Childhood eczema: The AAD outlines an expanded treatment options

The American Academy of Dermatology (AAD) has published its first guidelines on atopic dermatitis (eczema) in children under 18. This document, dedicated to therapeutic management, includes 27 evidence-based recommendations developed by a multidisciplinary group of experts using the GRADE methodology. It covers non-pharmacological skin care, topical medications, phototherapy, and systemic treatments.These are not the first pediatric recommendations on eczema. Other recent references already exist, including the 2023 guidelines from the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology (AAAAI/ACAAI), the clinical report from the American Academy of Pediatrics published in 2025, and the European guideline EuroGuiDerm, also published in 2025. For clinicians in Quebec, the interest remains significant: the Eczema Society of Canada indicates that there are currently no Canadian guidelines on atopic dermatitis.This reference guide should, however, be understood for what it is: primarily intended for American physicians and specifically aligned with the indications and approvals of the Food and Drug Administration (FDA). The AAD is also publishing, concurrently, a second document dedicated to the prevention of atopic dermatitis and associated comorbidities in children.The timing of these guidelines is also due to the expansion of the pediatric treatment arsenal. “The number of treatments with pediatric indications in the United States, supported by multicenter trials, has increased,” explains Dr. Dawn M. R. Davis, co-chair of the AAD expert group, in an interview with Medscape.The main document moves from non-pharmacological care to topical drug treatments, and then to systemic options. Beyond topical corticosteroids and calcineurin inhibitors, the recommendations address, among others, crisaborole, roflumilast, ruxolitinib, tapinarof, monoclonal antibodies (biologic therapies), JAK inhibitors, and older immunosuppressants. The purpose of the document is not, of course, to place all these options on the same level, but rather to clarify the strength of the available data and the conditions under which they were evaluated.Basic treatments remain central.Hydrating agents are strongly recommended, although the authors do not favour any particular product or active ingredient due to insufficient data. That said, "of all over-the-counter interventions, hydrating agents have the strongest data," they write.Furthermore, the guidelines recommend topical corticosteroids for those under 18 and also suggest their intermittent maintenance use—at low or medium strength, up to three times a week—to reduce flare-ups. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are also recommended, including for intermittent proactive use.New options, but no rankingThese recommendations broaden therapeutic options, but their authors do not offer an algorithm to rank treatments as first- or second-line, beyond limitations related to patient age or the specific indications for each product. The reason is simple: “We simply don’t have the comparative data,” says Dr. Davis. Even for the most recent treatments, pivotal trials have generally compared medications to a placebo, not to another active option.Practices to avoidThe guidelines also draw attention to certain practices to avoid. The AAD recommends against using topical antimicrobials in the absence of signs of infection in those under 18. This message applies to non-infected atopic dermatitis, not to impetiginization or cellulitis, which require a different approach.Another strong recommendation: systemic corticosteroids should not be used as maintenance therapy for atopic dermatitis in children. Their use should be reserved for severe acute flare-ups, as a short-term transitional treatment to a safer option. The AAD also recommends avoiding PUVA phototherapy when other modalities are available, due to recognized long-term adverse effects, including an increased risk of UV-induced squamous cell carcinoma and photoaging.This article has been translated from its original French and first appeared on our sister site Profession Santé. References:Davis DMR, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, et al. Guidelines of care for the management of atopic dermatitis in pediatric patients. J Am Acad Dermatol. Published online April 7, 2026. doi:10.1016/j.jaad.2026.02.113.Sidbury R, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, 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. Published online April 7, 2026. doi: 10.1016/j.jaad.2026.02.114AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312. 10.1016/j.anai.2023.11.009Schoch JJ, Anderson KR, Jones AE, Tollefson MM, Wright T, Hunt R, et al. Atopic dermatitis: update on skin-directed management: clinical report. Pediatrics. 2025;155(6):e2025071812. 10.1542/peds.2025-071812Wollenberg A, Kinberger M, Arents B, Aszodi N, Barbarot S, Bieber T, et al. European Guideline (EuroGuiDerm) on atopic eczema: living update. J Eur Acad Dermatol Venereol. 2025;39(9):1537-1566. doi:10.1111/jdv.20639

Childhood eczema: The AAD outlines an expanded treatment options

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