Advances in Pediatric Atopic Dermatitis Management

Atopic dermatitis (AD) is a chronic skin disease that affects 20–25% of children, having a real impact on the daily lives of both the children and their families. It develops due to various factors, including a weakened skin barrier, immune system dysfunction, and changes in the skin microbiome. Outpatient primary care visits for AD have nearly doubled over the past 20 years, with children accounting for most visits. However, many pediatricians feel undertrained due to limited training and inconsistent guidelines, causing frustration for clinicians and patients.

Since the American Academy of Pediatrics released its report in 2014, new insights have transformed the approach to care. A clinical report published in Pediatrics provides updated guidance on pediatric AD and emerging topical therapies, enabling clinicians to provide adequate care for most children with AD.

It was observed that effective management relies on a skin-directed approach. Standard care included short daily or every-other-day baths with lukewarm water and gentle cleansers, followed immediately by liberal moisturization. Avoid using products that contain fragrance, essential oils, and dyes, as they tend to irritate the skin or trigger allergic reactions. Apply topical anti-inflammatory medications, such as corticosteroids or calcineurin inhibitors, once or twice daily to active eczema patches. Do not mix these medications with topical emollients unless directed, as this can reduce their effectiveness. Proactive use of these anti-inflammatory agents can reduce the frequency of flares. 

Dupilumab and Janus kinase (JAK) inhibitors represent novel treatment options for managing AD. Clear and uncomplicated treatment strategies maximize patient compliance. Severe or complex AD should be referred to specialists, but primary care providers should confidently manage standard treatments and collaborate with specialists to optimize care.

Reference:

Schoch JJ, Anderson KR, Jones AE, Tollefson MM, Section on Dermatology Wright Teresa MD, FAAP Hunt Raegan MD, PhD, FAAP Lauren Christine MD, FAAP Boull Christina MD, FAAP Gupta Deepti MD, FAAP Kenner-Bell Brandi MD, FAAP. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 Jun 1;155(6):e2025071812.

https://publications.aap.org/pediatrics/article/155/6/e2025071812/201952/Atopic-Dermatitis-Update-on-Skin-Directed?autologincheck=redirected