Impact of Isosorbide Diesters from Coconut and Sunflower Fatty Acids on Pediatric Atopic Dermatitis and the Skin Microbiome: A Randomized, Double-Blind, Vehicle-Controlled Trial

<b>Background/Objectives</b>: Topical application of isosorbide diesters (IDEAS) derived from coconut and sunflower seed oil improve atopic dermatitis (AD) and reduce topical steroid use in adults. This randomized, double-blind, vehicle-controlled trial evaluates topical IDEAS (isosorbide diesters) with colloidal oatmeal for pediatric AD. <b>Methods</b>: Subjects aged 2-17 with mild to moderate AD applied either colloidal oatmeal cream or colloidal oatmeal cream with IDEAS daily. Hydrocortisone 2.5% was used as needed. AD severity, itch, sleep, steroid use, and microbiome data were collected at baseline, week 4, and week 8. <b>Results</b>: More participants in the IDEAS group compared to the control group achieved EASI 50 (81.0% vs. 56.3%, <i>p</i> = 0.10) and EASI 75 (42.9% vs. 18.8%, <i>p</i> = 0.12) and achieved a 4-point reduction in subjective itch at week 4 (45.5% vs. 6.3%, <i>p</i> = 0.0085) and week 8 (42.9% vs. 12.5%, <i>p</i> = 0.045). Use of topical steroids was lower in the IDEAS group (3.4 g vs. 13.3 g, <i>p</i> = 0.012) and the relative abundance of <i>Staphylococcus aureus</i> was reduced after 8 weeks. <b>Conclusions</b>: The addition of IDEAS to colloidal lotion improved AD, improved itch, reduced the use of topical steroids, and reduced the relative abundance of <i>S. aureus</i> in the skin microbiome.