Atopic eczema (AE) is a multifactorial chronic inflammatory skin disease characterized by pruritic, typically distributed eczematous skin lesions. Deficiencies in innate and adaptive immunity based on a genetic predisposition result in skin barrier dysfunction with hyperreactivity to environmental stimuli and susceptibility to skin infections which influence the course and severity of AE. In this review, we provide an overview of the complex pathophysiology of AE with a focus on recent advances published in this field.