Key Clinical Practice Pearls in Atopic Dermatitis, With Elaine Siegfried, MD

The Revolutionizing Atopic Dermatitis (RAD) Conference 2026 in Nashville, Tennessee, featured a wide array of unique sessions designed to highlight the most important developments in the atopic dermatitis landscape of 2026, including phase 3 data, upcoming news, clinical pearls, and more.

One such session was titled ‘Practice Pearls for Pediatric AD Spotlight CE Symposium.’ In an interview with HCPLive’s editorial staff at RAD, Elaine Siegfried, MD, a board-certified pediatrician and internationally recognized pediatric dermatologist, spoke about some of the most notable highlights of her session at the conference.1

Siegried is known for her role as a professor of Pediatrics and Dermatology at the Saint Louis University School of Medicine. She also serves as director of Pediatric Dermatology at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Missouri. Siegfried was asked about several important questions from her session, highlighting key clinical pearls for clinicians working in the field of dermatology.

The following Q&A highlights Siegfried’s responses to these inquiries regarding her presentation at RAD 2026:

HCPLive: How would you define the current standard of care for pediatric atopic dermatitis in 2026, and where do you believe the field has evolved most significantly in the past few years?

Siegfried: Well, that's a big question. You always evaluate the patient based on severity, and then you match the treatment based on their severity, and then a variety of other factors. You have to take into account parameters that are impacting them: tolerating treatment, how well are they sleeping, how's it impacting the family, those sort of things…Obviously we've got biologic systemic treatments, and now we have small molecules. I think one of the most important things that's happened in the last couple of decades is that children are included; they used to be excluded from trials, period, but now they're included, and they're included earlier, so it helps get us the data that we need.

HCPLive: Despite the growing number of obviously available therapies, what do you see as the most pressing unmet needs in the pediatric space?

Siegfried: Well, even though we have pediatric data, the data always follows adult data. Often that's by quite a long period of time. And another big unmet need is really children under the age of six months. That's when atopic dermatitis presents in early infancy, and we are at a real loss for being able to start children on, frankly, treatments other than topical corticosteroids.

HCPLive: How are you approaching treatment sequencing among topical therapies, biologics, JAK inhibitors, and what factors most impact this decision?

Siegfried: You always start with topical therapy, and there's a mechanism to do that. Just paying attention to the over-the-counter topical treatments that they're using, then adding systemic treatment, and then deciding when a child is beyond topical corticosteroids and needs a steroid-sparing agent. Then when they fail topical therapy, and there are a lot of reasons that contribute to failing topical therapy, from just not being able to do it. A big one is cost, frankly, and what you can get access to, and then not being able to tolerate it, and having severity that's beyond being able to treat it topically.

I think it's really important to recognize, for children who have atopic dermatitis, the most vulnerable percentage of the population, these are kids that have unrecognized nutritional or immune deficiencies. I think it's really important to thoroughly evaluate them, but the most important thing to start with there is how they're growing. I think a lot of dermatology providers, who especially who aren't trained in pediatrics, don't pay any attention to how they're growing. You've got to look at their growth curve always, and people who get children who aren't growing well is a very vulnerable subset.

HCPLive: Has the availability of advanced therapies changed your threshold for escalating treatment in these pediatric patients?

Siegfried: Absolutely. Having the newer non-steroidals particularly, I think that topical corticosteroid use is going to be significantly impacted in the next 10 years. It's going to require a lot of education, because those drugs have been around for such a long time, and frankly, because they're so cheap. But it's so important to monitor quantities that patients are using, and if they're beyond safe quantities and frequency, then they're going to be able to move on to non-steroids, which is great.

HCPLive: To what extent are we moving toward a sort of disease modification approach in pediatric atopic dermatitis, and what evidence do you find most can be done in support of that kind of thing?

Siegfried: Well, certainly, we don't have the amount of data that we'd like about disease modification; it's certainly a great theory, but our pharmaceutical industry friends are paying a lot of attention to looking at long-term remission, both on drug and especially off drug. That data is coming, and I think it’s exciting and it's going to be impactful.

HCPLive: Are there specific pediatric atopic dermatitis phenotypes or patient populations that remain particularly challenging to manage, despite recent therapeutic advances?

Siegfried: The subset that I alluded to is the kids that aren't growing well and that have moderate to severe disease that aren't growing well. Really, they deserve laboratory evaluation. A lot of them have sky-high total IgE levels, which puts them in a different immunologic category that we don't really understand very well. Then the subset that has marked eosinophilia, so the definition of hypereosinophilia is 1500 absolute eosinophil count three times in six months, and if you have that, that is the definition of hypereosinophilic syndrome. Those are kids who are very vulnerable and at risk, even with our current treatments. I think it's really important to recognize that subset.

Siegfried had no relevant financial disclosures of note.

References

1. Siegfried E, Eichenfield L. Practice Pearls for Pediatric AD Spotlight CE Symposium. Session presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN.