- Design
- International observational registry, 4-year analysis
- Population
- 500 children under 12 with moderate-to-severe atopic dermatitis (314 White, 186 non-White)
- Primary outcome
- Change in EASI on systemic treatment
- Effect
- Dupilumab −13.6 (non-White) and −14.2 (White) EASI points; methotrexate −8.2 and −10.1; cyclosporine −9.2 and −4.5
PEDISTAD is an international observational registry of children under 12 with moderate-to-severe atopic dermatitis. This four-year analysis compared 314 White and 186 non-White children on systemic treatment.
In non-White children, EASI improved by 13.6 points with dupilumab, 8.2 with methotrexate and 9.2 with cyclosporine; in White children by 14.2, 10.1 and 4.5. Itch and quality of life improved most with dupilumab in both groups. Exposure-adjusted adverse event rates were lowest with dupilumab or methotrexate and highest with cyclosporine in White children (58 per 100 person-years).
The finding answers a fair concern — that trial populations were mostly White — by showing dupilumab performs similarly across skin colours in routine care. It does not rank the drugs reliably, because children were not randomised.
- Assess EASI and itch at baseline so response can be measured.
- Do not expect a weaker dupilumab response in children with skin of colour.
- Where cost rules out a biologic, methotrexate is a reasonable systemic choice.
- Use cyclosporine as a short bridge rather than long-term treatment.
- In India, cost and access will often decide the drug; methotrexate remains the practical first systemic for many families.
Why it matters
It fills a gap: trials under-represented children with skin of colour, and this is the first large look at how they fare in practice.
Don't overread it
Registry data, not a trial — the differences between drugs are observed, not proven.
The statistics, in plain English
The point improvements are averages within each group, not head-to-head comparisons. In an observational registry, doctors chose each drug for reasons that may also affect outcome, so a larger improvement with one drug is not proof it is better.
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