When treating pediatric patients, knowing how to appropriately use topical steroids in this patient population is essential, according to Dr. Karan Lal, a dermatologist in Scottsdale, Ariz. Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Lal, who shares how to taper topical steroids and the role of non-steroidal agents. Hear the latest in the safety profile of topical steroids and when to consider other therapies. Plus find out how newer therapies can also address pigmentary alterations associated with inflammatory skin diseases.
Further Reading
If you want to read more about atopic dermatitis in children, check out the following articles published in the Journal of Drugs in Dermatology:
ABSTRACT
Background: Dupilumab has demonstrated benefits in patients with atopic dermatitis (AD), but there is limited information on real-world rates of dupilumab persistence and supplementation with topical and systemic treatments beyond adult populations.
Objective: This retrospective cohort study evaluated real-world dupilumab use among children (<13 years), adolescents (13–17 years), and adults (≥18 years) with moderate-to-severe AD, who initiated dupilumab (March 2017 to September 2021) in the United States.
Methods: The OM1 PremiOM™ AD dataset was used to assess dupilumab treatment persistence and treatment supplementation over a 24-month period.
Results: Of 5200 eligible patients who initiated dupilumab, 208 were children, 430 were adolescents, and 4562 were adults. Dupilumab persistence decreased consistently over 24 months of follow-up. The probability of dupilumab persistence at 12 and 24 months was 79.8% and 70.8% in children, 81.9% and 63.1% in adolescents, and 73.2% and 55.7% in adults, respectively. Across all patients, treatment supplementation increased over time; 31.5% received supplemental systemic therapy, and 62.1% received topical medications at 24 months.
Conclusions: Over a 2-year period, dupilumab persistence generally decreased while treatment supplementation increased for all patient groups, indicating a considerable proportion of patients with AD have unaddressed treatment needs.
ABSTRACT
Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that often manifests in infancy or early childhood, with significant impacts on quality of life and potential persistence into adulthood. S. aureus colonization and a complex interplay of immunological, genetic, and environmental (SAIGE) factors are key contributors to AD pathogenesis. In pediatric patients, the S. aureus colonization induces pruritus, barrier dysfunction, and inflammation, making AD management particularly challenging.
Methods: A panel of 7 pediatric dermatology experts employed a modified Delphi process, including a face-to-face meeting and online follow-up, to evaluate current evidence and formulate consensus recommendations for managing pediatric AD.
Results: The panel identified 6 consensus statements emphasizing S. aureus as a critical contributor to pruritus, skin barrier dysfunction, and AD exacerbation, reinforcing the need for effective, early skincare strategies. Recommendations include mitigating SAIGE factors, particularly S. aureus, through the proactive use of ceramide-containing skincare from birth in high-risk infants to delay and potentially prevent AD onset.
Conclusions: The consensus panel highlighted S. aureus as the most critical SAIGE factor in pediatric AD pathogenesis, driving the itch-scratch-inflammation cycle and contributing to disease exacerbation. Consensus recommendations underscore the role of early, targeted skincare in pediatric AD management to reduce S. aureus impact on the skin barrier and support the need for clinician education on SAIGE factors and therapeutic strategies that mitigate AD progression and severity.
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