AAD Publishes First-Ever Pediatric Atopic Dermatitis Guidelines

For the first time in its history, the American Academy of Dermatology (AAD) has produced guidelines for the prevention and management of atopic dermatitis (AD) in pediatric patients. Published in the Journal of the American Academy of Dermatology, the guidelines mark a significant milestone in dermatology—one long overdue, according to clinicians who treat children with the condition.¹

“Finally, we [have] AD guidelines for our pediatric patients,” Lisa Swanson, MD, a dermatologist and pediatric dermatologist based in Boise, Idaho, said in a statement to Dermatology Times. “These new AAD guidelines help clarify the treatment approach for our little peanuts, which will help patients, clinicians, and …hopefully even improve access to these recommended therapies. The care of atopic dermatitis has changed a lot over the past 5 to 10 years, and now we have guidelines that reflect all those advances.”

Pediatric AD affects up to 25% of children worldwide, making it one of the most prevalent chronic inflammatory diseases encountered in dermatology practice.² Despite that frequency, treatment approaches have historically been extrapolated from adult data, a gap these guidelines are designed to close. Developed by a working group of 14 experts, including 11 board-certified dermatologists and a pediatric allergist, the document addresses pediatric-specific concerns, including long-term safety, caregiver-dependent adherence, developmental considerations, and appropriate treatment sequencing in younger populations.¹

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Recognizing Pediatric AD as a Distinct Disease

Although pediatric and adult AD share overlapping pathophysiology, the new guidelines explicitly recognize childhood eczema as a clinical entity requiring its own framework. Beyond pruritic, xerotic eczematous plaques, pediatric AD carries a disproportionate quality-of-life burden, one that extends beyond the patient. Sleep disruption is common and frequently correlates with disease severity. Chronic itch contributes to irritability and behavioral changes in children, whereas caregivers shoulder a significant management burden through nighttime symptom control, complex treatment regimens, and persistent flare anxiety. The guidelines emphasize that effective management should prioritize functional outcomes alongside visible skin improvement.

Prevention: A Narrow but Practical Evidence Base

Despite widespread interest in preventing eczema onset, the guideline identifies moisturizers as the only intervention receiving a conditional recommendation for children aged 6 months to 3 years. The rationale centers on early skin barrier support and its potential to reduce the initiation of the inflammatory cascade in at-risk infants, though even this recommendation reflects variability in study outcomes.^1,3

The guideline found insufficient evidence or no benefit for a range of commonly discussed preventive strategies. Probiotic and vitamin D supplementation, early food introduction protocols, human milk exposure as a preventive measure, environmental modifications such as water softening and dust mite avoidance, and dietary restriction strategies all lack supporting evidence for eczema prevention.^1,3 For clinicians, the message is clear: Counseling should avoid recommending interventions without demonstrated preventive efficacy.

Emollients and Topical Corticosteroids

Regardless of disease severity, regular moisturization remains the foundation of pediatric AD management. By supporting stratum corneum integrity and reducing transepidermal water loss, emollients help mitigate both itch and inflammation and are strongly recommended in the guidelines. Topical corticosteroids remain first-line therapy for acute flares, supported by their efficacy, affordability, and accessibility. Importantly, the guidelines reinforce that maintenance therapy—rather than episodic, reactive treatment alone—improves long-term disease control and reduces flare frequency.

Structured bathing followed by immediate emollient application received a conditional recommendation as part of routine care, and wet wrap therapy is conditionally supported during acute flares under the guidance of clinicians experienced in eczema management.

A Broadened Topical Tool Kit for Clinicians and Patients

One of the most substantive expansions reflected in the guidelines concerns the range of steroid-sparing topical agents, which now carry strong recommendations. Topical calcineurin inhibitors—pimecrolimus 1% cream and tacrolimus 0.03% or 0.1% ointment—remain important tools for sensitive areas and intermittent maintenance therapy. Phosphodiesterase-4 inhibitors, including crisaborole (Eucrisa; Pfizer) and roflumilast (Zoryve; Arcutis Biotherapeutics), provide anti-inflammatory and antipruritic effects, with roflumilast specifically highlighted for proactive flare reduction.

Newer classes extend options across disease severity. Topical Janus kinase (JAK) inhibitors, specifically ruxolitinib cream, received a strong recommendation for mild to moderate disease. Tapinarof (Vtama; Organon) cream, an aryl hydrocarbon receptor agonist, targets both inflammation and barrier dysfunction and is supported across the full spectrum of disease severity. Together, these agents offer meaningful alternatives to corticosteroid exposure in a population where long-term safety considerations are particularly salient.

Systemic Therapy: Earlier Escalation, Targeted Control

For moderate to severe pediatric AD, the guidelines strongly support biologics and oral JAK inhibitors as effective systemic options, representing a notable shift away from reserving systemic therapy solely for refractory cases. The monoclonal antibodies dupilumab (Dupixent; Sanofi/Regeneron Pharmaceuticals), tralokinumab (Adbry; LEO Pharma), lebrikizumab (Ebglyss; Eli Lilly and Company), and nemolizumab (Nemluvio; Galderma Laboratories) target key inflammatory pathways and are associated with meaningful improvements in itch, sleep quality, and overall disease severity. Oral JAK inhibitors—upadacitinib (Rinvoq; AbbVie), abrocitinib (Cibinqo; Pfizer), and baricitinib (Olumiant; Eli Lilly and Company)—offer rapid symptom control and are viable options for select patients.

Phototherapy retains a role for severe or widespread disease but is limited by logistical access and treatment burden. Conversely, the guidelines issue a strong recommendation against routine systemic corticosteroid use, reserving them exclusively for short-term bridging during severe acute flares, given risks of rebound and systemic adverse effects. Psoralen plus UV-A phototherapy is discouraged in pediatric patients due to safety concerns, and routine topical antimicrobial use is similarly not supported, reflecting both limited benefit in noninfected AD and the principles of antimicrobial stewardship.

A Paradigm Shift in Management Philosophy

Perhaps the most consequential message embedded in the guidelines is a shift in treatment philosophy. Rather than repeatedly reacting to flares, clinicians are encouraged to adopt proactive maintenance strategies to reduce flare frequency and severity over time. The increasing availability of biologics, JAK inhibitors, and advanced topical agents supports earlier escalation when disease burden is high, with the ultimate goal of sustained disease control and functional improvement rather than short-term lesion suppression.

“These guidelines were developed to educate and empower patients, caregivers, and the medical community so children with eczema receive the best care possible,” said Dawn Davis, MD, FAAD, cochair of the AAD’s Atopic Dermatitis Guideline Workgroup. “Early, proactive intervention allows improvement in symptoms and quality of life for patients and their families.”³

For a condition affecting up to 1 in 4 children globally, the arrival of dedicated, evidence-based guidance represents both a clinical resource and a policy lever—one that clinicians and patients alike have been waiting for.

Looking for more pediatric insights? Check out our new pediatric dermatology show Don’t Be Rash!

References

1. Davis DMR, Alikhan A, Bercovitch L, 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
2. Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci. 2019;49(4):963-984. doi:10.3906/sag-1810-105
3. American Academy of Dermatology issues first-ever pediatric atopic dermatitis guidelines, highlighting prevention strategies and effective treatments. News release. American Academy of Dermatology. April 7, 2026. Accessed April 10, 2026. https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines