Title:Brief Academic Review and Clinical Practice Guidelines for Pediatric Atopic Dermatitis
Volume: 17
Issue: 3
Author(s): Yue Bo Yang, Amir Gohari and Joseph Lam*
Affiliation:
- Departments of Paediatrics and Dermatology and Skin Sciences, Faculty of Medicine, University of British Columbia, Vancouver,Canada
Keywords:
Pediatrics, atopic dermatitis, guideline, treatment, review, dupilumab.
Abstract: In this clinical guidelines article, we first include a brief review of the epidemiology,
pathogenesis, clinical diagnoses, and scoring-scales for pediatric atopic dermatitis (AD). We then
offer a set of pharmacologic treatment guidelines for infants and toddlers (<2 years), children (2-12
years), and adolescents (>12 years). We recommend irritant avoidance and liberal emollient usage
as the cornerstone of treatment in all age-groups. In infants <2 years, we recommend topical corticosteroids
as first-line medication-based therapy. In infants as young as 3 months, pimecrolimus, a
topical calcineurin inhibitor, may also be used. As a last resort in patients <2 years, non-traditional
therapies, such as the Aron regime, may be a safer option for refractory or resistant AD before off-
label medications are considered. In children and adolescents >2 years, topical corticosteroids are
still considered first-line therapies, but there is sufficient safety data to utilize topical calcineurin inhibitors
and topical PDE4 inhibitors as well. In children ages 2-12 years whose atopic dermatitis
fails to respond to prior treatments, oral systemic immunosuppressants can be used. For adolescents
>12, the biologic, dupilumab, is an additional therapeutic option. A trial of phototherapy may
also be utilized in children, particularly in adolescents >12 years, if they have access to treatment.
Although not currently approved for the treatment of AD, Janus-kinase (JAK) inhibitors represent
a promising new class of biologics with recently completed phase III clinical trials (JADE--
MONO1/2).
