Background: The availability of new topical molecular-targeted therapies, biologics, and oral Janus kinase (JAK) inhibitors has expanded treatment options for pediatric atopic dermatitis (AD). However, real-world prescribing patterns, rationale for use, and challenges in clinical decision-making remain unclear. This study aimed to characterize contemporary management practices and identify barriers to optimal therapy among physicians providing pediatric allergy care in Japan. Methods: We conducted a nationwide, cross-sectional, anonymous online survey of members of the Japanese Society of Pediatric Allergy and Immunology from July 2025 to August 2025. The questionnaire, developed by AD specialists, captured physician characteristics, treatment strategies, utilization of topical and systemic agents, adverse events, and perceived difficulties in clinical practice. Descriptive statistics were used to summarize responses. Results: A total of 488 physicians participated. Most were experienced pediatric specialists who reported high adherence to AD guidelines and frequent use of proactive therapy. Difamilast and delgocitinib were widely used among topical nonsteroidal agents. Biologics had been prescribed by 65.6% of respondents and oral JAK inhibitors by 36.1%, although substantial caution was observed. Safety was the primary factor guiding selection between biologics and JAK inhibitors. Many physicians reported difficulty determining appropriate discontinuation timing for systemic therapies. Conclusions: Japanese pediatric allergy physicians actively employ novel topical and systemic therapies but face persistent uncertainty regarding long-term management and treatment discontinuation. Strengthening standardized topical care, clarifying exit strategies for systemic therapy, and enhancing long-term safety data are essential to optimize pediatric AD management.
Yamamoto-Hanada et al. (Tue,) studied this question.