Q&A: Where the Pediatric Atopic Dermatitis Systemic Pipeline Stands

Systemic treatment options for pediatric atopic dermatitis are expanding rapidly below age 12, where dupilumab has long stood as the only biologic approved in most of the world. In a phase 3 open-label extension study, 79.3% of children aged 6 months to 5 years reached at least a 75% improvement in disease severity after 1 year of treatment.¹ Another 58.6% reached a 90% improvement, with investigators reporting a favorable long-term safety profile in this younger age group.¹

Newer agents targeting the interleukin (IL)-13 and IL-31 pathways are now generating pediatric data of their own. Lebrikizumab met its primary and key secondary endpoints in the phase 3 ADorable-1 trial, with 63% of children aged 6 months to 17 years achieving a 75% reduction in Eczema Area and Severity Index (EASI) score.² Nemolizumab has separately shown clinically meaningful reductions in lesions and itch through week 16, sustained to 1 year, in an open-label study of children aged 2 - 11 years.³

These results raise practical questions for clinicians managing young children with limited topical options. As differently targeted biologics reach younger age groups, dosing intervals, injection frequency, and effects on comorbidity development will help determine how each agent fits alongside dupilumab in practice.

Lawrence Eichenfield, MD, is chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and vice chair of the department of dermatology at the University of California, San Diego. He reviewed this expanding pipeline during a recent 2026 Maui Derm conference session on atopic dermatitis. In the following interview, Eichenfield discusses which advances he sees as most impactful and where unmet needs remain for the youngest patients:

HCPLive: Which of these agents do you feel has the most potential to be impactful, whether from new data or recent approvals?

Eichenfield: What's most impactful is that we now have a choice of non-steroids. Families come in so concerned about topical steroid use that they're often underutilizing it; there's so much penetration of the idea of steroid addiction, even though it's very uncommon with judicious topical steroid use.

The real takeaway is having an option, depending on choices, access, and the clinical situation, and now we have a broader ability to get those options across different ages. I'm especially excited to have a potentially useful drug under age 2, since there are so few options in that group, which I think is really important in the topical space.

HCPLive: What are the remaining unmet needs in the topical space for children under 2?

Eichenfield: We have very few topical corticosteroids approved under age 2, but we use them with limitations, in a non-continuous manner, generally at lower strengths. Our first nonsteroidals, historically tacrolimus and pimecrolimus, never got approval for younger ages in the U.S. There's a fair amount of studies, especially with pimecrolimus, so sometimes they're covered and sometimes they're not from an access standpoint, but they also just haven't been well studied.

People still get concerned about the boxed warning even though we're reassuring about that. Topical crisaborole has been approved and is a very safe product, though it can cause stinging and burning. So we're trying to bring a new agent into this younger age group that shows safety in a broad population, with tolerance meaning not a lot of stinging and burning, or essentially none, and very few side effects in the PDE4 class, which is where roflumilast sits. I think that could be very useful, especially in long-term disease control models, as we're learning that if we can control disease earlier, whether with topicals or systemics, we may decrease the whole impact of the disease on a child and the family over time.

HCPLive: Are there any other treatments on the horizon for pediatric patients, whether new drugs or new data?

Eichenfield: The systemic space is really heating up. We have extended experience and data sets on dupilumab in younger children, with multi-year data showing decreased development of comorbidities in patients treated with the drug. From an approval standpoint, around the world dupilumab is essentially the only biologic approved under age 12, though in some parts of the world patients may have access to an oral JAK inhibitor.

Part of what I reviewed was new data presented in the last few months: nemolizumab had data not just in the adolescents included in its core study, but in open-label studies in 2- to 11-year-olds, used alongside topical agents, showing some nice efficacy. Lebrikizumab has also completed placebo-controlled trials in children as young as 6 months up to 17 years of age, including a cohort of 6-month- to 2-year-olds, showing very good utility in that population.

It could be very interesting over time to see how a differently directed agent, a specific IL-13 or IL-31 agent, will be used in younger children the way we've used dupilumab, and whether there are advantages or disadvantages in terms of impact on developing comorbidities or frequency of injections. These are issues we haven't dealt with yet, especially in younger kids with pediatric atopic dermatitis, but within the next year or two that's going to be what we're figuring out in practice.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Paller AS, Siegfried EC, Simpson EL, et al. Dupilumab safety and efficacy up to 1 year in children aged 6 months to 5 years with atopic dermatitis: results from a phase 3 open-label extension study. Am J Clin Dermatol. 2024;25(4):655-668. doi:10.1007/s40257-024-00859-y.

2. Eli Lilly and Company. Lilly's EBGLYSS (lebrikizumab-lbkz) is the first and only selective IL-13 inhibitor to deliver positive Phase 3 outcomes in patients aged six months to 18 years with moderate-to-severe atopic dermatitis. Published March 16, 2026. Accessed August 11, 2026. https://investor.lilly.com/news-releases/news-release-details/lillys-ebglyss-lebrikizumab-lbkz-first-and-only-selective-il-13.

3. Galderma. AAD 2026: Late-breaking nemolizumab data demonstrate clinically meaningful benefits for children aged 2 to 11 with moderate-to-severe atopic dermatitis. Published March 28, 2026. Accessed August 11, 2026. https://www.galderma.com/news/aad-2026-late-breaking-data-atopic-dermatitis.