Topical steroid and non-steroidal treatments for pediatric atopic dermatitis and potential new agents

In this Contemporary Pediatrics interview, Lawrence Eichenfield, MD, breaks down topical steroid and non-steroidal atopic dermatitis (AD) treatments for the pediatric population.

In addition, Eichenfield highlights anticipated new pediatric AD treatment agents that have the potential to be FDA approved in the future.

This interview with Lawrence Eichenfield is the last of a 3-part discussion of pediatric AD. Click here for part 1. Click here for part 2.

Interview transcript (edited for clarity):

Lawrence Eichenfield, MD:

The topical steroids range from super weak to super potent, the numbers don't correlate, right? 2.5%, hydrocortisone is 2.5%. It's a pretty big number in the scheme of things, but it's a low potency topical steroid, very safe to use, but not continuously, because it can thin skin, very little chance of having so much absorption, that you're going to have adrenal problems with that product.

But it's tricky to patients, because if I give them a topical steroid, like 0.1% triamcinolone, which is the standard, is 0.1%, it's a lower number and our most potent topical steroid, the one that's 2000 times stronger, is point .05% clobetasol. So that's confusing. It's not intuitive, the numbers don't necessarily correlate and there can be concerns with topical steroids, if they're used in a continuous manner, or just the quantity of use is too much. So I mean, our new model is to really sort of get a sense of what quantity patients are using, and to direct them to what quantity they might use.

They should also know, a pediatrician should also know, that there's this increasing number of non-steroidal topical agents with really new technologies that will be helpful. We had calcineurin inhibitors, you know, in 2000 and 2001, they're tried and true to a degree, not that much use amongst general pediatricians. There were concerns that were raised about potential cancer back in the early 2000, even though the data's come back negative for that. They have restricted age of of use, still reliable products. We had topical crisaborole approved a few years ago, it can work quite well.

In some individuals there can be some stinging and burning with that, but it can be highly useful, and that's approved down to 3 months of age, and recently got approved in a daily use where they used it every day for a year, you could never do that with a topical steroid. And then we have these new agents. So topical ruxolitinib is a topical JAK inhibitor that's approved already ages 12 years and older that have some early data.

Then we have two totally new different types of products. One is topical tapinarof, which is an aryl hydrocarbon receptor agonist, and my pediatrician should go, "what, I've never heard of that," because we haven't heard of that. This is a whole different mechanism of action. It's not a steroid, already approved for psoriasis in adults. They've completed their pediatric studies with that 1% cream down to children age 2 with really really good datasets and can be very, very exciting and that drug's become very popular for psoriasis in adults.

Then roflumilast has completed their clinical trials at different formulations for atopic dermatitis, that's a novel PDE4 inhibitor. So we've seen a topical PDE4 with crisaborole, but this is a novel agent. So those aren't ready to be handed to the patient yet, or to my pediatric colleagues to hand to their patients. But, hopefully we'll move along in the process of approval. The takeaway is that we want to bring long term disease control, regardless of severity for atopic dermatitis patients.

We'd like to do it efficiently and safely. There's a burden of care for the patients, a bit of a burden of care for our pediatric colleagues to educate families how to use it appropriately, but an increasing set of tools that allow you to do that much more effectively.

Eichenfield disclosed the following with Contemporary Pediatrics:

Board membership, Verrica Pharmaceuticals

Grants/research funding pending, Amgen, Johnson & Johnson

Stock ownership, Verrica, Forte (options for both)

Consultant/Advisor, Arcutis

Board, Arcutis

Investigator/Research grant, Arcutis

Eichenfield has served as a consultant, speaker, advisory board member or investigator for AbbVie, Amgen, Arcutis, Aslan, Bristol-Myers Squibb, Castle Biosciences, Dermavant, Eli Lilly, Forte, Galderma, Incyte, Janssen, Johnson & Johnson, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi-Genzyme, Target RWE and UCB.