Novel treatments for pediatric atopic dermatitis.

Abstract

To describe new and emerging therapies for pediatric atopic dermatitis (AD). Recent investigations have highlighted the importance of type 2 immunity and interrelationships among the skin immune system, epidermal barrier, and microbiome in the pathogenesis of AD, including in infants and children. These discoveries have translated into more targeted therapy. Crisaborole ointment, a topical phosphodiesterase 4 (PDE4) inhibitor, and dupilumab, a subcutaneously injected interleukin (IL)-4 receptor inhibitor, are now Food and Drug Administration-approved. Topical agents under investigation for use in the pediatric population include Janus kinase (JAK) inhibitors, PDE4 inhibitors, an aryl hydrocarbon receptor agonist, an antimicrobial peptide, and commensal skin bacteria. Emerging systemic agents for pediatric AD include biologics targeting IL-13, the IL-31 receptor, and the IL-5 receptor, as well as oral JAK inhibitors. Increased understanding of AD pathogenesis has resulted in the development of new, more targeted therapies that show promising safety and efficacy results in Phase 2 and 3 clinical trials, although long-term safety remains to be evaluated. AD is a heterogeneous disease and having choices of therapies with different mechanisms of action will allow a broader group of children and adolescents with moderate-to-severe disease to achieve disease control.