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Delgocitinib and difamilast rank highest among nonsteroidal topical therapies for pediatric atopic dermatitisNew Topical Treatments Show Promise for Children with Eczema

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Key Takeaway
Consider delgocitinib or difamilast as high-ranking nonsteroidal topical options for pediatric atopic dermatitis.

This systematic review and network meta-analysis evaluated the efficacy of novel nonsteroidal topical therapies, including delgocitinib 0.5% twice daily, difamilast 1% twice daily, and tapinarof 0.5% once daily, in pediatric patients with atopic dermatitis. The analysis included a total sample size of 3,994.

Key findings indicate that most active regimens improved Investigator Global Assessment treatment success (IGA-TS) compared to vehicle, except for tapinarof 0.5% once daily. Regarding secondary outcomes, five of ten evaluated active regimens showed significant benefit for EASI-75, while all six regimens evaluated for EASI-90 were superior to vehicle. In comparative rankings, delgocitinib 0.5% twice daily ranked highest for IGA-TS, and difamilast 1% twice daily ranked highest for EASI-90.

Safety data showed no consistent increase in treatment-emergent or treatment-related adverse events compared to vehicle, suggesting no clear overall safety penalty. However, the authors note limitations including limited direct active-comparator evidence and limited stratified evidence regarding age-related differences. These therapies may provide effective short-term steroid-sparing options for pediatric patients, though long-term data is not available.

How this fits prior evidence

This finding addresses a gap in managing pediatric atopic dermatitis by identifying nonsteroidal topical alternatives to steroids. While prior coverage notes that upadacitinib 30 mg is a high-efficacy option for moderate-to-severe cases and dupilumab shows a favorable long-term safety profile, this study focuses on local, nonsteroidal options. It complements existing evidence regarding systemic treatments by providing data on topical agents like delgocitinib and difamilast as potential steroid-sparing choices.

Researchers analyzed data from nearly 4,000 pediatric patients to compare different topical treatments for atopic dermatitis. The study looked at several nonsteroidal options, including delgocitinib, difamilast, and tapinarof, to see how they performed compared to a standard vehicle treatment.

The findings showed that most active treatments improved skin condition scores over the vehicle. Specifically, delgocitinib ranked highest for one measure of success, while difamilast ranked highest for another. While five out of ten regimens showed significant benefits in reducing eczema area, all six regimens tested for a high level of improvement were superior to the vehicle.

These treatments are considered promising because they do not contain steroids. However, this study was a network meta-analysis with limited direct comparisons between the active drugs themselves. Because long-term data is missing and evidence for specific age groups is limited, these findings should be viewed as an early look at short-term options. Talk to a doctor to see if these treatments are right for your child.

What this means for you:
Nonsteroidal topical creams may offer effective, steroid-free ways to manage children's eczema in the short term.

Common questions

Are these new treatments safe for children?

The study found no consistent increase in treatment-related adverse events compared to the vehicle. This means there was no clear overall safety penalty reported during the study period, though it does not mean that no side effects occurred at all.

How do these compare to steroid creams?

These are nonsteroidal topical therapies. They are considered promising because they provide effective short-term options for children with atopic dermatitis while avoiding the use of steroids in their treatment plan.

Which specific treatments performed best?

Delgocitinib 0.5% twice daily ranked highest for one measure of success, while difamilast 1% twice daily ranked highest for another. All six regimens evaluated for a high level of improvement were superior to the vehicle.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Novel nonsteroidal topical therapies are increasingly used for pediatric atopic dermatitis (AD), but their comparative efficacy and safety remain unclear because direct active-comparator evidence is limited. We conducted a systematic review and frequentist network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating novel nonsteroidal topical therapies in children with AD. The study was registered in PROSPERO (CRD420261400624). Efficacy outcomes included Investigator’s Global Assessment treatment success (IGA-TS), Eczema Area and Severity Index 75 response (EASI-75), and EASI-90. Safety outcomes included treatment-emergent adverse events (TEAEs) and treatment-related adverse events (TRAEs). Treatment nodes were defined by drug, concentration, and dosing frequency. Pairwise vehicle-controlled meta-analyses, sensitivity analysis, and subgroup analyses by treatment duration and age were also performed. Twelve articles reporting 15 RCTs involving 3,994 pediatric patients were included. The network was largely centered on vehicle, with only one active-comparator trial. Most active regimens improved IGA-TS versus vehicle, except tapinarof 0.5% once daily. For EASI-75, five of ten evaluated active regimens showed significant benefit, while all six regimens evaluated for EASI-90 were superior to vehicle. Delgocitinib 0.5% twice daily ranked highest for IGA-TS and EASI-75, whereas difamilast 1% twice daily ranked highest for EASI-90. No consistent increase in TEAEs or TRAEs was observed. Pairwise meta-analyses and sensitivity analysis were generally consistent with the primary findings. Subgroup analyses suggested timepoint- and age-related differences, but stratified evidence was limited. Novel nonsteroidal topical therapies provide effective short-term steroid-sparing options for pediatric AD without a clear overall safety penalty. Further head-to-head, long-term, and age-stratified trials are needed. https://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD420261400624.
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