The American Academy of Pediatrics (AAP) released newly updated guidance to manage eczema (atopic dermatitis). This common but complex skin condition affects an estimated 20%-25% of children. The revised clinical report, "Atopic Dermatitis: Update on Skin-Directed Management," published in the June 2025 Pediatrics. It covers the most recent advances in skin-directed management for eczema.
How eczema affects kids & families
Eczema causes not only discomfort, but can be a significant source of mental distress for youth. It is characterized by dry, red and itchy skin. These symptoms can disrupt sleep and be accompanied by depression and anxiety. For some, the condition is temporary, while others experience it through adulthood.
"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 well-being 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.
Re-examining the role of food allergies in eczema
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. 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 year old. 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:
Moisturizers that are fragrance free and thick in texture, with low water content (creams).
If a stinging sensation is encountered, ointments such as petrolatum may be substituted.
Daily—or frequent—short baths with lukewarm water and gentle cleansers, followed by a moisturizer.
Avoiding triggers such as low humidity, skin irritants such as harsh soaps or detergents, and contact allergens.
Use of topical corticosteroids under appropriate supervision but also used to appropriately control chronic disease, including a maintenance regimen for patients with recurrent disease.
AAP also suggests referring patients to pediatric subspecialists, often pediatric dermatologists, or allergists, in cases of severe, complicated or chronic forms of the disease.
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.
More information