The role and management of dietary and environmental factors in pediatric atopic dermatitis.

BACKGROUND: The pathogenesis of pediatric atopic dermatitis (AD) is complex, and the role of dietary and environmental factors in its onset and progression warrants systematic investigation. OBJECTIVE: To explore the associations between dietary allergen sensitization, environmental factors, and the development of pediatric AD through a retrospective case-control analysis, and to evaluate the clinical efficacy of a multidimensional intervention strategy. METHODS: This study employed a two-stage design. The first stage was a retrospective case-control study, enrolling 535 pediatric AD patients diagnosed between 2022 and 2024 and age- and sex-matched healthy children (n = 535). Conditional logistic regression models were used to analyze the associations between variables-including dietary allergen sensitization (milk/egg), air pollution index (PM2.5), indoor humidity, and skin microbiota characteristics (Staphylococcus aureus colonization rate)-and AD onset. The second stage was a prospective interventional study, enrolling 66 AD children who met the full inclusion criteria between January and December 2025. Participants were divided into an intervention group (n = 33, home-based care + allergen-specific dietary guidance) and a control group (n = 33, conventional intervention) according to the intervention modality. Propensity score matching (PSM) was applied to balance baseline characteristics. Differences in clinical efficacy, quality of life (CD-LQI score), sleep quality (PSQI score), and disease control (ADCT score) were compared between the two groups after three months of intervention, with additional analysis of changes from baseline to follow-up. RESULTS: Conditional logistic regression analysis revealed that early milk/egg sensitization (AOR = 3.18, 95%CI: 2.08-4.78), winter indoor humidity <40% (AOR = 1.92, 95%CI: 1.30-2.71), PM2.5 >35 μg/m3 (AOR = 2.48, 95%CI: 1.80-3.50), and Staphylococcus aureus colonization rate >50% (AOR = 4.08, 95%CI: 2.98-5.58) significantly increased the risk of AD onset (all P < 0.05). The interventional study showed that the clinical efficacy rate in the intervention group was significantly higher than that in the control group (81.82% vs. 45.45%, P < 0.05). Furthermore, the intervention group demonstrated significantly better outcomes in CD-LQI score (9.01 ± 1.24 vs. 11.47 ± 1.52, P < 0.05), PSQI score (6.14 ± 1.21 vs. 8.23 ± 1.33, P < 0.05), and ADCT score (6.73 ± 1.54 vs. 12.58 ± 1.48, P < 0.05). The mean reductions (Δ) from baseline to three months in the intervention group were significantly greater than those in the control group for all three measures: CD-LQI (9.10 ± 2.01 vs. 6.85 ± 2.21, P < 0.001), PSQI (10.84 ± 3.12 vs. 8.66 ± 2.78, P < 0.001), and ADCT (11.50 ± 2.34 vs. 5.61 ± 2.21, P < 0.001). CONCLUSION: Dietary avoidance should be based on documented allergen sensitization and integrated with nutritional assessment, while environmental regulation should focus on humidity control and microbial homeostasis restoration. A multidimensional intervention strategy based on dietary and environmental factors (home-based care + allergen-specific dietary guidance) can effectively control pediatric AD, improve quality of life and sleep quality, and provide evidence-based support for the clinical management of AD.