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- Presentation
Recent Advances in Topical Therapies for Atopic Dermatitis, Including New Non-Steroidal Treatments and Guidelines
Description
The talk reviewed the continued importance of topical therapy in atopic dermatitis, especially in children, while emphasizing rapid progress in newer non-steroidal options and updated guideline recommendations. The speaker highlighted recent U.S. age-expansion approvals for ruxolitinib cream, roflumilast cream, and tapinarof, and noted that established non-steroidals such as tacrolimus and pimecrolimus remain part of practice. The AAD atopic dermatitis guidelines were described as a multi-year, evidence-based effort that strongly supports topical corticosteroids, topical calcineurin inhibitors, roflumilast, crisaborole, ruxolitinib, tapinarof, and wet dressings, while not recommending topical antimicrobials as first-line. Maintenance with intermittent corticosteroids or calcineurin inhibitors was endorsed based on evidence, even though proactive use is not labeled. A substantial section addressed topical steroid withdrawal, explaining that social media has amplified patient concern, that true withdrawal exists but is rare in pediatrics, and that clinicians should distinguish it from recurrent eczema using characteristic clinical signs. Newer data were summarized for ruxolitinib in ages 2 to 11, roflumilast 0.05% in ages 2 to 5 with good efficacy and tolerability, tapinarof in children with moderate disease, and the newly approved PDE4 inhibitor difamilast. The speaker also stressed practical issues such as access, cost, site selection, and the common real-world practice of mixing therapies. Finally, the lecture discussed emollients for prevention of atopic dermatitis from the Cascade trial, noting benefit but stronger effects in lower-risk infants and when a dog was present in the home, and briefly mentioned approval of delgocitinib for chronic hand eczema.
View moreConclusions
- Topical therapy remains a central part of atopic dermatitis management despite the growth of biologics and systemic agents, especially in pediatric disease.
- Recent years have brought major expansion of approved topical options for children, including ruxolitinib, roflumilast, tapinarof, and difamilast.
- The newest topical non-steroidal agents generally show meaningful efficacy with acceptable safety profiles in pediatric trials.
- Ruxolitinib cream was effective in children as young as 2 years old without evidence of systemic JAK-related safety signals in the studied population.
- Roflumilast cream provided effective control in young children with low rates of stinging, burning, and other adverse effects, and maintenance use may prolong disease control.
- Tapinarof cream showed strong efficacy in children and a manageable adverse-event profile, with folliculitis being the main concern.
- Difamilast adds another PDE4-inhibitor option for mild to moderate atopic dermatitis, but its role in U.S. pediatric practice remains to be defined.
- Topical corticosteroid withdrawal appears to be a real but uncommon pediatric phenomenon, and clinicians need better counseling and diagnostic clarity to address it.
- Social media strongly amplifies fears about steroid withdrawal and steroid addiction, making patient education especially important.
- Evidence-based guidelines favor topical corticosteroids, topical calcineurin inhibitors, and several newer non-steroidals, while topical antimicrobials are not recommended as first-line therapy.
- Proactive intermittent use of topical anti-inflammatory therapy is supported by evidence for maintenance control, even when formal labeling is limited.
- In practice, treatment choice is shaped as much by access, cost, tolerability, and body-site considerations as by efficacy data alone.
- Mixing and matching topical steroids and non-steroidals is common in real-world care, but the evidence base for the best combinations is still limited.
- Daily emollient use in infancy may modestly reduce the risk of atopic dermatitis overall, but the preventive effect is weaker in genetically high-risk children.
- The preventive benefit of emollients appears greater in children without strong family risk and may be influenced by environmental context such as having a dog in the home.
- Chronic hand eczema is an important underrecognized target for topical innovation, and delgocitinib shows promising efficacy in both adults and adolescents.
- Overall, the field is moving toward individualized topical regimens that aim for the lowest achievable disease activity with acceptable trade-offs rather than one universal treatment approach.
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