Atopic dermatitis (AD) is commonly considered a T-helper type 2-dominated disease. The severity of pediatric AD is usually less than that of adult AD. Still, it may emerge as moderate to severe lesions that are inadequately managed by current modalities, including emollients/moisturizers, topical corticosteroids (TCSs), topical calcineurin inhibitors (TCIs), and even systemic immunosuppressants (like cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil). Additionally, systemic immunosuppressants are frequently not recommended for childhood AD by the current guidelines due to their toxicities. Thus there is a need for safe and effective long-term therapy for pediatric AD patients with inadequately controlled disease or those intolerant to current treatments.

The emerging therapeutics for AD focus on interfering with the inflammatory pathway by targeting specific cytokines/chemokines or their receptors. Monoclonal antibodies against immunoglobulin E (IgE), interleukin (IL)-4 receptor subunit α, IL-5, IL-13, IL-31 receptor subunit α, IL-33, and thymic stromal lymphopoietin (TSLP) have already been evaluated clinically for AD. Many biologics have shown encouraging results, of which dupilumab is the most exciting. Other emerging systemic therapies include small molecules like baricitinib, abrocitinib, upadacitinib, and tradipitant. 

Several novel topical agents are also in the pipeline for benefitting patients with AD, like topical phosphodiesterase 4 (PDE4) inhibitors, Janus kinase (JAK) inhibitors, aryl hydrocarbon receptor (AhR) modulating agents, and transient receptor potential vanilloid subfamily member 1 (TRPV1) antagonists. By thoroughly analyzing different phenotypes and endotypes, precision medicine can provide new prospects for treating AD optimally.

Chu CY. Treatments for Childhood Atopic Dermatitis: an Update on Emerging Therapies. Clin Rev Allergy Immunol. 2021 Oct;61(2):114-127. doi: 10.1007/s12016-020-08799-1. PMID: 32607924.