J Am Acad Dermatol
Updated pediatric atopic dermatitis guidance reshapes treatment pathways
Clinical Takeaway: For children with moderate to severe atopic dermatitis, early use of targeted topicals and systemic agents—including biologics and oral JAK inhibitors—is now strongly recommended, while systemic corticosteroids should be avoided.
What’s new in the guideline
The American Academy of Dermatology (AAD) has published its first dedicated, evidence-based guideline for managing atopic dermatitis (AD) in children and adolescents, marking a major update since prior guidance largely extrapolated from adult data. The recommendations reflect a rapidly expanded therapeutic landscape, with multiple pediatric approvals since 2014.
Using a GRADE-based systematic review, the multidisciplinary panel issued 27 treatment recommendations covering topical therapy, phototherapy, and systemic agents for patients under 18 years of age.
Drug-related recommendations: key highlights
Strong recommendations were issued for multiple therapies across disease severities.
Foundational therapy
- Daily moisturizers remain first-line for all children with AD.
Topical anti-inflammatories
- Topical corticosteroids (low–medium potency) for flares and proactive maintenance.
- Topical calcineurin inhibitors (pimecrolimus; tacrolimus 0.03% and 0.1%) for flare control and maintenance.
- Nonsteroidal topicals, including crisaborole and roflumilast, to reduce itch and flare frequency.
- Topical JAK inhibitor ruxolitinib and tapinarof cream for mild to moderate disease.
Systemic therapies for moderate to severe AD
- Biologics: dupilumab (≥6 months), tralokinumab, and lebrikizumab.
- Oral JAK inhibitors: upadacitinib, abrocitinib, and baricitinib.
- Nemolizumab is strongly recommended with concomitant topical therapy, highlighting its role in itch-driven disease.
In contrast, the guideline strongly recommends against systemic corticosteroids, citing unfavorable risk–benefit balance and lack of sustained disease control.
Conditional recommendations—and what not to use
Conditionally recommended options include bathing practices, bleach baths, wet wrap therapy, narrowband UVB phototherapy, and traditional immunosuppressants (methotrexate, cyclosporine, azathioprine, mycophenolate mofetil).
The panel recommends against topical antimicrobials and PUVA phototherapy and found insufficient evidence to support dietary or environmental interventions for prevention or treatment.
Expert perspective
“Pediatric eczema is not the same as adult eczema… The unique care necessary to treat pediatric eczema requires dedicated, age‑appropriate guidance,” — Murad Alam, MD, FAAD, President, American Academy of Dermatology
Bottom line
This guideline signals a paradigm shift in pediatric atopic dermatitis management: targeted, mechanism-driven therapies are now strongly supported earlier in the treatment course, offering clinicians clearer direction—and children and families better long-term disease control—than ever before.
Source: Davis DMR, et al. (2026, April 7). J Am Acad Dermatol. Guidelines of care for the management of atopic dermatitis in pediatric patients