New treatments in atopic dermatitis update.

This review evaluates the efficacy and safety of novel and emerging topical and systemic therapies for atopic dermatitis across pediatric and adult populations with an emphasis on recent advancements and future directions. Data were sourced from peer-reviewed publications (PubMed), scientific meeting abstracts, ClinicalTrials.gov, and industry press releases. Several new agents have received Food and Drug Administration approval, expanding therapeutic options for patients. Nonsteroidal topical treatments, such as roflumilast and tapinarof creams, are approved for adults and for children down to 6 and 2 years, respectively. Topical Janus kinase (JAK) inhibitors, including ruxolitinib, leverage inhibition of the JAK1 pathway with low concern for toxicity. The use of biologics targeting the interleukin (IL)-4/IL-13 pathway has expanded; dupilumab is approved for patients aged 6 months and older, and tralokinumab and lebrikizumab are approved for those aged 12 years and older. Most recently, nemolizumab, targeting the IL-31 receptor, which mediates nonhistaminergic itch, has been approved for patients 12 years and older. Although baricitinib is approved in Europe and Japan, upadacitinib and abrocitinib remain the only oral JAK inhibitors approved for patients 12 years and older in the United States. Promising investigational therapies, particularly through topically altering the microbiome (bacteriotherapy) and systemic agents targeting the OX40/OX40L pathway and multispecific antibodies, are in development. These innovations represent a shift toward personalized atopic dermatitis management. As the treatment landscape evolves, ongoing research is essential to assess long-term safety and efficacy, and to develop predictive models that optimize treatment strategies, ultimately improving patient outcomes and quality of life.