Genetics, environmental triggers, immune dysfunction are some of the causes of this complex yet common skin disease
ITASCA--The American Academy of Pediatrics has updated its guidance for a common skin condition that not only causes discomfort but can be a significant source of mental distress for youth. The revised clinical report, “Atopic Dermatitis: Update on Skin-Directed Management,” published in the 2025 Pediatrics, estimates that 20%-25% of children experience the condition, also called eczema.
Atopic dermatitis is characterized by dry, red and itchy skin, which can disrupt sleep and be accompanied by depression and anxiety. For some, the condition is temporary, while others experience it through adulthood.
The clinical report, published online May 19, reviews and incorporates the most recent advances in skin-directed management for eczema since the initial clinical report published in 2014. All clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
“Pediatricians are usually the first ones to identify and treat atopic dermatitis in children, and see the impact it can have on families,” said Jennifer J. Schoch, MD, FAAD, FAAP, lead author of the clinical report, written by the AAP Section on Dermatology. “Eczema can affect the way children and teens feel about themselves and they may feel embarrassed or stigmatized. They may avoid sports or activities, and research has shown it can affect the mental health and wellbeing of both patients and their caregivers. The good news is there are effective treatment approaches outlined in this report.”
The clinical report emphasizes proactive care, mental health impacts and emerging therapies. It incorporates new insights into immune dysfunction, addresses racial disparities in care and introduces new medications. The report also integrates lessons from landmark studies like the Learning Early About Peanut (LEAP) trial, which reshaped how pediatricians think about food allergy prevention in patients with atopic dermatitis. Up to 40% of patients with eczema also develop food allergies, but foods typically do not cause atopic dermatitis, according to the report. Overemphasis on food allergy as a cause of atopic dermatitis can lead to unnecessary, and potentially dangerous elimination diets that may result in intolerance of previously tolerated foods.
“Family history and genetics play a big role, and there are multiple other factors that may contribute to how active atopic dermatitis is on a child’s skin,” said Megha M. Tollefson, MD, FAAP, FAAD, a co-author of the report. “These include a weakened skin barrier; environmental triggers like harsh soaps, chemicals, and fragrances that can irritate the skin, low humidity or air pollution; or an overactive immune system.”
The onset of atopic dermatitis usually occurs before a child turns 1. Compared with white children, eczema severity is increased in both Black and Hispanic children, and both groups are more likely to miss school because of the disease, according to research.
The AAP recommends:
AAP also suggests referring patients to pediatric subspecialists, often pediatric dermatologists, or allergists, in cases of severe, complicated or chronic forms of the disease.
“While pediatricians are equipped to treat atopic dermatitis in the primary care setting with this guidance, it’s helpful to consult a specialist in some situations,” Dr. Schoch said. “Atopic dermatitis affects millions of families. This is a toolkit for all physicians on how to offer proactive, effective, and empathetic medical care."
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.