A Busy Time in the Field

It is a tremendous time of evolution in pediatric dermatology. Over the past decade, we have reaped the rewards of years of basic, translational, and clinical research. This increase in knowledge of disease pathogenesis, disease impact and associations, and new therapies has culminated in a revolution in management of common and uncommon pediatric dermatology conditions. This issue highlights some of the “hot areas” in pediatric inflammatory skin diseases.  

The article by Burns, Chu, and Schairer on topical therapy in AD puts into perspective traditional topical steroids; our “turn of the century” non-steroidals, tacrolimus and pimecrolimus; and our newer non-steroid topical PDE-4 inhibitors (crisaborole and roflumilast), JAK inhibitor (ruxolitinib) and aryl-hydrocarbon antagonist (tapinarof).  

Hidradenitis suppurativa (HS) was much less common in pediatric practice several decades ago and still can be devastating with its physical and psychological effects. Dr. Cotton’s discussion of pediatric HS, with its detailed list of “Do’s and Don’ts,” is superb in its approach and practicality.

Epidermolysis bullosa remains one of the most challenging and heart-wrenching groups of conditions managed in pediatric dermatology. Dr. Gorell’s fascinating story on epidermolysis bullosa highlights advancements in therapy that can now be offered to these patients, including novel therapies for wound healing and targeted therapies utilizing our knowledge of specific mutations and evolving corrective gene therapy. 

Unfortunately, given the limitations of space, many other areas of clinical development could not be featured. An example of this is pediatric psoriasis. Topical therapies have expanded, with roflumilast 0.3% cream approved for topical treatment of plaque psoriasis, including intertriginous areas in patients 6 and older, and roflumilast foam 0.3% for scalp and body psoriasis in patients 12 and older. Apremilast became the first approved oral agent for pediatric psoriasis in mid-2024, for children 6 and older. Guselkumab became the first interleukin-23 (IL-23) inhibitor approved for children with approval in late 2025 for psoriasis and psoriatic arthritis in patients 6 and older. It joins etanercept, adalimumab, ustekinumab, secukinumab, and ixekizumab as approved pediatric biologics. There is much enthusiasm surrounding a new targeted oral peptide, icotrokinra, which selectively binds IL-23 similar to injectable biologic agents. Presented at several meetings in late 2025, icotrokinra demonstrates high-level psoriasis clearance in 24-week data in teens with moderate-to-severe psoriasis. This peptide technology may herald a new age of oral therapies for psoriasis with profound efficacy. 

We are excited about the evolution in our practices surrounding our new understanding of pediatric skin disease and the innovation propelled by novel therapies.  We look forward to an exciting future of ongoing changes in pediatric dermatology disease management.