Pediatric Atopic Dermatitis and Biologics: Suitability in the Under-6 Age Group

Atopic dermatitis (AD) is a common inflammatory skin condition in children, affecting up to 20% of the population. It typically begins within the first five years of life and can be remitted by adolescence, with risk factors including early onset, persistent or severe disease, family history, polysensitization, and filaggrin gene mutations.

The clinical presentation varies based on age and disease stage, with infants typically exhibiting papulovesicular plaques and older children showing flexural areas with lichenification and chronic eczema.

Systemic treatments are limited for children under six due to safety concerns, while topical calcineurin inhibitors are safe for children over two. Dupilumab, a monoclonal antibody targeting IL-4Rα, was approved for use in children as young as 6 months, reducing symptoms of itching, inflammation, and infections. Expert opinions included:

Biologicals revolutionized AD care, improving the quality of life for patients and caregivers.
Dupilumab, approved for use from 6 months of age, demonstrated strong safety and efficacy.
Emerging biologics may expand safe options for infants and preschoolers.
Key barriers include cold storage needs and needle phobia.
Compliance can be improved with pre-warming syringes, topical anesthetics, distraction techniques, and caregiver support.
Dupilumab effectively reduced symptoms and improved quality of life in severe pediatric AD.
Unresolved issues: ideal treatment duration, dosing intervals, and long-term disease modification potential.

Despite significant progress with biological therapies, key questions persist regarding optimal treatment duration, personalized dosing intervals, and long-term disease modification. Ongoing real-world data and larger prospective studies are essential to guide future care.

(Source: Expert Opinion on Drug Safety, 24(2), 125–127. https://doi.org/10.1080/14740338.2024.2446428)

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