Nonsteroidal Topical Rx for AD: From Study Room to Clinic Room

In this episode of Derms and Conditions, Dr James Q. Del Rosso is joined by Dr Adelaide Hebert, Chief of Pediatric Dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston, Texas. Back by popular demand, Dr Hebert shares her clinical experience managing pediatric atopic dermatitis—particularly in patients who are treatment resistant, injection-averse, or fearful of topical steroids. 

The conversation begins with a discussion of therapeutic decision-making for new patients with moderate to severe atopic dermatitis. Dr Hebert emphasizes the importance of listening closely to both the child and their caregivers to identify emotional barriers, needle phobia, steroid concerns, and gaps in previous care. She explains why patient-centered care requires flexible strategies, and how once-daily, steroid-free topical agents are often more acceptable to families than systemic options or injectable biologics. 

Dr Del Rosso and Dr Hebert focus on topical tapinarof, an aryl hydrocarbon receptor agonist approved for atopic dermatitis down to 2 years of age. Dr Hebert walks through the advantages of its once-daily use, its natural compound origin, and favorable safety profile, particularly for young children and anxious parents. She shares several compelling cases, including a 3-year-old with 85% body surface area involvement who responded dramatically in a clinical trial, and a 7-year-old girl with longstanding disease and prior cyclosporine exposure who found relief with tapinarof. 

Together, the clinicians explore practical pearls for real-world use, including how to apply the cream properly, whether to moisturize before or after, how to avoid waste, and when to reintroduce the medication after a flare. Dr Hebert highlights that many of her patients, and their families, experience life-changing improvements in sleep, school participation, and self-esteem, underscoring the broader impact of effective topical treatment. 

The episode closes with a reminder that personalized care, consistent moisturization, and confidence in the safety of non-steroidal options like tapinarof can help families navigate treatment with less stress—and better results.