Pediatric atopic dermatitis: biomarker advances in severity, persistence, and non-invasive monitoring

Atopic dermatitis (AD) in children differs immunologically and in barrier characteristics from adult AD, yet current severity assessment still relies heavily on clinical scoring systems with inherent subjectivity. This review summarizes advances in biomarkers associated with disease severity and persistence, as well as non-invasive detection techniques and targeted therapies. TARC/CCL17, periostin, total IgE, and eosinophil counts show consistent utility in grading severity, whereas FLG loss-of-function mutations, VEGF, S100A8/A9, and early skin barrier indicators are promising predictors of disease persistence and atopic march progression. Tape stripping and sebum RNA analysis enable safe, repeated monitoring in children. Despite these advances, most biomarkers still lack pediatric-specific cut-offs and large-scale validation. Future efforts should focus on establishing multi-marker panels, pediatric reference intervals, and machine learning models for endotype classification. Incorporating these tools into routine practice would facilitate early risk stratification, precise targeted treatment selection, and ultimately more personalized management of pediatric AD.