Objective To explore the effect of Jianpi Shenshi decoction combined with Jiedu Zhiyang lotion in the treatment of atopic dermatitis and its influence on patients' skin barrier function. Methods A total of 110 patients with atopic dermatitis admitted to our department from February 2023 to February 2025 were selected as the research subjects, and they were divided into the reference group and the observation group by the random number table method, with 55 patients in each group. The reference group was given loratadine and tacrolimus ointment, and the observation group was additionally treated with Jianpi Shenshi decoction combined with Jiedu Zhiyang lotion on this basis. The treatment effect, skin barrier function, symptom improvement and serum inflammatory factor levels were compared between the two groups. Results The total effective rate of treatment in the observation group (96.36%) was higher than that in the reference group (78.18%) (P <0.05). After treatment, the scores of SCORAD and EASI and the levels of IL-4 and IL-10 in the observation group were lower than those in the reference group, and the sebum content and stratum corneum hydration were higher than those in the reference group (P <0.05). Conclusion Jianpi Shenshi decoction combined with Jiedu Zhiyang lotion has a definite effect in the treatment of atopic dermatitis, which can effectively relieve patients' clinical symptoms, improve skin barrier function, and regulate inflammatory factor levels. It is worthy of clinical application.