Therapeutic Approaches in Pediatric Atopic Dermatitis

Dr. Robert Sidbury (00:14):

My name is Dr. Robert Sidbury, and I am a pediatric dermatologist at Seattle Children's Hospital and the University of Washington in Seattle, Washington.

(00:22):

How do I adjust my treatment in kids, particularly with regard to topical steroids and topical carcinogen inhibitors? Well, I just see kids, so it is oftentimes an adjustment for me based upon a two-month-old versus a two-year-old versus a 12-year-old and so on, and I do make those adjustments. Certainly, with very young children, 90% of atopic dermatitis is diagnosed by kindergarten, a good 60% by one year of age.

(00:47):

So we're seeing patients who are very young, sometimes with very extensive atopic dermatitis, head to toe practically. And in those patients, you very much need to consider the topical therapies you're putting on their body because they're going to absorb some of anything you put on their skin. So one adjustment would be with the potency of the topical steroid. Another adjustment would be with increasing the breaks that you take from topical steroids. And that's a segue to topical carcinogen inhibitors because they are not approved in the United States under the age of two. And it certainly would be nice to have a non-steroidal alternative that could be a break from the steroids for this younger population. So that's sometimes a struggle that we face. The only non-steroidal that's approved under the age of two is crisaborole, approved down to three months of age. So sometimes I will incorporate that when it's tolerated by patients.