Non-Steroidal Topicals: A Game-Changer for Pediatric Atopic Dermatitis, With Emily Becker, MD

Over the past decade, the atopic dermatitis treatment landscape has undergone a profound transformation. What was once dominated by reliance on topical and systemic steroids has now shifted to precision-targeted therapies, including biologics, JAK inhibitors, and advanced non-steroidal topical agents. Notable recent approvals have helped drive this evolution: for example, nemolizumab (Nemluvio), an IL-31 receptor blocker, was approved by the FDA in December 2024 for patients 12 years and older.1 Meanwhile, tapinarof cream (VTAMA 1%), a once-daily non-steroidal topical aryl hydrocarbon receptor agonist, gained FDA approval for use in children aged 2 and up in December 2024.2 More recently in October 2025, the FDA extended the approval of roflumilast cream 0.05% (Zoryve) for children 2 to 5 years old, offering a long-acting, steroid-free alternative.3 These advances mark a major shift away from steroid dependence and toward more targeted, age-appropriate therapies.

At a recent clinical forum convened by HCPLive in Denver, Colorado, dermatologists led by Adelaide Hebert, MD, from University of Texas (UT) Health Houston and Emily Becker, MD, from UT Health San Antonio, gathered to explore how these developments are transforming real-world care for children with atopic dermatitis.4 The discussion centered on evolving treatment philosophies, the role of new nonsteroidal topicals in practice, and the ongoing importance of education and advocacy in overcoming barriers to access.

HCPLive caught up with Becker to discuss some of her takeaways from the recent forum and to learn more about how recent impactful additions to the atopic dermatitis treatment landscape have changed practice for the panelists and life for patients.

Becker reflected on how these changes have reshaped pediatric atopic dermatitis care. She described the “freedom” patients now feel, no longer tied to cycling through various steroids. Instead, providers can offer children and families a full toolbox, from systemic biologics like IL-4/IL-13 or IL-31 inhibitors for severe disease, to non-steroidal topicals for mild-to-moderate cases. According to Becker, this has not only improved efficacy and quality of life, but also restored hope: young pediatric patients now have FDA-approved, safe options starting as early as a few months or years of age, shifting the conversation from off-label use to licensed, accessible treatments.

Becker highlighted several practical and meaningful benefits from this therapeutic evolution. The availability of once-daily non-steroidal topicals has significantly boosted treatment adherence in children and teens: a tube lasts much longer, and the burden of frequent reapplication is greatly reduced. She also noted the profound impact on sleep and itch, which previously had been masked by older therapies like sedating antihistamines which have their own drawbacks. With newer treatments, providers are thinking beyond skin clearance, prioritizing sleep, itch, and overall quality of life when making therapeutic decisions.

"I think in general, the most meaningful change has been this movement away from the dependence on steroids in general," Becker said.

Beyond symptom control, Becker emphasized the move toward proactive, maintenance-based care. While topical steroids remain part of the toolkit, she encourages families to think bigger: envisioning care without topical steroids as part of the regular routine. She also underscored the role of advocacy and shared decision-making: by documenting disease severity, itch burden, and quality-of-life metrics, clinicians and families can strengthen insurance appeals and access discussions. She stressed that all the recent advances in the field have contributed greatly to empowering children and their caregivers to take a more active role in their atopic dermatitis care.

Relevant disclosures for Becker include Organon, Regeneron, Genzyme,
Lilly, Arcutis Biotherapeutics, Incyte Corporation, Dermavant Sciences, LEO Pharma, AbbVie, and Boehringer Ingelheim.

References

1. Galderma Receives U.S. FDA Approval for Nemluvio® (Nemolizumab) for Patients with Moderate-to-Severe Atopic Dermatitis. News release. Galderma. December 13, 2024. https://investors.galderma.com/news-releases/news-release-details/galderma-receives-us-fda-approval-nemluvior-nemolizumab-patients

2. FDA Approves VTAMA® (tapinarof) cream, 1% for the Treatment of Atopic Dermatitis in Adults and Children 2 Years of Age and Older. News release. Organon. January 3, 2025. https://nationaleczema.org/blog/press-release-vtama-tapinarof-cream-atopic-dermatitis/?utm_source=chatgpt.com

3. FDA Approves Arcutis’ ZORYVE® (roflumilast) Cream 0.05% for the Treatment of Atopic Dermatitis in Children Ages 2 to 5. News release. Arcutus. October 6, 2025. https://investors.arcutis.com/news-releases/news-release-details/fda-approves-arcutis-zoryver-roflumilast-cream-005-treatment?utm_source=chatgpt.com

4. Johnson V. Proactivity, Not Reactivity: Pediatric Atopic Dermatitis Care in the Modern Era. HCPLive. Article. October 20, 2025. https://www.hcplive.com/view/proactivity-not-reactivity-pediatric-atopic-dermatitis-care-modern-era