Dr. Sheila Fallon Friedlander Highlights Pediatric Prevention, Guidelines, and Practical Care at Maui Derm Hawaii
Giving clinicians tools they can use “in the here and now” was the theme as Sheila Fallon Friedlander, MD, presented on pediatric dermatology in one of the opening talks at Maui Derm Hawaii 2026.
Dr. Friedlander covered prevention strategies, recent guideline updates, treatment safety (especially JAK inhibitors and biologics), and important clinical history considerations when managing pediatric patients.
One of the most actionable areas reviewed was early skin care to prevent the onset of atopic dermatitis. Historically, studies on emollient use in infancy provided mixed results and often focused on high-risk populations, Dr. Friedlander noted. A 2024 systematic review found that prophylactic emollients may delay or reduce AD onset in high‑risk infants, though evidence was inconsistent overall.1
However, newer large and randomized data suggest a more promising role for early moisturizer use even in a general infant population. In the CASCADE trial, researchers randomized 1247 infants unselected for atopic risk to receive daily, full‑body emollient application starting by 9 weeks of age versus standard care without routine moisturization. At 24 months, the cumulative incidence of physician‑diagnosed atopic dermatitis was significantly lower in the emollient group (36.1%) vs controls (43.0%; relative risk 0.84; P = .02).2
Dr. Friedlander emphasized practical guidance for clinicians: encouraging daily use of fragrance‑free moisturizers early in life could reduce the incidence of eczema, and it is widely accessible and unlikely to cause harm, especially in non‑immunocompromised infants.3
Dr. Friedlander noted that recent clinical guidelines reflect evolving evidence and varied approaches to treatment, particularly for pediatric patients. In 2025, the American Academy of Pediatrics (AAP) published updated clinical practice guidance addressing skin‑directed management of pediatric AD. These recommendations emphasize frequent, short baths with gentle cleansers, liberal use of fragrance‑free moisturizers, and proactive topical anti‑inflammatory therapy with corticosteroids or calcineurin inhibitors to prevent flares.4
Meanwhile, the American Academy of Allergy, Asthma & Immunology (AAAAI) and American College of Allergy, Asthma & Immunology (ACAAI) released a comprehensive guideline framework that similarly outlines evidence‑based use of topical therapies (including JAK inhibitors and PDE‑4 inhibitors) and systemic options.5
Dr. Friedlander highlighted an important real‑world implication of these multiple guideline efforts: guideline recommendations sometimes diverge, particularly around newer therapies such as topical JAK inhibitors (eg, ruxolitinib). Some guideline panels are more cautious, reflecting theoretical safety concerns extrapolated from older adult arthritis studies, while others support their use in appropriately selected pediatric patients. She encouraged clinicians to share guideline summaries with families to facilitate informed decision‑making.
- Zhong Y, Samuel M, van Bever H, Tham EH. Emollients in infancy to prevent atopic dermatitis: A systematic review and meta-analysis. Allergy. 2022 Jun;77(6):1685-1699. doi: 10.1111/all.15116.
- Simpson EL, Michaels LC, Ramsey K, et al; CASCADE Consortium. Emollients to prevent pediatric eczema: a randomized clinical trial. JAMA Dermatol. 2025;161(9):957–965. doi:10.1001/jamadermatol.2025.2357
- American Academy of Pediatrics. Treating eczema (atopic dermatitis): AAP updates recommendations. HealthyChildren.org. Published May 19, 2025. Accessed January 25, 2026.
- Atopic Dermatitis: Update on Skin‑Directed Management: Clinical Report. Pediatrics. 2025;155(6):e2025071812.
- AAA/ACAAI Joint Task Force on Practice Parameters. Atopic dermatitis guidelines. Ann Allergy Asthma Immunol. 2024;132(3):277.