Breakthroughs in Pediatric Atopic Dermatitis Care

At Dermatology Week 2025, Elizabeth (Lisa) Swanson, MD, delivered a high-energy session titled "Relief for Our Little Patients: Advances in Pediatric Itch and Rash Care." Her talk explored the evolving treatment landscape of atopic dermatitis (AD) in children—highlighting simplified care strategies, novel nonsteroidal therapies, and the power of empathetic communication with families.

Dr Swanson began by emphasizing the importance of educating parents on the 2 core mechanisms of AD: skin barrier dysfunction and chronic inflammation. “When families understand why the skin is misbehaving, it opens the door to more collaborative and effective treatment conversations,” she said.

She advocated for adopting integrative-style language when explaining treatments, replacing clinical terms like “inhibit” or “block” with gentler concepts like “restore” and “balance.” This small shift, Dr Swanson explained, can help bridge the gap between families’ desire for “natural” solutions and evidence-based medicine.

Dr Swanson also took a critical look at traditional topical regimens, pointing to steroid phobia and overly complex routines as major barriers to adherence. “I’ve written routines so long they looked like recipes,” she joked, noting the need for simpler, more manageable plans.

One such option is the Aron regimen—a compounded mix of diluted betamethasone, mupirocin, and a moisturizer. Dr Swanson shared compelling before-and-after images demonstrating its rapid efficacy in infants with stubborn cheek eczema, praising it as a safe, customizable solution even for steroid-wary families. “There’s no wrong way to Aron,” she quipped, underscoring its flexibility.

The session then turned to newly approved nonsteroidal topicals revolutionizing pediatric AD care, and Dr Swanson delved into the “new kids on the block,” referencing topical ruxolitinib 1.5% cream, roflumilast 0.15% cream, and tapinarof 1%.

Dr Swanson highlighted dupilumab (Dupixent) as a “luxurious bathroom” compared to the “port-a-potty” options like methotrexate and cyclosporine that preceded it. Approved for use as early as age 6 months, dupilumab has revolutionized care—not only reducing disease burden, but also improving sleep and growth. She cited a recent study where one-third of children aged 6 to 11 years gained at least 5 percentiles in height within just 16 weeks on dupilumab, compared to 10% on placebo.

More than skin deep, Dr Swanson pointed to emerging data connecting AD to neurodevelopmental challenges, including attention-deficit/hyperactivity disorder (ADHD) and cognitive delays—potentially driven by excess IL-4. Blocking IL-4 with dupilumab, she explained, has led to a notable reduction in ADHD medication use among affected children.

She also reassured clinicians about vaccination logistics, noting that non-live vaccines are safe during dupilumab treatment. While live vaccines are still officially contraindicated per the label, recent immunology findings support co-administration with shared decision-making, providing new flexibility in care.

The session continued with an overview of new biologic therapies, including lebrikizumab and tralokinumab (IL-13 inhibitors) and nemolizumab (IL-31 blocker), each offering more tolerable injection options and monthly maintenance dosing. These agents expand the treatment toolkit for patients aged 12 years and up.

Finally, Dr Swanson delved into oral JAK inhibitors like abrocitinib and upadacitinib. Known for rapid and high-level efficacy—including reductions in itch and improvements in quality of life—these treatments are now approved for pediatric use (age 12 years and up), with younger age trials underway.

To address parental safety concerns, Dr Swanson offered a pragmatic communication strategy. She likened the black box warning to a “big barking Berne doodle—it looks scary from far away, but once you get close, you realize it’s not so bad.” Her structured, 3-part explanation covers the need for blood work, viral risk, and the broader context of Janus kinase inhibitor warnings—helping families make informed, confident choices.

“Growth is what moves the needle,” she concluded. “And these medicines are frankly too dang good to not be offering.”

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Reference
Swanson E. Relief for our little patients: advances in pediatric itch and rash care. Presented at: Dermatology Week; May 14–16, 2025; Virtual.