLive special report, Krakowski and Torres-Zegarra share how they counsel patients about these agents in practice, including strategies for prescribing sufficient quantities to support real-world adherence and for labeling prescription instructions clearly enough to prevent confusion between maintenance and rescue use. Krakowski also highlights a clinically meaningful detail from the guidelines: the relative potency table, which reveals that the same molecule in cream versus ointment formulation can represent an entire class difference in corticosteroid strength—information that may be less familiar to clinicians outside pediatric dermatology.

Disclosures: Krakowski and Torres-Zegarra have no relevant reported disclosures.

References

1. American Academy of Dermatology Issues First-Ever Pediatric Atopic Dermatitis Guidelines, Highlighting Prevention Strategies and Effective Treatments. American Academy of Dermatology. April 7, 2026. Accessed June 4, 2026. https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines.

2. Smith T. First-Ever Pediatric Eczema Guidelines Issued by American Academy of Dermatology. HCPLive. April 10, 2026. Accessed June 4, 2026. https://www.hcplive.com/view/first-ever-pediatric-eczema-guidelines-issued-american-academy-dermatology.