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How the AAP’s Latest Eczema Recommendations Could Improve Your Child’s Skin and Mental Health

  Eczema, or atopic dermatitis, remains one of the most prevalent and burdensome skin conditions in children, affecting an estimated 20% to 25% of the pediatric population in the United States. This chronic and often misunderstood condition doesn't just manifest physically—it deeply affects emotional well-being, family dynamics, and overall quality of life. In response to the evolving understanding of eczema and its wide-ranging effects, the American Academy of Pediatrics (AAP) has released a comprehensive update to its clinical recommendations, reflecting the latest science, practical insights, and therapeutic approaches that can reshape how this condition is managed in children.

The clinical report, titled “Atopic Dermatitis: Update on Skin-Directed Management,” was published in the June 2025 issue of Pediatrics. It aims to equip pediatricians and healthcare providers with up-to-date knowledge and actionable strategies to better care for children living with eczema. As the first line of defense in diagnosing and treating atopic dermatitis, pediatricians are in a unique position to not only provide relief from physical symptoms but also to help families navigate the emotional and logistical challenges of the condition.

Eczema in children presents as patches of dry, red, itchy skin, which can lead to constant scratching, disrupted sleep, and skin infections. It frequently starts in infancy, often before the first birthday, and while some children outgrow it, others carry the condition into adolescence and adulthood. The visibility and persistent nature of the symptoms can take a toll on a child's mental health, contributing to low self-esteem, anxiety, depression, and social withdrawal. Children may avoid activities like swimming or sports for fear of exposing their skin, and the constant need for treatment and avoidance of triggers can feel overwhelming to both them and their caregivers.

Dr. Jennifer J. Schoch, the lead author of the report and a pediatric dermatologist, emphasized the often-overlooked emotional burden eczema places on families. She pointed out that children with eczema can feel embarrassed or stigmatized by their condition, which may interfere with normal childhood development and social experiences. The strain extends to caregivers as well, many of whom experience stress and burnout from managing daily care routines and medical appointments. The new guidelines reflect this broader perspective by recognizing mental health as a critical component of eczema care and urging clinicians to assess not only the skin but also the psyche.

One of the key takeaways from the updated guidance is the emphasis on proactive, skin-directed care that goes beyond reactive treatment of flare-ups. A foundational approach recommended by the AAP involves maintaining the skin barrier through regular use of fragrance-free, thick moisturizers—preferably creams with low water content, which help retain hydration and protect against environmental irritants. For children who experience a stinging sensation with creams, the use of ointments like petroleum jelly is encouraged as an alternative.

Bathing practices also play a crucial role in eczema management. Contrary to some older beliefs that frequent bathing might dry out the skin, the report supports daily or frequent short baths using lukewarm water and gentle cleansers, followed immediately by moisturizer application to lock in moisture. This practice helps reduce the accumulation of irritants and allergens on the skin surface while reinforcing the skin’s protective barrier.

Avoidance of known triggers is another essential aspect of care. Environmental factors such as low humidity, air pollution, and contact with skin irritants like harsh soaps, detergents, or synthetic fragrances can aggravate eczema symptoms. Caregivers are advised to identify and mitigate these triggers wherever possible, which might include using humidifiers in dry climates, switching to fragrance-free household products, and choosing breathable fabrics for clothing. For children with persistent or severe symptoms, an allergist or pediatric dermatologist may assist in identifying more specific triggers, including allergens that might not be immediately apparent.

While environmental control and moisturization form the cornerstone of skin-directed care, the use of topical corticosteroids remains a critical tool in managing inflammation. The AAP recommends supervised use of these medications—not only during acute flares but also as part of a maintenance regimen to prevent recurrence in chronic cases. This approach reflects a shift from episodic treatment to long-term disease control, helping to minimize discomfort and improve daily functioning. Providers are encouraged to educate families about the safe use of corticosteroids, including proper dosing and application techniques, to avoid side effects and maximize efficacy.

Beyond skin care, the updated report delves into the increasingly complex relationship between eczema and food allergies. For years, there was a prevailing belief that dietary triggers were a primary cause of eczema. However, groundbreaking research, particularly the Learning Early About Peanut (LEAP) trial, has clarified that while children with eczema are at higher risk of developing food allergies, food itself is rarely the cause of the skin condition. In fact, unnecessary elimination diets based on the assumption that food causes eczema may result in nutritional deficiencies and the loss of tolerance to previously safe foods. This has profound implications for both diagnosis and treatment, highlighting the importance of evidence-based allergy testing and a cautious approach to dietary restrictions.

According to Dr. Megha M. Tollefson, a co-author of the report, multiple factors influence the activity and severity of eczema. These include genetic predisposition, immune system dysregulation, environmental stressors, and a compromised skin barrier. The interplay of these variables explains why eczema manifests differently in each patient and underscores the need for individualized treatment plans. In addition, emerging therapies targeting specific immune pathways offer new hope for patients with moderate to severe disease who do not respond to conventional treatment. Biologic medications and non-steroidal anti-inflammatory agents are among the cutting-edge options now available, although their use is typically reserved for cases managed by pediatric specialists.

The updated guidance also calls attention to disparities in eczema severity and access to care among racial and ethnic groups. Research has shown that Black and Hispanic children experience more severe forms of the disease and are more likely to miss school due to eczema. These disparities may be due to a combination of genetic differences, environmental exposures, and systemic inequities in healthcare delivery. The AAP urges clinicians to be mindful of these factors and to consider cultural, social, and linguistic barriers that might affect adherence to treatment or access to specialists. Culturally competent care and advocacy for equitable access to dermatologic and allergy services are essential for improving outcomes across diverse populations.

The chronic nature of eczema requires long-term commitment, not just from the healthcare team but from families and caregivers as well. Consistency in applying moisturizers, managing flares, avoiding triggers, and following up with providers is vital. But equally important is the acknowledgment of emotional fatigue. Children and parents alike may feel discouraged by the unrelenting nature of the disease, especially when treatments seem to offer only temporary relief. The updated AAP guidelines stress the need for empathetic communication, emotional support, and when needed, mental health referrals to help families cope with the psychological toll of the disease.

In practical terms, this means that pediatricians should screen for signs of anxiety, depression, or social withdrawal during routine eczema evaluations. Incorporating behavioral health into the eczema care plan is not just compassionate—it is medically necessary. Children who are emotionally supported are more likely to adhere to treatment, experience fewer flares, and maintain a better quality of life. Pediatricians are encouraged to collaborate with child psychologists, social workers, and school counselors to ensure that the needs of the whole child are being met.

For severe, complicated, or treatment-resistant cases, referral to pediatric dermatologists or allergists is not only warranted but essential. Subspecialists bring expertise in diagnosing rare variants of eczema, assessing potential secondary infections, and prescribing advanced therapies that may not be appropriate in general practice settings. Early referral can prevent the escalation of symptoms and reduce the risk of complications such as skin thickening (lichenification), scarring, or systemic infections. The AAP report also highlights the value of multidisciplinary care teams in managing complex eczema cases, especially when co-occurring conditions like asthma or food allergies are involved.

Ultimately, the updated guidance from the AAP is more than a list of treatment protocols—it is a call to action for pediatricians to adopt a comprehensive, proactive, and compassionate approach to eczema care. It acknowledges the layered challenges that children and families face, from daily discomfort to long-term emotional scars, and provides a blueprint for managing the disease in a way that is both evidence-based and empathetic. By incorporating the latest scientific insights, advocating for equitable care, and addressing the psychological dimensions of eczema, the AAP aims to transform the standard of care and improve the lives of millions of children living with this chronic skin condition.

In conclusion, eczema is far more than a simple skin rash. It is a complex, multifactorial disease that demands a nuanced and patient-centered response. With these updated guidelines, pediatricians are better equipped than ever to help children not only manage their symptoms but also thrive. Through consistent skincare routines, smart use of medications, attention to mental health, and timely specialist referrals, the burden of eczema can be significantly reduced. Families affected by eczema can take heart in knowing that the medical community is listening, learning, and evolving—working toward a future where every child can live with healthy skin and a confident smile.