Emerging Treatments Expand Atopic Dermatitis Options in the US

Recent advances in topical and systemic therapies for atopic dermatitis (AD) have significantly broadened treatment choices for both pediatric and adult populations, according to a comprehensive review.

The investigators highlight several newly approved and investigational agents that reflect a shift toward precision-based management of this chronic inflammatory skin disease.

Expanding Therapeutic Landscape

The authors examined data from PubMed, ClinicalTrials.gov, and industry sources to evaluate safety and efficacy across recent AD interventions.

Nonsteroidal topical agents have diversified the frontline arsenal. Roflumilast 0.15% cream, a phosphodiesterase-4 inhibitor, is approved for adults and children aged ≥6 years, while tapinarof 1% cream, an aryl hydrocarbon receptor agonist, is indicated for those aged ≥2 years. Topical Janus kinase (JAK) inhibitors, such as ruxolitinib, provide targeted JAK1 inhibition with minimal systemic toxicity; delgocitinib is similarly approved in Japan.

Biologic therapies continue to redefine systemic AD treatment. Dupilumab, targeting the interleukin (IL)-4/IL-13 pathway, now extends to patients as young as 6 months. Tralokinumab and lebrikizumab—also IL-13 inhibitors—are approved for adolescents and adults (≥12 years). The most recent entrant, nemolizumab, blocks the IL-31 receptor to address nonhistaminergic itch in patients aged ≥12 years. Oral JAK inhibitors upadacitinib and abrocitinib remain the only U.S.-approved systemic JAK therapies for adolescents and adults, while baricitinib retains approval in Europe and Japan.

Beyond current options, innovative approaches such as topical bacteriotherapy, OX40/OX40L inhibition, and multispecific antibody therapies are under investigation, suggesting future expansion of targeted modalities.

Clinical Implications

These developments mark a paradigm shift in AD management. Pediatric indications now extend across biologic and nonsteroidal categories, allowing earlier intervention and potential long-term disease modification.

The integration of topical nonsteroidal and biologic therapies provides tailored options for patients with varying disease severity. Meanwhile, the emergence of anti-itch biologics such as nemolizumab addresses a major quality-of-life burden. Ongoing trials exploring microbiome modulation and immune costimulatory pathways may further personalize therapy, aligning with contemporary trends in immunodermatology.

Continued longitudinal studies will be vital to assessing durability, optimizing combination strategies, and guiding evidence-based clinical decision-making in dermatology practice.

Reference:

Gallagher K, Halperin-Goldstein S, Paller AS. New and emerging treatments expand atopic dermatitis options in the United States. J Am Acad Dermatol. 2025;135(5): 498-510.e10. DOI: 10.1016/j.anai.2025.06.020