American Academy of Dermatology Issues First Pediatric Atopic Dermatitis Guidelines Highlighting Prevention and Expanded Therapies

The American Academy of Dermatology’s first pediatric atopic dermatitis guidelines note limited evidence for most preventive interventions, with early moisturizer use conditionally recommended in infants. Core treatment includes moisturizers, topical corticosteroids, and calcineurin inhibitors, while newer options like PDE-4 inhibitors, topical JAK inhibitors, and tapinarof broaden anti-inflammatory therapy choices.

For the first time in its history, the American Academy of Dermatology (AAD) has published guidelines of care for both the prevention and management of atopic dermatitis (commonly known as eczema) in pediatric patients. While pediatric and adult eczema share similarities, these guidelines recognize the unique safety, dosing, and patient-caregiver-clinician interactions of individuals under the age of 18.

The most common pediatric skin disease, eczema affects up to 25% of children worldwide. It is a long-lasting inflammatory skin disease often marked by itchy skin, dry patches, rashes, and rough bumps.

“Eczema is extremely common in children, though it doesn’t always look or behave the same way it does in adults,” said AAD President and board-certified dermatologist Murad Alam, MD, FAAD. “Because eczema can decrease the quality of life of children and their families, we need dedicated guidelines just for children to ensure their best care.”

The new guidelines, published in the Journal of the American Academy of Dermatology (JAAD), will guide dermatologists in deciding the best possible prevention and treatment options for pediatric patients. The guidelines were developed by a working group of 14 experts, including 11 board-certified dermatologists and one pediatric allergist.

Prevention

Because eczema is so common and can significantly affect a child’s health, there is strong interest in identifying ways to help prevent it. However, current research shows that supplemental therapies like special diets or skipping baths aren’t proven to prevent eczema.

Moisturizers were the only treatment to receive a conditional recommendation for use to reduce the occurrence of eczema in children aged 6 months to 3 years.

Conditional recommendations reflect an intervention whose benefits are closely balanced with risks and burdens. These recommendations apply to most patients, but the most appropriate action may differ depending on the patient and presentation.

The guidelines find insufficient evidence or no benefit to dietary or environmental interventions, including early food introduction, human milk consumption, probiotic or vitamin D supplementation, water softening, and dust mite avoidance.

Treatment

There are more treatments for eczema than ever before, though standard treatments like regular moisturizing remain effective in managing eczema in children.

The guidelines provide 26 evidence-based recommendations for topical therapies (prescription and non-prescription), phototherapy, and systemic therapies based on the treatment's reduction of eczema symptoms and itch severity, inclusive of the below.

Strong recommendations reflect treatments in which benefits clearly outweigh the risks and burdens. These recommendations apply to most children with eczema in most circumstances. Strong recommendations were made for the use of the following:

• Moisturizers to reduce the severity of patients’ dry, itchy skin.

• Topical calcineurin inhibitors (pimecrolimus 1% cream and tacrolimus 0.03% or 0.1% ointment) to manage patients’ flares when their dry, itchy skin worsens and as intermittent maintenance therapy.

• Topical corticosteroids (steroid creams), considered a first-line treatment in most cases due to affordability and accessibility, to manage patients’ flares and as maintenance therapy.

• Phosphodiesterate-4 inhibitors (crisaborole ointment and roflumilast cream) to reduce patients’ itchiness and decrease the frequency of flares. When used proactively, roflumilast can keep skin clearer more consistently.

• Topical JAK inhibitors (ruxolitinib cream) to decrease the severity of the dry, itchy skin in patients with mild to moderate eczema.

• Topical aryl hydrocarbon receptor (AhR) agonists (tapinarof cream) to reduce inflammation, improve skin barrier function, and decrease the severity of dry, itchy skin in patients with mild, moderate and severe eczema.

• Monoclonal antibodies (dupilumab, tralokinumab, and lebrikizumab) to decrease the severity of eczema symptoms, reduce flares and improve itching in patients with moderate to severe eczema.

• JAK inhibitors (upadacitinib, abrocitinib, and baricitnib) to decrease the severity of eczema symptoms and improve itching in patients with moderate to severe eczema.

Conditional recommendations were made for the use of treatments inclusive of the following:

• Bathing for treatment and maintenance for pediatric patients, followed by a moisturizer as standard care.

• Wet wrap therapy, under the guidance of a healthcare professional skilled in eczema management, are typically encouraged for patients during eczema flares.

• Phototherapy (light therapy) at a dermatologist’s office can be usedto treat patients with severe cases of eczema involving many body sites.

Strong recommendations were made against systemic corticosteroids, which should be reserved exclusively for patients with sudden, severe flares and as short-term bridge therapy. Conditional recommendations were made against the use of topical antimicrobials and PUVA phototherapy for children with eczema.

“These guidelines were developed to educate and empower patients, caregivers, and the medical community so children with eczema receive the best care possible. Early, proactive intervention allows improvement in symptoms and quality of life for patients and their families,” said board-certified dermatologist Dawn Davis, MD, FAAD, co-chair of the AAD’s Atopic Dermatitis Guideline Workgroup. “Since 2014, the landscape for eczema care has been transformed by the approval of new therapies for adults. Our goal was to review how these advancements relate to the pediatric population so children also receive optimal, individualized care.”

“Many children’s eczema cases can be improved with a treatment plan made specially just for their needs, and starting treatment early can help keep the problem from getting worse,” said Dr. Alam. “Please partner with a board-certified dermatologist to get expert care for your child’s eczema."

Reference:

Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the primary prevention of atopic dermatitis and awareness of comorbid conditions in pediatric atopic dermatitis. JAAD. 2026. doi:10.1016/j.jaad.2026.02.114.