Emerging topical nonsteroidal therapies in pediatric dermatology: atopic dermatitis, psoriasis, alopecia areata, vitiligo, and seborrheic dermatitis

Purpose of review – To review the current literature for updates on pediatric nonsteroidal topical therapies (NSTT) for the treatment of atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo, and seborrheic dermatitis (SD). Recent findings – The FDA approved difamilast and expanded the approved age ranges for roflumilast, tapinarof, and ruxolitinib to treat AD. Recent studies also show positive results with delgocitinib. In the field of psoriasis, current research shows promise for tapinarof and roflumilast in an expanded age range. Among new AA treatments, relevant literature supports the use of both ruxolitinib and tofacitinib. Research in pediatric vitiligo is currently focused on roflumilast and latanoprost. The FDA approved age ranges for roflumilast in SD treatment was expanded, and recent data shows promising efficacy and safety with long term use. Summary – Current pediatric topical therapies are limited for the treatment of AD, psoriasis, AA, vitiligo, and SD. Historically, first line treatment options have included topical corticosteroids (TCS), though these have an increased risk of side effects in a pediatric population. Future clinical practices will likely rely less on TCS and more on NSTT for treatments of chronic pediatric dermatologic conditions.