Abstract
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by impaired skin barrier function and immune dysregulation. Despite advancements in understanding its pathogenesis, clinical management remains challenging due to high recurrence rates, complex symptom control, and diminished quality of life, particularly highlighting the lack of standardized protocols for skin barrier repair. Compromised skin barrier integrity in AD leads to increased transepidermal water loss (TEWL) and heightened susceptibility to irritants and allergens, exacerbating inflammation. Thus, restoring skin barrier function is pivotal in AD management. Current therapeutic strategies predominantly prioritize anti-inflammatory treatments while undervaluing barrier repair. Traditional care models relying on qualitative symptom assessments inadequately guide personalized interventions, necessitating an integrated approach combining barrier restoration and immunomodulation. Although diverse barrier repair methods and moisturizers are available, systematic evaluation and evidence-based selection criteria remain limited. This review aims to comprehensively summarize the structure and function of the skin barrier in AD, the role of skin barrier dysfunction in AD pathogenesis, current barrier repair strategies, and evidence-based emollient selection criteria. By analyzing existing research, we provide clinical recommendations for skin barrier restoration and long-term management in AD patients, while proposing future research directions. Emphasis should be placed on developing multi-omics-driven personalized barrier interventions and constructing a "barrier-immune-environment" interaction model to advance precision medicine in AD care.