Eliminating the Itch: How Nonsteroidal Topicals Are Changing Pediatric Atopic Dermatitis Care

Over the past decade, the treatment of atopic dermatitis (AD) has undergone a profound transformation, especially within pediatric care. Once managed primarily through topical corticosteroids and broad anti-inflammatories, the field now benefits from an expanding toolbox of targeted, nonsteroidal therapies designed to deliver efficacy without compromising safety. This evolution has been driven by growing recognition of the long-term consequences of chronic inflammation in children—from disrupted sleep and impaired growth to emotional and family strain—and by the emergence of innovative topical agents such as ruxolitinib (Opzelura), tapinarof (Vtama), and roflumilast (Zoryve).1,2,3 Their approvals between 2021 and 2024 mark a turning point, offering clinicians and families alternatives that balance disease control with parental concerns over steroid exposure.

At the same time, the philosophy of care for pediatric AD is shifting from reactive flare management toward proactive, sustained disease suppression. Dermatologists and allergists are increasingly emphasizing early intervention, consistent barrier repair, and individualized maintenance therapy to prevent exacerbations before they begin. Yet, systemic challenges remain—insurance restrictions, limited pediatric data, and educational gaps among families and primary care providers continue to hinder optimal use of these therapies. Within this context, recent expert discussions have underscored how the integration of nonsteroidal topicals, patient education, and age-tailored treatment strategies together represent not just incremental progress, but the foundation of a safer, more holistic era in pediatric atopic dermatitis management.

At a recent clinical forum convened by HCPLive in Miami, Florida, allergists and dermatologists led by Vivian Trujillo-Hernandez, MD, Director, Division of Allergy & Immunology, Nicklaus Children's Hospital, gathered to discuss the evolving management of pediatric atopic dermatitis, emphasizing the importance early, proactive, and personalized care.

"The typical profile of the patient that comes to my clinic is usually babies or the less than 5-year olds that have eczema and then the parents want food allergy testing," one panelist said. "So I think it's a lot of education with those patients that you don't necessarily have to avoid that food. You can limit it in some form [but] you don't want them to take that completely away from their diet, if the reaction is eczema, for example."

Panelists highlighted the limitations of steroids and the growing preference for nonsteroidal options like ruxolitinib, tapinarof, and roflumilast, which offer improved safety, efficacy, and adherence. The group discussed practical challenges, including parental steroid phobia, education gaps, cost barriers, and long-term safety in young patients, while noting how newer agents and proactive maintenance strategies can reduce flares, itch, and caregiver burden.

"It's very emotionally traumatic for the parents to... see their kids suffering... It is also a very difficult decision because a medicine like Dupixent sounds like a big deal to a baby. It's like, am I giving something to my baby that's going to harm them later? But at the same time, nothing's working. And, do I trust that this doctor's telling you the truth that it's safe? And maybe the doctor believes it, but doctors have been wrong. So it's a very difficult, loaded visit for me," another panelist said.

They emphasized that pediatric management centers around age-specific approaches, and stressed education, empowerment, and shared decision-making to support sustained control and quality of life improvements, and acknowledged the importance of allergy-dermatology collaboration.

"I think referring to allergies, the collaborative nature of our specialties is crucial. And I think that you have those patients that walk in and you know what they need. Sometimes they need to get the reassurance and have these [allergy] tests done... just to make them comfortable. And then vice versa, where that's the main cause. But then they think it's something from the outside and then they come to us to reassure them," a panelist said.

References

1. Shirley M. Dupilumab: First Global Approval. Drugs. 2017;77(10):1115-1121. doi:10.1007/s40265-017-0768-3.

2. Nevid M, Boguniewicz M. Current and Emerging Biologics for Atopic Dermatitis. Immunol Allergy Clin North Am. 2024;44(4):577-594. doi:10.1016/j.iac.2024.08.001

3. Smith T. FDA Approves Tapinarof 1% Cream for Adult, Pediatric Patients with Atopic Dermatitis. HCPLive. Article. December 16, 2024. https://www.hcplive.com/view/fda-approves-tapinarof-cream-adult-pediatric-patients-atopic-dermatitis