In his session, “Pediatric Dermatology Update 2022,” on the last day of Fall Clinical 2022, Lawrence F. Eichenfield, MD, presented an overview of new and emerging therapies for pediatric patients.

Dr Eichenfield began his discussion with the newer medications for atopic dermatitis (AD).

Topicals include ruxolitinib, which is approved for patients aged 12 and older. Tapinarof and roflumilast are in the works. For systemic therapy, dupilumab is approved for patients as young as age 6 months and upadacitinib is approved for patients aged 12 and older. Tralokinumab has adolescent data out and lebrikizumab has phase 3 data that include patients aged 12 and older.

For pediatric patients with AD, treatment goals include minimal disease, minimal rash, and minimal sleep disturbance.

He then looked at cyclosporine versus methotrexate. Cyclosporin is quicker to clear AD in children, but methotrexate continues to have a positive impact after stopping it. However, Dr Eichenfield remarked, “The biologic agents or oral JAKs in the appropriate age group get much higher levels of clearance than with traditional agents. With adolescents and children, the newer agents are remarkable in terms of impact on the lives of the individuals.” He continued, “This is a pearl for you. If you're considering systemic therapy, it’s always good to query how [the parents] think the disease might be impacting on the regular activities of the child, and the follow up questions are incredible. When I have a patient come back, I say, ‘By the way, are you able to do things differently than you have before?’ And the room lights up. With the younger kids it's like, ‘We send him to day care. Now we don't have to worry about his arms and legs being covered with clothes. He can play outside in the grass.’”

Dr Eichenfield introduced TARC: thymus and activation-regulated chemokine. He shared a study that took tape stripping at birth, 2 months, 6 months, and 12 months. At 2 months, the infants did not have AD. They did not have trans epidermal water loss, but they had different TARC levels on their skin, probably preceding the development of AD. There were changes in the skin that were totally predictive of AD at age 2 months. He also pointed out a study that showed prevention of AD with moisturizer use in pediatric patients both with and without filaggrin mutations.

He ended by discussing pediatric hidradenitis suppurativa, alopecia areata (AA), and vitiligo. “The buzz around the community is that oral minoxidil is becoming a standard for severe alopecia areata even in children.” Dr Eichenfield offered the following clinical pearl for AA, “It's nice to estimate how much AA you have. A hand is 1% of your body, a thumb is 1% of your scalp.” He noted that there are guidelines coming out this year for treatment of vitiligo in children and young adults.

In conclusion, Dr Eichenfield commented, “Isn't it a great time for pediatric dermatology? I ask you to be proud of the work that is being done in the field and be an advocate for your patients.”

Reference

Eichenfield LF. Pediatric dermatology update 2022. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.