**Background:** Psoriasis is a chronic immune-mediated disorder affecting 1–3% of the general population, with increasing prevalence in children. Pediatric psoriasis is associated with comorbidities such as metabolic syndrome, psoriatic arthritis, and psychological distress. Children often present with milder, focal disease involving sensitive areas like the face and anogenital region, where conventional topical therapies (corticosteroids, calcineurin inhibitors, vitamin D analogs, anthralin, coal tar) are limited by side effects, tolerability, or efficacy. Parental concerns about corticosteroids further complicate adherence. This review examines new topical agents approved or in development for pediatric psoriasis, focusing on their mechanisms, efficacy, and safety.
**Methods:** The authors conducted a narrative review of the literature, summarizing data from phase II–IV clinical trials, FDA approvals, and ongoing studies. Key sources include the DERMIS-1 and DERMIS-2 phase III trials for roflumilast, PSOARING 1–3 trials for tapinarof, and phase III/IV studies for halobetasol propionate foam. The review also covers emerging agents like JAK inhibitors and other PDE-4 inhibitors.
**Key Results:** Roflumilast 0.3% cream (PDE-4 inhibitor) was FDA-approved in July 2022 for plaque psoriasis in patients aged ≥12 years. In DERMIS-1 and DERMIS-2 (8-week, phase III, ages ≥2 years), 37.5–42.4% of roflumilast-treated patients achieved IGA success vs. 6.1–6.9% for vehicle (P<0.001). Intertriginous IGA success was 68.1–71.2% vs. 13.8–18.5% (P<0.001). Itch reduction (≥4-point WI-NRS) occurred in 67.5–69.4% vs. 26.8–35.6% (P<0.001). Adverse events were similar to vehicle, with diarrhea and headache <4%. Bioavailability is <2%. A foam formulation showed similar efficacy for scalp and body psoriasis in a phase II study (scalp IGA success 59.1% vs. 11.4%, P<0.001). Halobetasol propionate 0.05% foam (super-high potency corticosteroid) was FDA-approved in 2021 for ages ≥12 years. In two phase III adult studies, IGA success was 25.3–30.7% vs. 3.9–7.4% for placebo. A phase IV study in adolescents (12–17 years) showed 26.1% had HPA-axis suppression after 2 weeks of twice-daily use, but all normalized within 4 weeks. Tapinarof 1% cream (AhR modulator) was FDA-approved for adult psoriasis; pediatric studies are ongoing (NCT05172726). In PSOARING 1 and 2 (12-week, phase III, adults), PGA success was 35.4–40.2% vs. 6.0–6.3% for vehicle (P<0.001). Folliculitis occurred in 17.8–23.5% vs. 0.6–1.2%. PSOARING 3 (44-week open-label) showed 40.9% complete clearance and 58.2% PGA success, with no tachyphylaxis and a remittive effect of ~4 months. Other agents (JAK inhibitors tofacitinib, brepocitinib) showed modest efficacy or were discontinued.
**Clinical Implications:** Roflumilast and tapinarof offer non-steroidal options with good efficacy and tolerability, especially for sensitive and intertriginous areas, addressing a key gap in pediatric psoriasis management. Halobetasol propionate foam provides a potent corticosteroid with improved convenience and reduced systemic absorption, though HPA-axis suppression remains a concern. These new agents may improve adherence and outcomes, but more pediatric-specific data are needed. Combination and rotational therapy with existing treatments may further optimize care.