This study investigated resting-state EEG alterations in patients with atopic dermatitis (AD) and chronic pruritus and their associations with clinical symptoms, aiming to provide insights into central neurophysiological mechanisms and identify candidate biomarkers. This case-control cross-sectional study recruited AD patients and matched healthy controls (HCs). All underwent eyes-closed resting-state EEG and clinical assessments. Frequency features and power spectral density were compared using t-tests. Functional connectivity was assessed using network-based statistics, and entropy measures using permutational multivariate analysis of variance. Spearman correlations examined relationships between EEG indices and clinical scores. The Benjamini–Hochberg false discovery rate (FDR) procedure was additionally applied to account for multiple comparisons. Thirty-seven AD patients and 38 HCs were included. Nominally significant between-group differences in right-hemispheric peak and mean frequencies across the delta and low-frequency beta bands did not survive FDR correction. Global EEG power was reduced in the theta, alpha, and beta bands (all FDR-adjusted P < 0.05). At the regional level, significant reductions were observed in the central region for the theta, alpha, and beta bands and in the occipital region for the beta band (all FDR-adjusted P < 0.05). No significant between-group differences were identified in functional connectivity or multivariate entropy measures. In AD patients, right-hemispheric delta peak frequency was positively correlated with anxiety symptoms ( r s = 0.511, FDR-adjusted P = 0.029). No significant correlations were observed between EEG power measures and clinical symptoms. Patients with AD accompanied by chronic pruritus exhibit alterations in resting-state EEG, characterized by reduced global power in the theta, alpha, and beta bands. Right-hemispheric delta peak frequency was positively associated with anxiety symptoms in AD. Resting-state EEG measures may represent candidate biomarkers warranting further investigation. Trial registration: This study was registered in the Chinese Clinical Trial Registry (Registration No. ChiCTR2400093716).
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