Discussing Evidence-Based Skin Care for Pediatric Atopic Dermatitis

Among the many questions clinicians face when managing pediatric atopic dermatitis is how to prevent flares before they begin. The recently published pediatric-specific guidelines from the Journal of the American Academy of Dermatology (AAD) offer a clear, if perhaps unsurprising, answer: moisturize.^1,2 Of all the preventive interventions examined by the guideline authors, consistent emollient use was the only one to receive a strong recommendation for reducing flare frequency and preventing disease onset—reinforcing a practice that dermatologists have recommended for decades.

Andrew C. Krakowski, MD, of St. Luke's University Health Network, and Carla Torres-Zegarra, MD, of Children's Hospital Colorado, University of Colorado Anschutz, both noted that the guidelines deliberately avoided specifying a particular moisturizer formulation, a decision Torres-Zegarra welcomed. Parents of children with atopic dermatitis frequently encounter store shelves lined with products—some of which market themselves to eczema patients without evidence of superior efficacy—and the guideline's emphasis on consistent use over product selection removes a source of confusion and unnecessary expense. The discussion also addressed bathing frequency, bleach baths, and the use of topical and oral antimicrobials. On bleach baths, Torres-Zegarra described recommending dilute bleach baths twice weekly during active bacterial superinfection and once weekly for maintenance in colonized patients, while acknowledging that the guideline's conditional recommendation reflects a lack of large randomized controlled trial data rather than evidence of ineffectiveness.

Viewers watching this segment of the HCPLive special report will find a practical, evidence-grounded conversation that addresses common clinical scenarios—including how to counsel families about bathing routines, what to do when a bathtub is not available in the home, and why the rinse-and-moisturize sequence after any bath remains the most important takeaway for caregivers. Krakowski and Torres-Zegarra also discuss why the guideline's GRADE-based scoring system, while rigorous, can create the impression that longstanding clinical practices lack support when in fact they simply lack large-scale trial data, a distinction both clinicians emphasize when interpreting the document for practice.

Disclosures: Krakowski and Torres-Zegarra have no relevant reported disclosures.

References

1. American Academy of Dermatology Issues First-Ever Pediatric Atopic Dermatitis Guidelines, Highlighting Prevention Strategies and Effective Treatments. American Academy of Dermatology. April 7, 2026. Accessed June 4, 2026. https://www.aad.org/news/aad-issues-first-pediatric-atopic-dermatitis-guidelines.

2. Smith T. First-Ever Pediatric Eczema Guidelines Issued by American Academy of Dermatology. HCPLive. April 10, 2026. Accessed June 4, 2026. https://www.hcplive.com/view/first-ever-pediatric-eczema-guidelines-issued-american-academy-dermatology.