First-Ever Pediatric Eczema Guidelines Issued by American Academy of Dermatology

The American Academy of Dermatology (AAD) has issued its first-ever guidelines focused on both prevention and management of atopic dermatitis in pediatric patients, underscoring various distinctions in dosing, care considerations, and safety compared to those of adults.1

Released in the Journal of the American Academy of Dermatology, these new recommendations were developed through the work of a multidisciplinary expert panel. They were designed to help guide clinicians in dermatology who treat atopic dermatitis, a condition known to impact up to 25% of children worldwide.2

“These updated AAD pediatric [atopic dermatitis] guidelines feel genuinely practice-changing because they reflect a real evolution in how we think about disease burden, treatment goals, and when to escalate care,” Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University School of Medicine, told HCPLive regarding the updates.

Related to prevention, the AAD’s new guidelines point to limited supporting evidence for most strategies, with dietary, supplemental, and environmental interventions not having demonstrated consistent benefit. Moisturizer implementation was the only approach to be given a conditional recommendation by the AAD for diminishing disease risk in infants and young children.

For treatment, the AAD’s panel provided a set of 26 evidence-based recommendations across the available systemic, topical, phototherapy treatments for this disease. The guidelines helped to reinforce the role of standard treatments for atopic dermatitis such as emollients while incorporating newer targeted agents.

“What feels truly revolutionary is the normalization of systemic therapy as part of standard care for pediatric [atopic dermatitis], not a last resort—paired with a strong emphasis on quality of life, itch, and patient-reported outcomes as core treatment targets, not secondary considerations,” Shahriari said. “That shift matters, because in atopic dermatitis, the skin does not tell the whole story.”

Strong recommendations included:

• Moisturizers to diminish dryness and pruritus.
• Topical calcineurin inhibitors (pimecrolimus, tacrolimus) for addressing flare management and intermittent maintenance.
• Topical corticosteroids as first-line therapy for maintenance and flares.
• Phosphodiesterase (PDE)-4 inhibitors (crisaborole, roflumilast) to diminish itch and the frequency of flares.
• Topical JAK inhibitors (ruxolitinib) for treating those with mild-to-moderate disease.
• Topical aryl hydrocarbon receptor agonists (tapinarof) to improve inflammation and patients’ skin barrier function.
• Biologics (dupilumab, tralokinumab, lebrikizumab) for treating moderate-to-severe disease.
• Oral JAK inhibitors (upadacitinib, abrocitinib, baricitinib) for treating moderate-to-severe disease.

Among the conditional recommendations, the following were included by the AAD in their new guidelines:

• Bathing followed by moisturizer utilization as part of routine care.
• Wet wrap therapy at the time of patients’ flares under clinician guidance.
• Phototherapy for more extensive or severe disease.

Recommendations against routine use of systemic corticosteroids were also stressed in the guidelines. The release emphasized reserving them for short-term management of severe flares. Additionally, the panel discouraged topical antimicrobials and PUVA phototherapy in pediatric patients.

“These guidelines move us away from a reactive, topical-only mindset in pediatric [atopic dermatitis] and toward a more modern, proactive, patient-centered approach that recognizes the full burden of disease and supports earlier, more thoughtful intervention when topicals are no longer enough,” Shahriari opined.

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 April 10, 2026. https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines.

2. Hadi HA, Tarmizi AI, Jamshed S, et al. The Epidemiology and Global Burden of Atopic Dermatitis: A Narrative Review. Life (Basel). 2021 Sep 9;11(9):936. doi: 10.3390/life11090936. PMID: 34575085; PMCID: PMC8470589.