Today, we are outlining key recommendations from the American Academy of Dermatology (AAD) guideline on Management of Atopic Dermatitis in Pediatric Patients. Atopic Dermatitis (AD) is a chronic inflammatory skin condition, frequently seen in children, that can significantly impact quality of life in patients and their families. This guideline provides evidence-based recommendations on phototherapy, topical, and systemic treatment options. A total of 27 recommendations were developed to support providers in the medical management of AD in children. 

View the full-text version for the most thorough explanation of these recommendations. 

Key Elements from the 2026 Guideline

Nonprescription Topical Interventions:

  • For pediatric patients up to age 18 with AD, we recommend the use of moisturizers.
  • For pediatric patients up to age 18 with AD, we conditionally recommend bathing for treatment and maintenance.
  • For pediatric patients up to age 18 with AD, we conditionally recommend dilute bleach baths under the guidance of a healthcare professional skilled in the management of AD.
  • For pediatric patients up to age 18 with AD, we conditionally recommend the use of wet dressings under the guidance of a health care professional skilled in the management of AD.

Topical Antimicrobials:

  • We conditionally recommend against the use of topical antimicrobials for AD without signs of infection in pediatric patients up to the age of 18.

Topical Calcineurin Inhibitors:

  • For pediatric patients up to the age of 18, we recommend the use of topical calcineurin inhibitors (tacrolimus, pimecrolimus).
  • For pediatric patients up to the age of 18, we recommend proactive use of intermittent TCIs as maintenance therapy.

Topical Corticosteroids:

  • For pediatric patients up to age 18 with AD, we recommend topical corticosteroids.
  • For pediatric patients up to age 18 with AD, we recommend intermittent use of low to medium potency topical corticosteroids as maintenance therapy (up to 3 times per wk).

Topical Phosphodiesterase-4 Inhibitors:

  • For pediatric patients 3 mo and older with mild-to-moderate AD, we recommend the use of crisaborole.
  • For pediatric patients aged 2 y and older with mild-to-moderate AD, we recommend the use of roflumilast cream.

Topical Janus Kinase (JAK) Inhibitors:

  • For pediatric patients aged 2 y and older with mild-to-moderate AD, we recommend ruxolitinib cream.

Topical Aryl Hydrocarbon Receptor Agonists:

  • For pediatric patients aged 2 y and older with AD, we recommend tapinarof cream.

Phototherapy:

  • For pediatric patients up to age 18 with AD, we conditionally recommend phototherapy.
  • For pediatric patients up to age 18 with AD, we conditionally recommend against PUVA phototherapy.

Monoclonal Antibodies (biologics):

  • For pediatric patients 6 mo and older with moderate-to-severe AD, we recommend dupilumab.
  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend tralokinumab.
  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend lebrikizumab.
  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend nemolizumab with concomitant topical therapy.

JAK inhibitors:

  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend upadacitinib.
  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend abrocitinib.
  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend baricitinib.

Immunosuppressants:

  • For pediatric patients 12 y and older with moderate-to-severe AD, we recommend baricitinib.
  • For pediatric patients up to 18 y with refractory moderate-to-severe AD, we conditionally recommend mycophenolate mofetil with proper monitoring.
  • For pediatric patients up to 18 y with refractory moderate-to-severe AD, we conditionally recommend limited-term use of azathioprine with proper monitoring and prescreening of thiopurine methyltransferase activity.
  • For pediatric patients up to 18 y with refractory moderate-to-severe AD, we conditionally recommend limited-term use of cyclosporine with proper monitoring.

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