An update on the topical and oral therapy options for treating pediatric atopic dermatitis

ABSTRACT

Introduction: Atopic dermatitis (AD) is one of the most common childhood skin disorders. Multiple mechanisms contribute to the pathology of AD and treatment approaches are directed at these processes.

Areas covered: The purpose of this review is to discuss the chemical treatment options for pediatric atopic dermatitis, including immunomodulators and small molecule inhibitors. A systematic literature search was conducted, and publications were reviewed for applicable treatment guidelines.

Expert opinion: Topical therapy is first-line for pediatric atopic dermatitis. Providers should work closely with patients and caregivers to promote the success of topical treatments. In disease refractory to topical treatments, systemic agents may be considered. Clinical trials are ongoing for the use of biologics in the treatment of pediatric AD. When choosing the most appropriate treatment, physicians should consider the drug efficacy, potential adverse effects, patient adherence, and quality of life for both patients and caregivers. Additional studies are required to determine the safest and most effective doses for systemic therapy in childhood AD.

KEYWORDS:

• Atopic dermatitis
• topical corticosteroids
• calcineurin inhibitors
• azathioprine
• methotrexate
• mycophenolate
• cyclosporine
• apremilast
• crisaborole
• dupilumab

Article highlights

• AD is a common skin childhood skin condition and continues to increase in incidence.

• Topical therapy is considered first-line in AD treatment.

• Systemic therapy is warranted in severe cases of AD or in patients who fail to respond to topical therapies.

• Treatment decisions can be based on disease severity, patient adherence, treatment efficacy and affordability, and quality of life.

• Additional studies are required to compare available agents and determine the most appropriate dose and length of treatment.

This box summarizes key points contained in the article.

Declaration of interest

In the past 5 years, LC Strowd has received research, speaking and/or consulting support from Pfizer Inc, Sanofi, Regeneron, and Novartis. Meanwhile, SR Feldman has received research, speaking and/or consulting support from Galderma, GlaxoSmithKline/Stiefel, Almirall, Alvotech, Leo Pharma, Boehringer Ingelheim, Bristol-Myers Squibb, Mylan, Celgene, Ortho Dermatology/Valeant, Pfizer, AbbVie, Samsung, Janssen Pharmaceuticals, Eli Lilly and Company, Menlo, Merck & Co, Novartis, Regeneron, Sanofi, Novan, Qurient, the National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and the National Psoriasis Foundation. He is also the founder and majority owner of www.DrScore.com and founder and part owner of Causa Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.