Animal Allergies

Food Allergies

Allergy, Immunology, and ENT

Cardiovascular Diseases

Cardiology

Acne

Atopic Dermatitis

Dermatology

Emergency Medicine

Diabetes

Endocrinology

Formula

Nutrition

Obesity

Gastroenterology

Antibiotic Resistance

Bacterial Conjunctivitis

COVID-19

Influenza

Pneumonia

Sexually Transmitted Diseases

Vaccination and Immunization

Vaccines

Infectious Diseases

ADHD

Addiction

Antisocial Personality Disorder

Anxiety

Autism

Depression

Developmental/Behavioral Disorders

Psychiatry

Mental, Behavioral and Development Health

Concussion

Epilepsy

Headache

Neurology

Neonatal/Perinatology

OB/GYN

Pain

Drug Pipeline News

Pharmacology

Telemedicine

Practice Improvement

Asthma

Cystic Fibrosis

Respiratory

Rheumatology

News 

All News

AAP News

PNP Corner

Media

Around the Practice

Cure Connections

Expert Interviews

Insights

Medcast

Peer Exchange

Peers & Perspectives

Podcasts

Webinars

Puzzler

Publications

Contemporary Pediatrics Journal

Supplements And Featured Publications

CME/CE

Resources

Handouts

Job Board

Conferences

Conference Coverage

Conference Listing

Partnerships

Subscribe

Editorial

Editorial Advisory Board

Writer’s Guidelines

Reference Guidelines

Meet the Editors

. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

Articles

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

IDSA’s new GAS pharyngitis guidance emphasizes selective testing using clinical scoring to reduce overtreatment and antibiotic misuse.

IDSA recommends use of scoring systems to guide testing for Group A Streptococcal pharyngitis

Craig Press, MD, PhD, Associate professor, Clinical Neurology, University of Pennsylvania; Medical director, Neuroscience Unit, Children's Hospital of Philadelphia.

At the 2025 CNS Annual Meeting, Craig Press, MD, PhD, discussed challenges in achieving equitable access to diagnostics and expertise in pediatric neurocritical care.

Craig Press, MD, PhD, highlights challenges in pediatric precision care for epilepsy

Craig Press, MD, PhD, discussed the evolution of pediatric neurocritical care toward individualized care at the 2025 Child Neurology Society meeting. 

Craig Press, MD, PhD, on bringing precision medicine to pediatric neurocritical care

Franchesca Kelly, PBT, ASCP, a certified pediatric phlebotomist at Haymarket Medical Center and creator of Poke Pals.

Integrating health care and behavioral science transforms experiences for neurodivergent children, reducing anxiety and fostering confidence during medical procedures.

Bridging health care and behavioral science for neurodivergent children

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Contemporary Pediatrics – Clinical News & Pediatrician Practice Tips

Facebook

LinkedIn

Instagram

Clinical

Gynecology

Infectious disease

Mental Health

Oncology

Rheumatoid Arthritis

Sexual Health

View More

1rem

Authors

Mr Rollins is a third-year medical student, University of Texas Medical School at Houston.

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

On September 18, 2025, the FDA approved an expanded indication of Incyte's ruxolitinib (Opzelura) to treat atopic dermatitis in patients aged

2 to 11 years, according to a press release from

Incyte. Previously, the topical nonsteroidal treatment was indicated for patients 12 years or older.

“Navigating a complex condition like atopic dermatitis can be very challenging for children, who currently have limited treatment options to meet their specific needs,” said Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine. “With this approval, we now have a new, nonsteroidal topical option that expands how we care for kids with this chronic disease. This is a meaningful step forward and marks a significant advancement in our ability to better support our pediatric patients.”

"I think it is very exciting to have another nonsteroidal approved for kids with atopic dermatitis. [Ruxolitinib] has been approved in kids aged 12 years and older for vitiligo for some time now, so I do think that it is good to have multiple products approved that allow multiple options in treating atopic dermatitis," John Browning, MD,

. Browning is the chief of dermatology at Children’s Hospital of San Antonio.

John Browning, MD, reacts to the approval of ruxolitinib for atopic dermatitis in children

"It's just so great to finally be able to get a 2A nonsteroidal medicine as first line, which is what I think it should be," he said. "I don't think we should have to make patients try a topical steroid first and [potentially] have a rebound issue.... It is just good to finally be able to start with these."

Ruxolitinib's expanded approval was based on data from the phase 3 TRuE-AD3 study (NCT04921969), a randomized, double-blind, vehicle-controlled trial that evaluated safety and efficacy of the topical vs vehicle in children with atopic dermatitis aged 2 to 11 years. The trial featured more than 300 patients who had an atopic dermatitis diagnosis for at least 3 months.

The trial met its primary end point, the proportion of participants achieving Investigator Global Assessment treatment success (IGA-TS), defined as an IGA score of 0 (clear) or 1 (almost clear) with at least a 2-point improvement from baseline at week 8.

Data announced in 2023 revealed that 56.5% of patients treated with ruxolitinib cream 1.5% and 36.6% of patients treated with ruxolitinib cream 0.75% achieved IGA-TS at week 8 (

≤ .0001 for both) compared with 10.8% of patients treated with vehicle.

Additionally, 67.2% of patients treated with ruxolitinib cream 1.5% and 51.5% of patients treated with ruxolitinib 0.75%, respectively, achieved Eczema Area and Severity Index of 75% or greater improvement success compared with those treated with vehicle at week 8 (15.4%; 

 < .0001 for both). Among patients aged 6 to 11 years, the itch numerical rating scale 4 (NRS4; ≥ 4-point improvement in itch [NRS] score) was achieved by 43.4% of participants in the 1.5% treatment arm and 37.5% of patients in the 0.75% treatment arm at week 8 compared with those treated with vehicle (29.7%). Median time to NRS4 was 13.0/11.0 days (1.5% and 0.75%, respectively) compared with 23.0 days for vehicle (HR, 1.74 and 1.77; 

The JAK inhibitor was first approved by the FDA on September 21, 2021, for the short-term and noncontinuous chronic treatment of mild to moderate atopic dermatitis in nonimmunocompromised patients 12 years or older.

“While every child’s journey with AD [atopic dermatitis] is unique, for many, the skin redness and irritation can profoundly impact their well-being,” added Korey Capozza, founder of Global Parents for Eczema Research. “When you’re managing a condition that can affect daily life, access to safe, effective, and age-appropriate options is critical. With limited, safe treatment options currently available, especially for younger children, the addition of new therapies that control symptoms is so important to meet the needs and goals for children with AD and their families.”

1. Incyte announces additional FDA approval of Opzelura (ruxolitinib) cream in children ages 2-11 with atopic dermatitis. Press release. Incyte. September 18, 2025. Accessed September 18, 2025. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-additional-fda-approval-opzelurar-ruxolitinib

2. Incyte announces positive topline results from phase 3 trial evaluating ruxolitinib cream (Opzelura) in children with atopic dermatitis. Press release. Incyte. July 11, 2023. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-positive-topline-results-phase-3-trial

3. Incyte announces new data for ruxolitinib cream (Opzelura) in children with atopic dermatitis. Press release. Incyte. October 13, 2023. https://investor.incyte.com/news-releases/news-release-details/incyte-announces-new-data-ruxolitinib-cream-opzelurar-children

4. Incyte announces U.S. FDA approval of Opzelura (ruxolitinib) cream, a topical JAK inhibitor, for the treatment of atopic dermatitis (AD). Press release. Incyte. September 21, 2021. https://www.businesswire.com/news/home/20210921006072/en/Incyte-Announces-U.S.-FDA-Approval-of-Opzelura-ruxolitinib-Cream-a-Topical-JAK-Inhibitor-for-the-Treatment-of-Atopic-Dermatitis-AD

The FDA has approved an additional indication for Incyte's ruxolitinib cream to include pediatric patients. 

News

FDA approves ruxolitinib for pediatric patients with atopic dermatitis aged 2 to 11 years

The FDA has approved guselkumab (Tremfya; Johnson & Johnson) for the treatment of children 6 years or older with a weight of at least 40 kg with moderate to severe plaque psoriasis (PsO) or active psoriatic arthritis (PsA). Eligible patients include those who are candidates for systemic therapy or phototherapy. Guselkumab is now the first and only IL-23 inhibitor approved for these pediatric indications.

Guselkumab is a fully human, dual-acting monoclonal antibody that blocks IL-23 and binds to CD64, a receptor on cells that produce IL-23. IL-23 is a cytokine secreted by activated monocytes and dendritic cells and plays a key role in immune-mediated diseases, including PsO, PsA, ulcerative colitis, and Crohn disease.

This approval extends the drug’s use beyond its previous indications in adults with moderate to severe plaque PsO, approved in 2017, and active PsA, approved in 2020. Johnson & Johnson noted that the new approvals provide treatment options for approximately 20,000 children younger than 10 years diagnosed with plaque PsO each year and the estimated 14,000 children affected by PsA.

Plaque psoriasis is a chronic immune-mediated disease that often begins in childhood. The inflamed, scaly plaques can be painful, itchy, and distressing, with the potential for long-term physical and psychological impact. Active PsA, which accounts for approximately 5% of the juvenile idiopathic arthritis population, is characterized by joint inflammation, swelling, and skin involvement and may affect a child’s physical ability and quality of life.

“Despite advancements in the treatment of pediatric plaque psoriasis and active psoriatic arthritis, there continues to be a significant gap in available therapies for these debilitating immune-mediated diseases that impact a child's physical and emotional well-being during critical years,” said Vimal Hasmukh Prajapati, MD, clinical associate professor at the University of Calgary and study investigator. “The approval of Tremfya offers physicians as well as parents and care partners an established treatment option with proven safety and demonstrated efficacy that can significantly improve the signs and symptoms in children living with these diseases.”

The plaque PsO approval was based on results from the phase 3 PROTOSTAR study, a randomized, placebo- and active comparator–controlled trial in pediatric patients. Coprimary end points of Psoriasis Area Severity Index of 90% or greater improvement (PASI 90) and Investigator Global Assessment (IGA) score of 0/1 were achieved at week 16.

Approximately 56% of patients receiving guselkumab achieved PASI 90 compared with 16% of patients receiving placebo (

 < .01). At week 16, 66% of guselkumab-treated patients achieved an IGA score of 0/1 compared with 16% on placebo (

< .001). Complete clearance (IGA 0) was observed in nearly 40% of guselkumab-treated patients compared with 4% on placebo (

Approval for pediatric PsA was supported by pharmacokinetic extrapolation analyses of data from guselkumab studies in adults with PsO and PsA as well as pediatric patients with plaque PsO, including PROTOSTAR, VOYAGE 1 and VOYAGE 2, and DISCOVER-1 and DISCOVER-2.

“Every child deserves to feel comfortable in their own skin and to be active without the limitations of joint pain, stiffness, and swelling,” said Brandee Pappalardo, PhD, MPH, vice president of medical affairs in dermatology and rheumatology at Johnson & Johnson Innovative Medicine. “The approval of the first and only pediatric indications for an IL-23 inhibitor marks an important step forward not only for children but also for the parents and care partners who support them every day.”

The recommended pediatric dosage is 100 mg administered subcutaneously at week 0, week 4, and every 8 weeks thereafter, delivered via a 1-mL prefilled syringe.

Leah M. Howard, JD, president and CEO of the National Psoriasis Foundation, emphasized the need for more treatment options. “The physical and emotional impact of psoriasis and psoriatic arthritis can have children sitting on the sidelines of life, not attending social events because they are embarrassed [by] their plaques or their joint pain is too intense,” she said. “The National Psoriasis Foundation welcomes any new treatment option that provides hope for relief from the pain, discomfort, and the emotional burden of these conditions.”

PROTOSTAR safety data through week 16 showed adverse events in 42% of guselkumab-treated patients vs 68% in the placebo group. Common adverse events in the treatment group included nasopharyngitis, upper respiratory tract infection, and COVID-19. No serious or opportunistic infections were reported.

Johnson & Johnson highlighted that the approval is part of a broader commitment to advancing therapies for chronic immune-mediated diseases, noting additional recent FDA approvals for guselkumab in adults with ulcerative colitis and Crohn disease as well as ongoing label expansion efforts.

U.S. FDA approves TREMFYA (guselkumab) for the treatment of pediatric plaque psoriasis and active psoriatic arthritis, marking a first and only approval for an IL-23 inhibitor. Press release. Johnson & Johnson. September 29, 2025. Accessed September 29, 2025. https://www.jnj.com/media-center/press-releases/u-s-fda-approves-tremfya-guselkumab-for-the-treatment-of-pediatric-plaque-psoriasis-and-active-psoriatic-arthritis-marking-a-first-and-only-approval-for-an-il-23-inhibitor

A study to evaluate the efficacy, safety, and pharmacokinetics of subcutaneously administered guselkumab for the treatment of chronic plaque psoriasis in pediatric participants (PROTOSTAR). ClinicalTrials.gov. Updated September 29, 2025. Accessed September 29, 2025. https://clinicaltrials.gov/study/NCT03451851?tab=results

FDA approves guselkumab as the first IL-23 inhibitor for children 6 years or older with plaque psoriasis or psoriatic arthritis.

FDA approves guselkumab for children with plaque psoriasis and psoriatic arthritis

A pair of roflumilast clinial trial investigators react to the FDA approval of the 0.05% formulation to treat atopic dermatitis in children 2 to 5 years. 

Lawrence Eichenfield, MD, Rocco Serrao, MD, react to roflumilast approval for pediatric atopic dermatitis

A newly approved nonsteroidal topical agent offers pediatricians and caregivers an additional treatment option for young children with atopic dermatitis (AD). Lawrence Eichenfield, MD; and Rocco Serrao, MD, discussed the expanded 

indication of roflumilast 0.05% cream (Zoryve; Arcutis Biotherapeutics)

, a phosphodiesterase 4 inhibitor, for children aged 2 to 5 years with mild to moderate AD. 

Expanding options for pediatric atopic dermatitis

Eichenfield noted that the approval of roflumilast cream 0.05% cream provides a valuable new tool for clinicians managing AD in very young patients. “I’m excited to have an expanded nonsteroidal agent for very young children with atopic dermatitis,” he said. “It’s a water-based cream that’s approved for topical treatment of mild to moderate atopic dermatitis [for] ages 2 years and older.”

The formulation was specifically designed for this age group, taking into account the larger body surface areas affected by AD in young children. 

“Some children intrinsically have barrier dysfunction—skin that’s drier—and when you have inflammation, it makes it even drier,” Eichenfield explained. “This formulation brings moisturizing properties with anti-inflammatory medicine that can be used safely and effectively without limitation of body surface area.”

Addressing caregiver concerns and unmet needs

A pair of roflumilast clinical trial investigators react to the FDA approval of the 0.05% formulation to treat atopic dermatitis in children aged 2 to 5 years.

Lowell Rollins III, BS, MS3

Articles

Latest Updated Articles