Modern Interventions for Pediatric Atopic Dermatitis: An Updated Pharmacologic Approach

Abstract

Pediatric atopic dermatitis (AD) has historically challenged dermatologists given the variable response of patients to treatment and limited available therapeutic options, often with significant potential side effects. Over the last decade, targeted treatments including dupilumab and Janus kinase (JAK) inhibitors have emerged as significant treatment advances. An updated therapeutic approach for incorporating these new practice-changing medications can help clinicians manage these challenging patients. In this review, we discuss emerging topical and systemic (oral and injectable) treatments in pediatric AD, including topical PDE4 inhibitors and tapinarof, oral JAK inhibitors, and injected biologics including IL-4Ra inhibitor dupilumab, IL-13 inhibitor tralokinumab, IL-13Ra inhibitor lebrikizumab, IL-31Ra inhibitor nemolizumab, and IL-5Ra inhibitor benralizumab. We also review experimental agents in early clinical trials, such as targeted microbiome transplant lotions/antimicrobials, which may gain relevance in AD treatment. Finally, we propose a therapeutic approach for pediatric AD that incorporates newer therapies including dupilumab and JAK inhibitors, recognizing that these agents may not be universally available or approved. Further trials that include pediatric patients, especially head-to-head studies among therapeutic classes, are needed to clarify the role of emerging treatments.

Diseases from the Spectrum of Dermatitis and Eczema: Can “Omics” Sciences Help with Better Systematics and More Accurate Differential Diagnosis?

“…With more than five thousand dedicated articles indexed in PubMed in the last 5 years, AD (synonym: atopic eczema) is certainly one of most studied skin diseases. The accumulated knowledge on AD exceeds the scope of the present article by far; therefore, the reader is referred to state-of-the art reviews covering general aspects [ 23 , 24 ], the newest treatment options [ 25 , 26 , 27 ], comorbidities [ 28 , 29 ], the role of skin microbiota [ 30 , 31 ] and a systematic review of expert guidelines on the diagnosis and management of AD [ 32 ] to name just a few recent examples. This section will focus only on the possible application of “omics” sciences in the improvement of the diagnostic criteria and differential diagnosis of AD versus other diseases from the SoDE.…”

Lebrikizumab: a novel approach in managing atopic dermatitis in pediatric patients

“…Targeted microbiome transplantation lotion (TMT): contains Staphylococcus hominis, decreases the burden of S. aureus , however, in a phase 1 trial shows no improvement in dermatitis. 16 Lebrikizumab: it is an mAb that binds to IL-13 but unlike other drugs that bind to IL-13, it shows better qualities, among them: lower adverse effects, greater efficacy and safety.…”