Herbal Extracts and Plant-Derived Bioactives in Atopic Dermatitis: Evidence, Mechanisms, Pediatric Safety, and Translational Priorities.

Atopic dermatitis (AD) is a chronic, relapsing epithelial and neuroimmune disease in which barrier failure, type 2 inflammation, microbial dysbiosis, itching, metabolism, and environmental exposures reinforce one another. This review critically synthesizes clinical and preclinical evidence for herbal medicines, standardized extracts, food-derived bioactives, functional-food candidates, nutraceutical ingredients, and natural-product delivery systems in AD, with particular attention to pediatric safety. Recurrent experimental signals include attenuation of Th2 cytokines and IgE, suppression of mast-cell and IL-31-related itch pathways, restoration of filaggrin and tight-junction proteins, and modulation of MAPK/NF-κB, JAK/STAT, Nrf2/HO-1, and NLRP3 signaling. However, efficacy is not inferred from pathway changes alone. Human evidence remains heterogeneous, and apparently promising agents have failed to outperform active comparators, produced neutral microbiome results, or raised barrier and sensitization concerns. We therefore integrate four issues that are often treated separately: food sources and processing-dependent chemistry; oral bioaccessibility and food-matrix effects; gut-skin signaling and its uncertain causal direction; and compatibility with standard topical agents, cyclosporine, biologics, and JAK inhibitors. The evidence supports selected botanicals as investigational adjuncts rather than as replacements for guideline-based care. Translation requires authenticated materials, quantitative chemical fingerprints, exposure-response studies, age-appropriate safety surveillance, interaction assessment, and controlled trials using validated clinical and barrier endpoints.