How do you manage atopic dermatitis in pediatric patients who has failed dupilumab?   

If dupilumab fails a preschool-aged patient, I consider UVB, methotrexate, or cyclosporine. 

Are they over-bathing the kid? Ivory soap and a zealous grandmother can mess things up. Going old school with bleach baths often makes a big difference. I'd prefer JAK inhibitors over methotrexate by a wide margin. I've seen too many issues with azathioprine to consider it.

For a preschool child with atopic dermatitis who has failed dupilumab, the next choice is possibly off-label use of a systemic JAK inhibitor such as abrocitinib, or consideration of traditional systemic immunosuppressants or phototherapy, depending on availability, comorbidities, and risk-benefit as...

I would continue with traditional therapy with emollients, topical steroids, and topical calcineurin inhibitors, but I would also consider topical crisaborole, topical tapinarof, which is approved in kids 2 years and older, and topical ruxolitinib approved for 12 years old and older. I have been ver...

By chance, this study summary regarding the treatment of pediatric AD patients was just published today in Healthcare Daily News. A link to the full article follows. Treating widespread AD in kids with topicals alone is sometimes difficult compliance-wise. On occasion, I will treat initially with a ...