AAD Pediatric Guideline 2026

The Guidelines of care for the management of atopic dermatitis in pediatric patients (Davis, Sidbury et al., J Am Acad Dermatol 2026;95(1):121.e1–e26, online 7 April 2026) is the American Academy of Dermatology’s first guideline written only for children and adolescents under 18. It replaces the 2014 four-part guideline for children in the US. A multidisciplinary workgroup ran a systematic review and graded the evidence with GRADE. The PubMed abstract lists 27 recommendations. Only treatments available in the US were in scope, so herbal and complementary products were not assessed. A companion paper (Sidbury, Davis et al., 124.e1–e19) covers primary prevention and comorbidities. The two papers bring US paediatric guidance up to date. NICE CG57 still rests mostly on 2007 evidence reviews.

American Academy of Dermatology [part-of] AAD Pediatric Guideline 2026 AAD Pediatric Guideline 2026 [regulates] Atopic Dermatitis AAD Pediatric Guideline 2026 [relates] NICE CG57 GRADE [part-of] AAD Pediatric Guideline 2026

Non-prescription care (all ages). The guideline makes a strong recommendation for moisturisers (Emollient Therapy), based on moderate-certainty evidence from 9 RCTs with 1,260 children. It names no best product, vehicle or ingredient. It suggests warning caregivers off moisturisers with many additives, “particularly plant-based additives which may be sensitizers”. Bathing gets a conditional recommendation (very low certainty), with no standard frequency or duration (Bathing Frequency). The guideline notes that bath additives made little difference in a 461-patient RCT (BATHE Trial). Dilute Bleach Baths get a conditional recommendation (very low certainty), under the guidance of a clinician skilled in AD. They may lower EASI but barely change itch or quality of life, and a plain-water bath “may not be less advantageous”. Wet dressings (Wet Wrap Therapy) are also conditional, mainly for flares together with Topical Corticosteroids. The guideline flags infant-specific hazards: strangulation in layered pyjamas, hypothermia and skin maceration. It recommends against topical antimicrobials on skin without signs of infection (conditional), citing Antimicrobial Resistance and the risk of contact sensitisation.

AAD Pediatric Guideline 2026 [supports] Emollient Therapy AAD Pediatric Guideline 2026 [supports] Bleach Baths AAD Pediatric Guideline 2026 [supports] Wet Wrap Therapy AAD Pediatric Guideline 2026 [relates] Bathing Frequency AAD Pediatric Guideline 2026 [opposes] Antimicrobial Resistance

Prescription creams for toddlers. The guideline makes strong recommendations (moderate certainty) for Topical Corticosteroids and for Topical Calcineurin Inhibitors in all children. It also strongly recommends proactive maintenance: low- to medium-potency TCS up to 3 times a week (Weekend Therapy), with fluticasone 0.05% studied from age 1, or intermittent TCIs. For infants and young children it advises low-potency steroids, with medium potency on the body and high potency only for short, severe flares, because young children absorb more. It names Steroid Phobia as a real barrier: the mean caregiver distress score was 6.5/10. TCIs are FDA-labelled from age 2, but the guideline says use under 2 is backed by several studies and allowed in other countries from 3 months. Clinicians should explain that the cancer boxed warning rests on theoretical risk, and that Health Canada removed it in 2021. The non-steroid creams have age floors. Crisaborole is recommended from 3 months for mild-to-moderate AD. Roflumilast Cream is recommended from 2 years, for mild-to-moderate AD. Ruxolitinib Cream is recommended from 2 years, limited to 20% of body surface area because of its boxed warning. Tapinarof Cream is recommended from 2 years, with folliculitis as the main side effect and high-certainty evidence. All four are strong recommendations.

AAD Pediatric Guideline 2026 [supports] Topical Corticosteroids AAD Pediatric Guideline 2026 [supports] Topical Calcineurin Inhibitors AAD Pediatric Guideline 2026 [supports] Weekend Therapy AAD Pediatric Guideline 2026 [supports] Crisaborole AAD Pediatric Guideline 2026 [supports] Roflumilast Cream AAD Pediatric Guideline 2026 [supports] Ruxolitinib Cream AAD Pediatric Guideline 2026 [supports] Tapinarof Cream AAD Pediatric Guideline 2026 [opposes] Steroid Phobia

Conflict: [AAD Pediatric Guideline 2026, Tables V–VI] recommends roflumilast 0.15% cream for children aged 2 years and older. [FDA ZORYVE label, effective 2026-07-20] licenses 0.15% only from age 6 and a separate 0.05% strength for ages 2–5, noting 3- to 5-fold higher systemic exposure to 0.15% in 2–5-year-olds. Unresolved: the strength may be a manuscript error, since the cited 2–5-year trial (INTEGUMENT-PED) used 0.05%. Added to open_questions.

Phototherapy and systemic treatment. Phototherapy is conditionally recommended (low certainty, with no child-specific data in the updated Cochrane review), and PUVA is conditionally recommended against. For moderate-to-severe AD, Dupilumab is the only biologic recommended below age 12, strongly, from 6 months. The guideline says there are fewer data for 6 months to 2 years and suggests spacing injections 4-weekly. Tralokinumab, lebrikizumab, nemolizumab (with topicals) and oral JAK Inhibitors (upadacitinib, abrocitinib, baricitinib) are recommended only from 12 years. Of the older Systemic Immunosuppressants, methotrexate is conditionally recommended from age 2, and ciclosporin, azathioprine and mycophenolate are conditional for refractory disease. Systemic corticosteroids are recommended against (good practice statement), except as a short bridge in severe exacerbations, because of their effect on growth and bone. Evidence was “insufficient” for Oral Antihistamines, systemic antibiotics, IVIG, interferon-γ and systemic antivirals for Eczema Herpeticum. The guideline makes no recommendation for or against these.

AAD Pediatric Guideline 2026 [supports] Dupilumab AAD Pediatric Guideline 2026 [supports] Phototherapy AAD Pediatric Guideline 2026 [relates] Systemic Immunosuppressants AAD Pediatric Guideline 2026 [relates] Oral Antihistamines AAD Pediatric Guideline 2026 [relates] JAK Inhibitors

Conflict: [AAD Pediatric Guideline 2026, accepted-manuscript PDF] lists dupilumab as ”(≥ 3 months)” in its dosing table (VI), says “19 recommendations” in its abstract and leaves nemolizumab out of the abstract. [Same guideline, Table V; PubMed abstract PMID 41949508; FDA Dupixent label 2026] give dupilumab from 6 months, 27 recommendations, and include nemolizumab. Partly resolved: the typeset JAAD abstract (2026-10-03) confirms 27 recommendations including nemolizumab. Whether the typeset Table VI still gives dupilumab as ≥3 months is unresolved, because the table sits behind the paywall. Added to open_questions.

Diet, food testing, prevention and complementary therapy. The management guideline does not cover food allergy testing or elimination diets. The companion prevention paper (PMID 41949509) makes 14 prevention recommendations. It conditionally recommends moisturising skin care to reduce AD occurrence. It conditionally recommends against early food introduction, human milk, Probiotics and Vitamin D supplements for preventing AD. The abstract frames these as recommendations for preventing eczema. It does not say whether they affect early-peanut advice for allergy prevention (Dual-Allergen Exposure Hypothesis), and the full text was not retrieved. Neither paper assesses herbal, homeopathic or other complementary remedies. The only related advice is the caution about plant-based moisturiser additives. For UK families, the matching advice on complementary therapy is NICE CG57 rec 1.5.1.45 (amended 2025).

AAD Pediatric Guideline 2026 [opposes] Probiotics AAD Pediatric Guideline 2026 [opposes] Vitamin D AAD Pediatric Guideline 2026 [relates] Food Allergy AAD Pediatric Guideline 2026 [relates] Herbal and Home Remedies for Eczema

Connections

• American Academy of Dermatology — publisher; first child-specific AD guideline, source: AAD member page 2026
• NICE CG57 — UK counterpart for under-12s, source: NICE CG57
• Emollient Therapy — strong rec, moderate certainty; no product preferred, source: JAAD 2026
• Bathing Frequency — conditional; no standard frequency or duration, source: JAAD 2026
• BATHE Trial — cited: bath additives little or no benefit, source: JAAD 2026
• Bleach Baths — conditional, very low certainty, clinician-guided, source: JAAD 2026
• Wet Wrap Therapy — conditional; flares with TCS; infant hazards, source: JAAD 2026
• Antimicrobial Resistance — conditional against topical antimicrobials on uninfected skin, source: JAAD 2026
• Topical Corticosteroids — strong; low potency for young children; ≤3×/week maintenance, source: JAAD 2026
• Weekend Therapy — strong rec for intermittent TCS/TCI maintenance, source: JAAD 2026
• Topical Calcineurin Inhibitors — strong, incl. proactive; under-2 off-label use supported, source: JAAD 2026
• Steroid Phobia — caregiver distress 6.5/10, source: JAAD 2026
• Crisaborole — strong, ≥3 months, source: JAAD 2026
• Roflumilast Cream — strong, ≥2 y (strength conflict with FDA label), source: JAAD 2026; FDA label
• Ruxolitinib Cream — strong, ≥2 y, ≤20% BSA, source: JAAD 2026
• Tapinarof Cream — strong, ≥2 y, high certainty, source: JAAD 2026
• Phototherapy — conditional; PUVA conditionally against, source: JAAD 2026
• Dupilumab — strong, ≥6 months; fewer data under 2, source: JAAD 2026
• JAK Inhibitors — oral JAKi strong from 12 y only, source: JAAD 2026
• Systemic Immunosuppressants — MTX conditional ≥2 y; CsA/AZA/MMF conditional, source: JAAD 2026
• Oral Antihistamines — insufficient evidence, no recommendation, source: JAAD 2026
• Eczema Herpeticum — systemic antivirals: insufficient evidence for rec, source: JAAD 2026
• Probiotics — conditional against for AD prevention, source: PMID 41949509
• Vitamin D — conditional against supplementation for AD prevention, source: PMID 41949509
• Breast Milk — conditional against human milk for AD prevention, source: PMID 41949509
• Food Allergy — early food introduction not recommended for AD prevention, source: PMID 41949509
• Dual-Allergen Exposure Hypothesis — prevention recs target AD; peanut-allergy implications not stated in abstract, source: PMID 41949509
• Herbal and Home Remedies for Eczema — out of scope; plant-additive caution only, source: JAAD 2026
• GRADE — evidence-grading method, source: JAAD 2026
• Atopic Dermatitis — US paediatric management standard, source: JAAD 2026