Skin pain in pediatric atopic dermatitis: mechanisms and management

Purpose of review: While itch is the hallmark symptom of atopic dermatitis (AD), skin pain is increasingly recognized as a common and burdensome symptom even in the pediatric population. Despite its prevalence, pain remains underassessed and undertreated in children with AD. This review aims to synthesize current knowledge on the prevalence, pathophysiology, clinical relevance, and management strategies of skin pain in children with AD. Recent findings: Skin pain affects up to 50% of children with AD and is associated with increased disease severity, impaired sleep, reduced quality of life, and higher rates of school absenteeism. Despite its significant impact, few studies have designed pain as a primary outcome, and validated assessment tools for young children are still lacking. Pathophysiological mechanisms involve barrier disruption, neurogenic inflammation, and cytokine-driven sensitization pathways, which may partially diverge from those implicated in itch. Emerging evidence from recent clinical trials suggests that targeted therapies can markedly reduce skin pain, sometimes independently of an improvement in visible lesions. Nonpharmacologic approaches, including emollient therapy, patient education, and psychological support, are also crucial components of a multimodal management strategy. Summary: Skin pain in pediatric AD remains an underrecognized but clinically significant symptom. Incorporating validated, age-appropriate assessment tools and integrated management strategies into clinical practice seems crucial. At the same time, further research should clarify the underlying mechanisms and refine outcome measures to guide the development of targeted therapies for affected children.