Proactive Flare Prevention and Practical Use of Advanced Pediatric Topicals

Achieving disease control in pediatric atopic dermatitis and psoriasis requires setting realistic expectations with families regarding onset of action, degree of response, and the need for maintenance therapy. Autumn Atkinson, MD, associate professor in the Department of Pediatrics at McGovern Medical School at UTHealth Houston, notes that caregivers should be counseled that even effective therapies will not normalize skin overnight and that responses vary widely. Regular follow-up in primary care between dermatology visits allows clinicians to assess adherence, access issues, and application technique.

Adelaide Hebert, MD, professor and director of pediatric dermatology at McGovern Medical School at UTHealth Houston, describes proactive therapy strategies, such as continuing topical agents two to three times weekly on previously affected areas to reduce flare frequency. She reviews long-term safety data for newer steroid-sparing topicals, including ruxolitinib, tapinarof, and roflumilast, noting favorable profiles without clinically meaningful systemic absorption or need for routine laboratory monitoring. Hebert also contrasts newer PDE4 inhibitors with earlier agents that were limited by irritation and tolerability.

In this segment, Hebert and Atkinson offer practical guidance on selecting advanced topical therapies in real-world practice. They emphasize documentation of prior treatments, understanding payer formularies, use of samples when available, and shared decision-making based on dosing convenience, anatomic site, and prior patient experience.