The American Academy of Dermatology (AAD) has released its first evidence-based guidelines for preventing and treating atopic dermatitis, the most common type of eczema. The new guidelines are good news for the millions of children and adolescents living with itchy, inflamed skin caused by atopic dermatitis, according to a CU Anschutz pediatric dermatologist.
The AAD announced the 27 recommendations in April 2026, covering prevention strategies and treatments for the most prevalent pediatric skin disease. Atopic dermatitis commonly causes intensely itchy, dry skin, rashes and rough patches that can flare over time.
What are the new pediatric atopic dermatitis guidelines?
The AAD said it expects the guidelines to help provide the best possible care to children with atopic dermatitis. Early intervention is critical to improving symptoms and patients’ quality of life, according to the guideline work group.
“This is the first time a group of experts got together to review the evidence about different medications and skincare practices specifically for the pediatric population, which is really exciting because in pediatrics we always say that kids are not little adults,” said Carla Torres-Zegarra, MD, associate professor of dermatology and pediatric dermatology at the CU Anschutz School of Medicine. “Atopic dermatitis is a super common condition. It affects one out of five babies, and about one out of four of those diagnosed during infancy, will have it through a lifetime.”
New medications and treatments have emerged as recommended first-line treatments where, in the past, clinicians “didn’t have the same level of evidence” as they have now, Torres-Zegarra said. “It’s more common and easier to find these studies with the newer drugs as opposed to the older practices, like using wet wrap therapy, for example.”
Key points:
- Atopic dermatitis is a common inflammatory skin disorder that affects about 25% of children worldwide.
- In April 2026, the American Academy of Dermatology announced new guidelines of care that address both prevention and treatment of atopic dermatitis.
- Daily moisturizers remain the foundation of treatment.
- The guidelines emphasize personalized care based on each child's age, disease severity, and quality of life.
- People with atopic dermatitis have an increased risk of developing skin infections, autoimmune conditions, asthma, allergies, anxiety and depression.
- Eczema is an umbrella term for an inflammatory skin condition that causes dry and itchy skin. Atopic dermatitis is the most common type of eczema.
The AAD’s guideline grading scale included strong recommendations in favor of certain treatments (benefits clearly outweighing the risks and burdens), conditional options (benefits closely in balance with risks) and strong recommendations against other treatments.
Why these guidelines matter for children and their families
“I see the guidelines as empowering in that they validate what we already do every day with individualized treatment,” Torres-Zegarra said. “We’re treating inflammation early, and while supporting patients and their families. We’re obviously escalating therapy if we’re seeing a patient’s quality of life is being affected – like their sleep, their academic performance in school and their mental health. Overall, it’s a stepwise approach where we now have multiple different options to treat eczema. In all cases, we recognize the importance of individualizing treatments based on each child's symptoms, age, and family needs.
Here are Torres-Zegarra’s takeaways about the new guidelines:
- Moisturizers received a strong recommendation for use to reduce patients’ dry and itchy skin. They remain the foundation of atopic dermatitis care, with daily moisturization getting a strong recommendation. There isn't one 'best' moisturizer. The best moisturizer is one that families will use consistently every day.
- Use of topical steroids also received strong recommendations, including intermittent use of low- to medium-potency topical steroids up twice daily for flares. There’s a lot of misinformation on topical steroids in terms of safety and efficacy, but they still remain strongly supported by these guidelines. We’re talking about the correct use of topical steroids – using them on inflamed skin under the guidance of a healthcare provider and only when flares are present.”
- Steroid-sparing treatments are “great alternative” in cases when patients experience flares on sensitive areas. “These are areas of the skin like on the face, skin folds or groin, where we prefer to use steroid-sparing agents as opposed to topical steroids for a longer period of time.” These treatments include topical calcineurin inhibitors like protopic ointment and topical JAK inhibitors like rixolitinib cream.
- Dupilumab, a medication that received U.S. Food and Drug Administration (FDA) approval in 2017, has emerged as a game-changing treatment for moderate to severe eczema. “This is one of the most life-changing medications for kids with eczema – and also for their parents and providers – because it’s a medication that has an extensive and growing body of long-term safety data. It’s FDA approved to start at the age of 6 months and older for atopic dermatitis, and it’s an injection parents can give at home.”
- Routine use of antibiotics should be avoided unless infection is present. “It’s not uncommon for patients with constant scratching and itching, making small erosions and irritation to their skin and creating an environment where bacteria can grow more easily and cause infection. However, there’s no utility in using topical antibiotics to prevent infection. If there is a clear sign of infection taking place, that’s when antibiotics are recommended, but they shouldn’t be a routine practice to prevent infection.”
- The guidelines strongly recommend against using systemic steroids as therapy. “Historically, there was common use of systemic steroids. However, there are well-known potential side effects from their long-term use like affecting a child’s growth, increasing blood pressure, increasing blood sugar, stretch marks, thinning of the skin, easy bruising. They should only be used on in selective cases where a patient is acutely and severely affected while transitioning to a safer long-term treatment, such as a targeted therapy.”
