The American Academy of Pediatrics (AAP) recently released a clinical report and suggested that “skin-directed therapy is particularly important because atopic dermatitis (AD) is caused by a superficial reaction of the skin barrier. The report was published online in the November issue of Pediatrics. According to data from the clinical report, at least 10 percent of U.S. children have atopic dermatitis, commonly known as eczema, with 85 percent of these conditions first occurring in children younger than 5 years of age. The inflammatory skin disease presents as a chronic, recurrent lesion, often referred to as an “itchy rash” by the child and his or her parents. In infants, the rash often occurs on the cheeks, scalp, trunk, hands and feet. In early childhood, the skin folds are often severely infested. And in adolescence and adulthood, the rash often occurs on the hands and feet. In nearly 50% of patients, atopic dermatitis has serious negative effects in terms of disrupting sleep, affecting quality of life, limiting activities, causing fatigue and frustration, and affecting social circles. For parents of children with moderate to severe atopic dermatitis, close to 3 hours per day are spent caring for their child’s skin. Although most parents mistakenly believe that food allergies are a key element in causing eczema, mutations in filaggrin (FLG), which plays an important role in the structural integrity of the epidermis, actually increase the risk of atopic dermatitis two to three times. Therefore, the guidelines suggest that skin directed therapy is the treatment of choice for atopic dermatitis. Every day, the child should keep the skin moist and avoid skin irritation. Daily bathing with warm water is very effective, along with the use of unscented body wash and the application of emollient cream after bathing. Parents should adjust the frequency of bathing according to the child’s response to it. Frequent use of emollient creams can be effective in reducing skin discomfort, complemented by repair of the skin barrier, and has been shown to reduce dependence on topical steroid medications. Parents should apply emollient cream to the child’s entire body at least once a day, even to healthy areas of skin. Oil-rich ointments are most effective in moisturizing action. Common skin irritants are antiseptics and fragrances, harsh soaps, coarse cloths, sweat, and stress. Finally, topical steroids can directly affect the immune response of the skin and can be used effectively and safely to treat atopic dermatitis when used appropriately. For acute attacks or severe cases, parents can use wet cloths dissolved in steroids on the affected area. Although the pathogenesis of atopic dermatitis is complex, recent studies have identified an abnormal skin barrier as an important aspect, leading clinicians to recognize that skin directed therapy is the treatment of choice for children with atopic dermatitis.