Q&A: First Pediatric Eczema Guidelines and New Topical Options Down to Age 2

The American Academy of Dermatology (AAD) issued its first pediatric-specific atopic dermatitis guidelines in 2026, covering primary prevention and comorbidity awareness for children with the disease.¹ The prevention guideline gives moisturizers a conditional recommendation to reduce eczema occurrence in children aged 6 months to 3 years, while water softeners and dust mite avoidance showed no preventive benefit.¹

Eosinophilic esophagitis carries the only high-certainty comorbidity link to pediatric atopic dermatitis, with moderate-certainty evidence connecting the disease to allergic rhinitis, asthma, food allergy, urticaria, and ADHD.¹ Pediatric access to non-steroidal topicals has also widened. Tapinarof cream 1% gained US Food and Drug Administration (FDA) approval for children as young as 2 years in December 2024, adding an aryl hydrocarbon receptor agonist to the pediatric toolkit.²

Roflumilast cream 0.05% followed in October 2025 for children aged 2 to 5 years, with the phase 3 INTEGUMENT-PED trial showing 25.4% of treated children reaching treatment success at week 4 versus 10.7% on vehicle.³

These approvals carry real clinical weight because many families arrive concerned about topical steroid use and end up undertreating their child's eczema as a result. A broader menu of nonsteroidal options, spanning several drug classes and now reaching a wider pediatric age range, gives clinicians more flexibility to match therapy to a family's needs.

Lawrence Eichenfield, MD, is chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego and vice chair of the department of dermatology at the University of California, San Diego. He reviewed these updates during a Maui Derm session titled ‘Atopic Dermatitis and Itch Update 2026.’ In the following Q&A interview segment, Eichenfield discusses why the pediatric guidelines and expanding topical options matter for clinicians:

HCPLive: Why was this session on atopic dermatitis and itch important to highlight for clinicians?

Eichenfield: There is an incredible amount happening in atopic dermatitis along the spectrum of ages we treat, and the therapeutic agents we're using are changing. They've morphed every year, with new agents, new information, and new experiences. For this session, I divvied up the activities with my co-presenter [UNCLEAR — please review], and my job was to review pediatric atopic dermatitis and the new changes in topical medications, then look from a pediatric perspective at the changes happening in systemic medicine. There's really just a ton of new information.

HCPLive: What were the key pediatric-focused topics from the session you feel are most important for clinicians?

Eichenfield: The American Academy of Dermatology never had specific pediatric atopic dermatitis guidelines, and now we do. That information was put out in two different papers, and they're really important for people to know about. The first one, which a lot of people might not be aware of because it's not as much a direct therapy paper, was a paper on prevention of atopic dermatitis and consideration of comorbidities, and it raised several issues we face with patients.

I structured some of the answers in this evidence-based guideline around questions patients might have. For instance, can you prevent atopic dermatitis with the use of moisturizers? That's been a highly controversial topic over the years, because we have some studies showing the ability to decrease rates of development of atopic dermatitis and others that don't. We discussed there's some conditional evidence that moisturizer may help prevent atopic dermatitis, and I went through some very interesting recent studies showing benefits of moisturizer to prevent atopic dermatitis, though maybe less in patients who already have a family history of the disease.

One big study was by Eric Simpson, and another out of Ireland showed a higher ability to decrease atopic dermatitis when moisturizers were started very early. Still, it's a conditional recommendation, and the basis of evidence isn't that strong. We also discussed other prevention strategies that didn't pan out: water softeners don't prevent atopic dermatitis, and neither does dust mite avoidance.

Then I went through the comorbidity listing, which is really important from an eczema standpoint. Allergic comorbidities are highly associated with eczema. Certain autoimmune diseases, including alopecia areata or [UNCLEAR — please review], are considered comorbidities of atopic dermatitis, and there's also data on bone health, though the evidence is actually uncertain from a pediatric standpoint.

Then I moved on to new therapies. We've had an extension of approval of non-steroids in pediatrics over the past year or two, including several within just a few months. Topical ruxolitinib has been approved down to 2 years of age; we need a little more data, but with a maximal 20% body surface area rule, it can be really helpful in our practices and has very good safety data. Topical tapinarof is also approved down to 2 years of age, with some very high efficacy data. Topical roflumilast has been developed in different concentrations: it was approved for ages 6 and up in a 0.15% cream, and now for 2- to 5-year-olds in a .05% cream.

We also reviewed infant data presented for the first time a few months ago at the American Academy of Dermatology meeting. The drug isn't yet approved in that age group, but in a study of children 3 months to 2 years old, it showed really good data on utility. In a novel approach, the researchers also looked at scalp disease, which I really like, and showed nice improvement in global scalp dermatitis in patients who had it.

Lastly, I briefly touched on delgocitinib, which has been approved for chronic hand eczema in adults; studies have been done in teens, and we believe we're going to see changes in the topical world for that age group within the next few months.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. 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. J Am Acad Dermatol. 2026;95(1):124.e1-124.e19. doi:10.1016/j.jaad.2026.02.114.

2. Organon. FDA approves VTAMA (tapinarof) cream, 1% for the treatment of atopic dermatitis in adults and children 2 years of age and older. Published December 16, 2024. Accessed August 11, 2026. https://www.organon.com/news/fda-approves-vtama-tapinarof-cream-1-for-the-treatment-of-atopic-dermatitis-in-adults-and-children-2-years-of-age-and-older/.

3. Arcutis Biotherapeutics. FDA approves Arcutis' ZORYVE (roflumilast) cream 0.05% for the treatment of atopic dermatitis in children ages 2 to 5. Published October 6, 2025. Accessed August 11, 2026. https://www.arcutis.com/fda-approves-arcutis-zoryve-roflumilast-cream-0-05-for-the-treatment-of-atopic-dermatitis-in-children-ages-2-to-5/.