Biological therapies for pediatric atopic dermatitis

INTRODUCTION: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disorder in children. Moderate-to-severe cases often remain uncontrolled with conventional therapies. Advances in type 2 immunopathogenesis have enabled the development of biologic agents targeting key cytokines.EVIDENCE ACQUISITION: We conducted a narrative review of studies published up to August 2025, including randomized controlled trials, open-label extensions, observational studies, and systematic reviews on biologics in pediatric AD.EVIDENCE SYNTHESIS: Dupilumab, blocking IL-4Rα, has robust evidence across all pediatric ages. Tralokinumab and lebrikizumab (anti-IL-13) show efficacy in adolescents, with ongoing studies in younger children. Nemolizumab (anti-IL-31RA) provides rapid antipruritic effects but more modest skin clearance. Upstream inhibitors such as tezepelumab (anti-TSLP), etokimab, and itepekimab (anti-IL-33) are investigational. Compared with biologics, JAK inhibitors offer oral delivery but require stricter safety monitoring. Real-world data confirm effectiveness and tolerability, though access remains uneven.CONCLUSIONS: Biologics represent a milestone in pediatric AD management, combining sustained efficacy and favorable safety. Future priorities include long-term safety studies, biomarker-guided treatment, and equitable access strategies.