AAD releases pediatric AD guidelines
- John Evans
- 20 minutes ago
- 3 min read
For the first time, the American Academy of Dermatology (AAD) has published guidelines for the prevention and management of atopic dermatitis (AD) in pediatric patients.
A press release from the Academy notes that while pediatric and adult AD share similarities, the new guidelines recognize the unique safety, dosing, and patient-caregiver-clinician interactions of individuals under the age of 18.
“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, in the release. “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, are intended to guide dermatologists regarding 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.
Both prevention and treatment are discussed within the guidelines, though after reviewing the available literature on prevention, the guideline team concluded that there are no truly effective ways to prevent a child from developing AD.
Moisturizers were the only treatment granted a conditional recommendation to reduce the occurrence of AD in patients aged six months to three years.
The guideline writers found insufficient evidence for other prevention methods, including diets, skipping baths, vitamin D or probiotic supplements, early food introduction, breastfeeding, water softening, and reducing exposure to allergens.
Regarding treatment, the guidelines provide 26 evidence-based recommendations for topical therapies, phototherapy, and systemic therapies based on the treatment's reduction of AD symptoms and itch severity.
Strong recommendations include:
Moisturizers to reduce the severity of xerosis and pruritus.
Topical calcineurin inhibitors to manage patients’ flares and as intermittent maintenance therapy.
Topical corticosteroids are considered a first-line treatment in most cases due to affordability and accessibility, to manage patients’ flares and as maintenance therapy.
Phosphodiesterase-4 inhibitors to reduce pruritus and decrease the frequency of flares.
Topical JAK inhibitors to decrease the severity of xerosis and pruritus in patients with mild to moderate AD.
Topical aryl hydrocarbon receptor (AhR) agonists to reduce inflammation, improve skin barrier function, and decrease the severity of xerosis and pruritus in patients with mild, moderate, and severe eczema.
Monoclonal antibodies (dupilumab, tralokinumab, and lebrikizumab) to decrease the severity of AD symptoms, reduce flares and improve pruritus in patients with moderate to severe disease.
JAK inhibitors (upadacitinib, abrocitinib, and baricitnib) to decrease the severity of symptoms and improve pruritus in patients with moderate to severe AD.
Strong recommendations were made against systemic corticosteroids, which the authors say 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 AD.
“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.
The full guidelines can be read here.