Breakthroughs in Pediatric Atopic Dermatitis and More, with Peter A. Lio, MD

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Lio reviews a field now teeming with FDA-approved options and candidates throughout early-age eczema, psoriasis and more.

To describe the pediatric dermatology drug development as busy over the last 5 years would be an understatement to experts like Peter A. Lio, MD. In fact, the dermatologist told HCPLive many of the recent breakthroughs in treatment indications across a number of drug classes have been unprecedented in the duration of his career.

In the second segment of an interview with HCPLive prior to the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA this week, Lio, clinical assistant professor of dermatology at Northwestern Medicine Feinberg School of Medicine, highlighted some of the most recent outstanding developments in pediatric dermatology pharmacotherapy.

Lio began with topical Janus kinase (JAK) inhibitors including ruxolitinib cream—indicated already for patients with either atopic dermatitis or vitiligo—as well as JAK1/JAK2 inhibitor roflumilast cream and tapinarof cream, both indicated to treat psoriasis.

“And I'm excited about those,” Lio said. “Those are both once-daily nonsteroidal agents that are anti-inflammatory, anti-itch, so they may have some really nice indications for our kids, where we have unmet need.”

Lio highlighted crisaborole, which was approved by the US Food and Drug Administration (FDA) to treat atopic dermatitis in children and adults ≥3 months old—a “huge” age indication, Lio said.

"For the littlest babies, we don't have a lot of things,” he explained. “Our calcineurin inhibitors had been out for 20-plus years, but they're only approved down to age 2 (years) in the United States. So, this is nice, to have something lower.”

Lio also noted breakthroughs in systemic therapies, such as the FDA approval of dupilumab to treat atopic dermatitis down to 6 months of age—again joining crisaborole as an agent that bolsters the limited options in earliest-stage eczema. He additionally highlighted the oral JAK inhibitor upadacitinib, which initially received an adolescent-age indication for atopic dermatitis at FDA approval, as well as its drug class companion abrocitinib.

“So we finally have some real options with some real evidence, and a bunch of new indications for the first time in my career—everything from vitiligo to alopecia areata,” Lio said. “It's really neat to actually have new indications—even in seborrheic dermatitis. Just this past year (topical roflumilast foam became) one of the first treatment specifically approved for seborrheic dermatitis.”

Beyond a bolstered armamentarium, Lio believes the surge of targeted therapies kickstarted something in pediatric dermatology that which he calls the “virtuous cycle of drug development.”

“We get a new medicine, but that also informs us more about the disease, which then allows for better medicines,” Lio explained. “But the other point (is), what if we treat things early? Is it possible that we can actually change the outcome of the disease? Can we modify the disease? And the answer is ‘we don't know’, for a lot of things. But I think there's real potential, especially for atopic dermatitis.”

Eczema is similarly cyclical in its effect, Lio said—a continuous compromise of the immune system, skin barrier and microbiome in ways that which then also exacerbate disease. Being able to intervene early and effectively in childhood could spare patients years of physical toll. It could even potentially prevent patients from progressing into the atopic march: increased risk of food allergy, asthma, allergic rhinitis, and other comorbidities.

“All these other things that seem to come after atopic dermatitis for many patients—could we potentially change the narrative? And I think the answer is maybe,” Lio said. “I'm cautiously optimistic, so I can't wait to learn. There's real potential there.”