Ruxolitinib Cream Holds Potential for Children With More Severe Atopic Dermatitis: Lawrence Eichenfield, MD

Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital in San Diego and professor of dermatology and pediatrics and vice chair of the Department of Dermatology at the University of California, San Diego, School of Medicine, discussed the efficacy of ruxolitinib for moderate to severe atopic dermatitis in children aged 2 to 11 years.

Results presented at the Society of Pediatric Dermatology 2025 annual meeting found ruxolitinib effective in patients with a baseline Investigator’s Global Assessment (IGA) score of 3, those with 10% or greater affected body surface area (BSA) at baseline, and those with a combined IGA of 3 and 10% or greater BSA. The findings support the potential of nonsteroidal management of atopic dermatitis with ruxolitinib in this patient subpopulation.

Transcript

How does the sustained response in children with baseline IGA 3 or ≥10% BSA reshape how we should think about treating more moderate or extensive pediatric atopic dermatitis with nonsteroidal options?

In pediatric atopic dermatitis, there's a tremendous variation in terms of disease severity. It could be the extent of disease, and it could be the qualities of eczema, and our different scores sort of represent different things. We tend to have children with higher body surface area in pediatrics. One of the things we're learning is that patients with moderate disease and higher body surface area can still be adequately controlled, and certainly the topical ruxolitinib data in the pediatric age group—that 2 to 11 in addition to our prior experience in the adolescents—but in that particular sub cut, it shows that more extensive disease and/or more severe disease can still be appropriately managed with topical medicine.

My translation to clinical practice is that going from minimal rash, minimal itch, and minimal sleep disturbance, we can do that with a topical—and now more potent, non-steroid topicals, they can bring that to fruition. [I'm] happy to do that. If it's not handled with topicals, then we have the systemic options, but it opens up that consideration for more severe disease being appropriately managed in a long-term, safe manner with good disease control.

Given the comparable week 52 outcomes between the 0.75% and 1.5% strengths, how would clinicians decide which strength to initiate in moderate or extensive disease if both are approved in this patient population?

At the time that we're discussing this, this is a theoretic question of, "Will the FDA approve a 0.75% formulation and a 1.5% formulation?" Hopefully not just the 0.75% formulation. From my standpoint, what I love about topical ruxolitinib is that it has incredible efficacy. In that phase 2 trial, they compared it with triamcinolone, and at 4 weeks, it did way better than BID [twice daily] triamcinolone, so it's a nonsteroidal option that's highly effective. I want that effectiveness. We'll see from a regulatory standpoint.

I think that in real-life clinical practice, we very much go to a "Get the disease under control, and then figure out what you need to keep it under control." And there may be a tradeoff of the 0.75% or 1.5%. My psychology is that when I limit body surface area to 20% with topical ruxolitinib at 1.5%, I'm not concerned about systemic absorption in that population when done the right way. I'd probably just be happy to use the 1.5% and see how that works. But these are unanswered questions. We don't really have that movement back and forth between them—we'll figure that out in the future.