Atopic dermatitis (AD) is a common chronic inflammatory skin disease affecting up to 20% of children and 3% of adults globally. It often begins in early childhood and is the first stage of the 'atopic march', a sequence of allergic conditions including asthma and allergic rhinitis. Genetic and environmental factors interact to influence AD, with mutations in the filaggrin gene being a significant risk factor. Environmental exposure, particularly to microbes, also plays a role. Breastfeeding is protective, and for infants who cannot be breastfed, partially or extensively hydrolyzed whey formulas are recommended. Modulating the gut microbiota with pre- and probiotics shows promise, though more research is needed. Protecting the skin barrier is crucial, especially in children with genetic mutations. AD prevalence varies globally, with increasing rates in low-income countries. Prevention should start early, targeting skin barrier, immune, and environmental factors. Dietary factors, such as fish consumption during pregnancy, may reduce AD risk. The skin barrier is a key target for preventing eczema progression to allergic diseases. AD poses a significant burden on healthcare resources and quality of life, necessitating improved prevention strategies. Understanding the complex interplay between genetics, immune, and environmental factors is essential for effective prevention and management of AD.Atopic dermatitis (AD) is a common chronic inflammatory skin disease affecting up to 20% of children and 3% of adults globally. It often begins in early childhood and is the first stage of the 'atopic march', a sequence of allergic conditions including asthma and allergic rhinitis. Genetic and environmental factors interact to influence AD, with mutations in the filaggrin gene being a significant risk factor. Environmental exposure, particularly to microbes, also plays a role. Breastfeeding is protective, and for infants who cannot be breastfed, partially or extensively hydrolyzed whey formulas are recommended. Modulating the gut microbiota with pre- and probiotics shows promise, though more research is needed. Protecting the skin barrier is crucial, especially in children with genetic mutations. AD prevalence varies globally, with increasing rates in low-income countries. Prevention should start early, targeting skin barrier, immune, and environmental factors. Dietary factors, such as fish consumption during pregnancy, may reduce AD risk. The skin barrier is a key target for preventing eczema progression to allergic diseases. AD poses a significant burden on healthcare resources and quality of life, necessitating improved prevention strategies. Understanding the complex interplay between genetics, immune, and environmental factors is essential for effective prevention and management of AD.