Summary of Review on Treatments for Moderate to Severe Atopic Dermatitis in Pediatric Patients

Atopic dermatitis (AD) is the leading inflammatory skin condition among children, affecting 15%–20% globally. Treatments for moderate to severe AD include hydration, topical medications, antimicrobial approaches, phototherapy, and systemic immune suppressants. However, there is a scarcity of direct comparisons between topical and systemic therapies for this age group. This systematic review aimed to evaluate the effectiveness and safety of various topical and systemic treatments for moderate to severe AD in children.

Out of 1,114 potential clinical trials identified, 68 met the inclusion criteria. These comprised 34 articles on topical treatments—such as corticosteroids, calcineurin inhibitors, and emollients—and 34 on systemic treatments, including cyclosporine, dupilumab, upadacitinib, thymopentin, omalizumab, antihistamines, and probiotics. Notably, 41 of the studies were randomized controlled trials.

The findings indicated that topical steroids and calcineurin inhibitors are both effective and safe for treating mild to moderate pediatric AD. While systemic treatments like dupilumab and JAK inhibitors show significant effectiveness in young patients, their high costs and limited availability hinder their use in countries like India. In these contexts, cyclosporine and, occasionally, tapering doses of oral prednisolone are recommended as first-line options for severe AD while considering steroid-sparing alternatives.

Source: Mahajan R, Sarkar R, Panda M, Katakam BK, Padhiyar J, Haritha T, Mohapatra L, Patro N, Vora R, Shah S, Gaurkar SP, Patel KB, Rangappa V; Members of SIG Pediatric Dermatology and IADVL Academy. Evidence-Based Recommendations for Managing Atopic Dermatitis in Pediatric Patients: A Systematic Review and Meta-Analysis From the Pediatric Dermatology Special Interest Group of IADVL. Int J Dermatol. 2025 Mar 17. doi: 10.1111/ijd.17723. Epub ahead of print. PMID: 40097336.

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