Topical Janus Kinase Inhibitors for Pediatric Atopic Dermatitis: A Systematic Review of Efficacy and Safety

Background: Atopic dermatitis (AD) is a common inflammatory skin disease affecting up to 20% of children. Long-term topical management is often limited by safety concerns, tolerability issues, and caregiver hesitancy. Topical janus kinase (JAK) inhibitors have emerged as targeted nonsteroidal therapies, with recent pediatric approval of ruxolitinib expanding treatment options. This systematic review synthesizes pediatric-only evidence on topical JAK inhibitors for AD, focusing on efficacy, safety, and treatment strategies for clinical practice. Methods: A PRISMA-guided systematic review of PubMed, Embase, Web of Science, and ClinicalTrials.gov was conducted through November 2025. Eight studies met inclusion criteria, encompassing 541 pediatric patients treated with ruxolitinib or delgocitinib. Results: Across randomized and extension studies, both agents produced rapid, clinically meaningful improvements in both disease severity and pruritus, with benefits observed within the first several weeks of treatment. Ruxolitinib showed consistent efficacy in patients with both limited and extensive disease involvement, while delgocitinib showed sustained disease control with continuous use, including in younger children and infants. Topical JAK inhibitors were generally well tolerated, with adverse event rates comparable to vehicle and few discontinuations. Application-site reactions were uncommon, and no treatment-related serious AEs were reported. Conclusions: Overall, available pediatric data supports topical JAK inhibitors as effective and well-tolerated nonsteroidal options for AD, providing rapid symptom relief and disease control that may help expand steroid-sparing treatment options for children.