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Proactivity, Not Reactivity: Pediatric Atopic Dermatitis Care in the Modern Era
Over the past decade, the treatment of atopic dermatitis (AD) has undergone one of the most profound evolutions in dermatology. What was once managed almost exclusively through topical steroids and broad immunosuppressants has now expanded into an era of targeted, mechanism-driven therapies that address the inflammatory roots of disease. The 2017 approval of dupilumab (Dupixent) marked a turning point, introducing the first biologic therapy for moderate to severe AD and setting new expectations for efficacy, safety, and quality of life improvement.1 Since then, a wave of innovation—including tralokinumab (Adbry), lebrikizumab, and systemic JAK inhibitors like upadacitinib (Rinvoq) and abrocitinib (Cibinqo)—has redefined disease control across adult and adolescent populations, reshaping what long-term management can look like.2
As the systemic treatment landscape has matured, attention has increasingly turned toward topical innovation—especially in pediatrics, where steroid phobia, chronic relapsing disease, and developmental considerations drive unique care challenges. New nonsteroidal agents such as roflumilast (Zoryve), ruxolitinib (Opzelura), and more recently, tapinarof (Vtama), have expanded therapeutic flexibility for patients as young as 2 years old, offering effective, steroid-free anti-inflammatory options that bridge the gap between topical and systemic therapy.3 These advances reflect a growing recognition that AD management must be personalized, proactive, and sustained—not merely reactive to flares.
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 AD. 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.
The panelists emphasized that pediatric dermatology is shifting toward nonsteroidal topical treatments such as tapinarof, roflumilast, and ruxolitinib. Chief concerns in the field are early, proactive intervention to prevent chronic inflammation, improve sleep, and support normal growth and emotional well-being, with proactive therapy maintaining anti-inflammatory treatment even after flares subside.
"Sleep is the big thing for the parents...The kids are itchy, and up at night. The parents don't sleep, the kids don't sleep," one panelist said.
"Kids need sleep to grow. Kids need sleep for their brains to develop. That was the one thing that is ingrained into your mind [starting as a pediatrician]. Kids need sleep [and] parents need sleep in order to be effective caregivers.Sleep is the crux of everything," another said.
Despite strong safety data validating these newer agents for younger patients, systemic barriers, including cost, insurance restrictions, and limited pediatric data, continue to limit access. Improving quality of life and reducing itch and sleep disruption remain central goals, while education and advocacy by dermatologists are key to advancing understanding, ensuring access, and promoting a safer, more patient-centered era in atopic dermatitis care.
"What's nice about that when you're in a busy practice... or maybe you're not used to seeing the pediatric population as much and you're wondering, is that mild, is that moderate, is it severe - I don't have to know. Even for documentation purposes, we don't have to stress... We can move on because we can rest assured because [tapinarof is used] across all severity characteristic severity types... and that's been nice," a panelist said.
"[Tapinarof] is probably one of the most effective products that's out there. It's expensive but if you get it covered [the eczema] melts away," another said.
Overall, panelists concur that in 2025, dermatology’s progress is measured not only by clinical outcomes, but by how effectively clinicians can deliver safer, more tailored, and family-centered care to their youngest patients.
References
Shirley M. Dupilumab: First Global Approval. Drugs. 2017;77(10):1115-1121. doi:10.1007/s40265-017-0768-3.
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
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
