Editor’s Note: Dr. Carly Pierson (she/her) is a resident physician in pediatrics at the University of Virginia. She is in the Primary Care Track. Her interests include allergy and immunology. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Atopic dermatitis (AD), also known as eczema, is a common and chronic inflammatory skin condition characterized by itchiness and dryness. It affects about a quarter of the pediatric population—I see it nearly every day in my resident clinic. For something as common as AD, one would think treating it is simple and straightforward.
However, treating pediatric AD is often frustrating for both patients and physicians. This is partly because there are many conflicting treatment options, which leads to significant variability in treatment practices for AD. Additionally, parents and patients may:
- Worry about medication side effects
- Misunderstand the chronicity of the disease
- Lack the time or resources for adequate skin care
Additionally, the pathogenesis of AD is complex and multifactorial; it involves genetic predisposition, skin barrier pathology, environmental triggers, and immune dysfunction.
A clinician’s professional competence in treating AD is important for treatment satisfaction, so standardizing treatment guidelines and improving the primary care clinician’s ability to treat AD is critical. Thus, Dr. Jennifer Schoch from the University of Florida, along with colleagues on the AAP Section on Dermatology, wrote the AAP clinical report “Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report,” which is being early released this week in Pediatrics (10.1542/peds.2025-071812).
The authors conducted a large literature review to determine an updated standard of care for AD treatment. They state that AD treatment guidelines should focus on the triad of (1) skin care maintenance, (2) topical (meaning, applied directly to skin) anti-inflammatory medications, and (3) avoidance of triggers. Continuous daily moisturization is necessary to repair the skin’s barrier defect and decrease the frequency of AD flares, while topical medications (like corticosteroids) help with active flares. Evidence does not currently support one brand of moisturizer over another, but they should be fragrance-free.
Daily baths are recommended in children with AD, followed by moisturizer application immediately after the bath. There is no resounding evidence in favor of bleach baths, but they may theoretically reduce infection of Staphylococcus aureus—a bacteria that lives on our skin—in patients with AD. Wet wraps, which include the wetting of cotton pajamas and wearing them for a short time after applying topical medications to the skin, may also be beneficial because the occlusion and moisture of the wrap enhances penetration of the steroid cream.
Proven triggers of AD include dry air, skin irritants (i.e., harsh soaps or detergents), and contact allergens. Data are inconsistent, but some studies find contact allergies to be more common in people with AD.
Lastly, the use of a written action plan (an example is provided in the article) offered to patients and their families increases parent understanding of AD treatment and may positively impact patient outcomes. To learn more about the mainstay treatment guidelines of atopic dermatitis, check out this article.
