How Do We Treat Children with Systemic Eczema Therapies?

Among any age groups, children may have benefitted the most from recent developments in dermatologic systemic therapies. In the last year, agents such as ruxolitinib cream have been indicated to treat vitiligo in patients as young as 12 years old; dupilumab (Dupixent) became the first biologic approved for all atopic dermatitis patient ages down to 6 months old; and research is ongoing for topical non steroidal options including tapinarof and roflumilast for pediatric patients with psoriasis.

In an interview with HCPLive during the Fall Clinical Dermatology 2022 Meeting this year, Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at the University of California, San Diego, discussed the the major progressions achieved in inflammatory and rare genetic skin disease alike for pediatric patients.

Few stand out more than the latest pediatric indication for dupilumab, in patients with atopic dermatitis.

“We had this tremendous change in our ability to manage atopic dermatitis with development of new medications,” Eichenfield said. “One of the leading points is dupilumab, our first specifically-approved biologic agent, has gone down to 6 months of age—and that’s been very eye-opening in the field. It has tremendous impact on affected patients in the field.”

Along with newly available agents, Eichenfield highlighted the past year in pediatric dermatology research. He cited data recently presented at the European Association of Dermatology and Venereology (EADV) 2022 Meeting showing distinct treatment characteristics of the older topical options of cyclosporine versus methotrexate.

“They thought cyclosporine would be quicker in disease but that methotrexate might catch up…and it showed that cyclosporine was quicker, but after multiple months of therapy and a prolonged follow-up period, a number of people who flared or needed additional medicine were more so on cyclosporine than methotrexate,” Eichenfield highlighted.

Really, this current period of achieved landmarks and new concepts of care is also a time for reflection and reevaluation of best practices for both new and old therapies alike. For the latest systemic agents, Eichenfield wants to learn what happens when therapy is discontinued in treated pediatric patients—can they achieve remission or not?

“The younger the age of the patient, the more were trying to figure out whether we really need it,” Eichenfield said. “But the need comes to if you can’t have someone with sustained, generally eczema-free, itch-free life without sleep disturbance. That’s the goal.”

If dermatologists can accomplish that with the same old topical regimen, they should. But therapies are now available if they cannot.

“The unknown answers to the questions are, ‘For how long, and will it change the overall course of the disease?’” Eichenfield said.