Kanika GARG, Uchenna OZUZU, Amor KHACHEMOUNE
The Journal of Pediatric Academy - 2026;7(2):50-54
Atopic dermatitis (AD) is a chronic inflammatory skin disease with childhood onset. However, children with moderate-to-severe AD often do not achieve adequate disease control with current broad immunotherapies, leaving them with limited treatment options. The Janus kinase (JAK)-signal transducer and activator of transcription pathway is central to AD pathogenesis and an emerging therapeutic target. Ruxolitinib and delgocitinib are two topical JAK inhibitors that have been studied in pediatric populations. This structured literature review, utilizing a systematic search strategy, aimed to evaluate the efficacy and safety of topical JAK inhibitors in children under 12 years of age with AD. A systematic search of PubMed/MEDLINE and Cochrane CENTRAL was performed in accordance with PRISMA guidelines. Eligible studies included randomized controlled trials, open-label extension studies, and pharmacokinetic and safety studies of topical JAK inhibitors in patients under 12 years of age with AD. Systemic JAK inhibitor studies, adult-only trials, non-AD eczematous conditions, and non-peer-reviewed sources were excluded. Four eligible trials were identified. In children aged 2-11 years, ruxolitinib cream (0.75% and 1.5%) significantly improved investigator's global assessment 0/1 response, Eczema Area and Severity Index-75/90, pruritus, and quality of life compared with the control cream, and efficacy was maintained in long-term studies. Treatment was well tolerated, with mainly mild application-site reactions and minimal systemic exposure. Delgocitinib ointment (0.25% and 0.5%) demonstrated consistent efficacy and a favorable safety profile in Japanese pediatric populations, including infants as young as 6 months, and long-term follow-up studies showed sustained tolerability and undetectable plasma levels in most patients. Limitations included small sample sizes, short, blinded treatment periods, geographic restrictions, and a lack of head-to-head comparisons with standard therapies. Although limited, current evidence suggests that topical JAK inhibitors are effective and well-tolerated in children <12 years of age with AD, offering itch relief and potential as steroid-sparing options. Multinational, long-term pediatric trials are needed to define their comparative effectiveness and role in treatment.
