Written by Hannah Harp
Spoon Feed
The AAAAI/ACAAI Joint Task Force released updated guidelines for the treatment of pediatric atopic dermatitis (AD). Medications are just one aspect and must be accompanied by ongoing patient education, trigger avoidance, and frequent moisturizing.
Summary
The AAAAI/ACAAI Joint Task Force (JTF) has updated guidelines for managing pediatric atopic dermatitis (AD), emphasizing evidence-based approaches. Recommendations include using over-the-counter moisturizers and adding topical corticosteroids (TCS) or calcineurin inhibitors (TCI) when moisturizers alone are insufficient. Proactive therapy with TCS or TCI is advised for recurring flares, while the use of crisaborole or dilute bleach baths are suggested for specific cases. Elimination diets are discouraged due to limited benefits and potential harm. For moderate to severe AD, biologics like dupilumab and tralokinumab are recommended. The guidelines prioritize patient-centered care, shared decision-making, and focus on health disparities. (AI-generated)
Let’s AD to the discussion…
Topical Treatments: Once Daily for Rx
- No need for prescription moisturizers
- Topical corticosteroid (TCS): avoid face, hands and skin folds; avoid prolonged use
- Topical calcineurin inhibitor (TCI, i.e. tacrolimus): age over 3 months, can use on face and hands
- For all topicals — once daily application is sufficient in most cases
- PDE4-inhibitor (i.e. crisaborole): per patient preference for mild to moderate disease
- For relapsing localized AD: use TCS or TCI proactively for 2-3 consecutive days/week
- Bleach baths: moderate to severe AD only
- Wet wraps: use with low or mid-potency TCS for mild to moderate AD unresponsive to TCS.
Systemic Treatments: Beyond Topicals
- Biologics: moderate/severe only
- Dupilumab: > 6 months of age
- Tralokinumab: >12 years of age or refractory to dupilumab/high potency TCS
- Oral JAK inhibitors: moderate/severe AD only, refractory to biologics
- Systemic corticosteroids: do not use
- Elimination diet: recommend against
- Allergen immunotherapy
- For moderate/severe AD refractory to mid-potency topicals
- Recommended against for mild AD
How will this change my practice?
It’s so easy to just step up TCS potency rather than consider other topicals. This is a great reminder that TCIs are just as easy to prescribe (prior authorizations notwithstanding) and safer for prolonged use. I’m also hoping that once-daily dosing helps my patients stay on top of their treatment.
Source
Updated Guidelines for Atopic Dermatitis-AAAAI/ACAAI Joint Task Force. JAMA Pediatr. 2024 Oct 1;178(10):961-962. doi: 10.1001/jamapediatrics.2024.1395. PMID: 38976275
