How fragrance plays a role in atopic dermatitis treatments, with John Browning, MD

For pediatricians treating children with atopic dermatitis, safe and effective topical options are now more accessible and increasingly important to understand, says John Browning, MD, chief of dermatology at Children’s Hospital of San Antonio.

“Pediatricians should be very confident to prescribe steroid-free creams,” Browning said. “They can and should do that when they see a patient.” In many cases, children first present with symptoms of eczema during routine visits or sports physicals, he noted, making the pediatrician the first opportunity for timely intervention.

Having a non-steroidal, fragrance-free treatment readily available “is great,” Browning added, particularly given the limited number of pediatric dermatologists.

“Otherwise, those patients are going to suffer before they’re finally going to be seen by a pediatric dermatologist. Fragrance is a major player in both irritating atopic dermatitis, but also in causing allergic contact dermatitis,” he explained, and noted that in children with eczema, even common daily products like cleansers, shampoos, or moisturizers can be problematic.

“People with atopic dermatitis have a lower threshold for irritation from fragrance. If you look at the top 10 list for cutaneous allergies in children, fragrance is going to make that list every single time,” Browning said.

He urged pediatricians and caregivers to look for products labeled “fragrance-free” rather than simply “unscented,” which may still contain masking fragrances. “Oftentimes it doesn’t even list fragrance, it may use a funny word like ‘parfum’,” he said. “Even things like essential oils should really be avoided if you’ve got a child with sensitive skin and eczema.”

Browning highlighted the December 16, 2024, FDA approval of tapinarof cream 1% (Vtama) in December 2024, which is indicated to treat atopic dermatitis in patients 2 years of age and older.¹

“This product is fragrance-free. It’s not irritating to the skin. It doesn’t have harmful preservatives or things like petroleum jelly,” he said. “Thankfully, now we’ve got newer products that don’t have some of the harmful ingredients.”

RELATED: Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up²

Editor's note: A relevant disclosure for Browning is Organon.

References:

1. Fitch J. FDA approves tapinarof cream, 1% for atopic dermatitis patients 2 years and up. Contemporary Pediatrics. December 16, 2024. Accessed June 11, 2025. https://www.contemporarypediatrics.com/view/fda-approves-tapinarof-cream-1-for-atopic-dermatitis-patients-2-years-and-up

2. Ebert M. Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up. Contemporary Pediatrics. March 10, 2025. Accessed June 11, 2025. https://www.contemporarypediatrics.com/view/tapinarof-cream-1-demonstrates-positive-long-term-results-for-atopic-dermatitis-in-patients-2-years-and-up